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Cost a major concern for ACA marketplace enrollees

More exchange plan members have high deductibles than those with employer-based plans

On the heels of a report that warned employer-based coverage is getting more expensive for families, two new issue briefs from the Commonwealth Fund indicate that individuals enrolled through the Affordable Care Act marketplaces also struggle with costs.

Both briefs, released Friday, are based on the results of the Commonwealth Fund's Affordable Care Act Tracking Survey.

The first brief finds that, overall, premium costs are comparable for marketplace enrollees and those who have employer-based coverage, as neither tend to pay the full premium amount out of pocket. But higher income adults with marketplace plans--who receive smaller subsidies--tend to pay larger shares of their premiums compared to those with employer-based plans.

In addition, 43 percent of individuals with marketplace coverage reported they had deductibles of $1,000 or higher, compared to 34 percent of those covered through their employer. What's more, 76 percent of people with employer-based plans felt their coverage was affordable, compared to only 53 percent of marketplace enrollees.

The second brief further emphasizes marketplace shoppers' costs concerns, noting that 57 percent of individuals who looked for a plan on the exchanges but didn't choose one said they couldn't find an affordable option. Of those individuals, 26 percent weren't eligible for subsidies and lived in a state that hadn't expanded Medicaid. The cost of premiums, deductibles and co-pays also was the primary reason why 66 percent of individuals bought a new marketplace plan or switched coverage in 2015.

Cost concerns aside, though, the second brief notes that one-quarter of all working-age adults in the country have used the marketplaces to shop for insurance. Only 30 percent of these individuals ended up selecting a private health plan through the marketplace, however; 15 percent ended up enrolling in Medicaid, and the largest share, 52 percent, selected neither option.  

Uninsured individuals--particularly those who declined to purchase health insurance during the ACA's first two open enrollment sessions--are the target of the Department of Health and Human Services' latest enrollment push. Many of these individuals are young people, members of minority groups and/or have incomes that would make them eligible for subsidies.

To learn more:
- here's the first brief
- check out the second brief
- read the Commonwealth Fund announcement

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