Choosing Health Plans in State Health Insurance Exchanges
<p>In 2014, the health insurance exchanges created under the Affordable Care Act will be available in every state as marketplaces for people without employer insurance, as well as small employers. All plans will include the same package of essential health benefits, but will vary by four different levels of "actuarial value," or the percentage of medical costs that a plan pays for on average. The actuarial value of a plan will be indicated by the tiers of bronze, silver, gold, and platinum, and comparative information will be available to help people select plans. A <a href="/publications/issue-briefs/2012/aug/choosing-best-plan-health-insurance-exchange-actuarial-value">new Commonwealth Fund study</a> looks at out-of-pocket costs that might result from plans with various designs and actuarial values. </p><p>In their analysis, authors Ryan Lore, M.P.P., of Towers Watson, Jon Gabel, M.A., of NORC, and colleagues found that average out-of-pocket expenses decline as actuarial values rise, but two plans with similar actuarial values might result in different out-of-pocket costs for a given person. This variability might arise because plans have different cost-sharing designs; plans may differ by deductible and copay amounts, for example, so the types of medical services a person uses and how frequently he or she uses services will affect total out-of-pocket expenses. </p>
<p>The overall affordability of a plan also will be influenced by age rating, income-related premium subsidies, and out-of-pocket subsidies, the authors say. </p>