Cost-Sharing Subsidies in Federal Marketplace Plans, 2016

Medical Deductible November 12, 2015

Percent of Plans Where Medical Deductible is Combined With or Separate from Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Medical Deductible In Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Drug Deductible November 12, 2015

Average Prescription Drug Deductible In Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Out-of-Pocket Limits November 12, 2015

Average Out-Of-Pocket Limit In Plans with Combined Limit for Medical and Prescription Drug Cost Sharing NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Inpatient Facility Cost Sharing November 12, 2015

Share of Plans by Type of Inpatient Facility Cost Sharing NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayments for Inpatient Facility Services (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Inpatient Facility Coinsurance Rate (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Inpatient Physician Services November 12, 2015

Share of Plans by Type of Cost Sharing for Inpatient Physician Services NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayments for Inpatient Physician Services (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rate For Inpatient Physician Services (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Primary and Specialist Physician Cost Sharing November 12, 2015

Share of Plans by Type of Cost Sharing for Primary Care Physician Visits (deductible may apply first) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayments for Primary Care Physician Visits (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Primary Care Physician Visits (includes plans with 'coinsurance' or 'both copayment & coinsurance' ) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Specialist Physician Visits (deductible may apply first) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayments for Specialist Physician Visits (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Specialist Physician Visits (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Prescription Drugs November 12, 2015

Share of Plans by Type of Cost Sharing for Generic Prescription Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Generic Prescription Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayment for Generic Drugs (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Generic Drugs (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayment for Preferred Drugs (includes plans with 'copayment' or 'both copayment & coinsurance' ) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Preferred Drugs (includes plans with 'coinsurance' or 'both copayment & coinsurance' ) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayment for Non-Preferred Drugs (includes plans with 'copayment' or 'both copayment & coinsurance' ) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Non-Preferred Drugs (includes plans with 'coinsurance' or 'both copayment & coinsurance' ) NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Copayment for Specialty Drugs (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Coinsurance Rates for Specialty Drugs (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Emergency Room Cost Sharing November 12, 2015

Share of Plans by Type of Emergency Room Cost Sharing NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Emergency Room Copayments (includes plans with 'copayment' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Average Emergency Room Coinsurance Rate (includes plans with 'coinsurance' or 'both copayment & coinsurance') NOTES: CSR 73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR 87 and CSR 94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016 (including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/