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December 13, 2018

4.2M Americans could pay $0 for an exchange plan in 2019, analysis finds

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    About 4.2 million uninsured U.S. residents who qualify for premium subsidies under the Affordable Care Act (ACA) are eligible to enroll in bronze-level exchange plans that would cost them $0 out of pocket, according to a Kaiser Family Foundation (KFF) analysis released Monday.

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    Analysis details

    For the analysis, KFF researchers looked at the premiums costs U.S. residents would face when enrolling in ACA exchange plans. The researchers reviewed data on population, income, and eligibility for premium subsidies from a separate KFF analysis of the U.S. Census Bureau's 2017 American Community Survey, as well as data on 2019 premiums for exchange plans from and state rating filings.

    The researchers focused on the full price of exchange plans, which includes the cost of covering the ACA's 10 essential health benefits (EHBs). U.S. residents can use premium subsidies only to cover the share of premiums related to the ACA's 10 EHBs, meaning they are responsible for paying the share of premiums that cover other benefits. The analysis focused on 15.9 million uninsured U.S. residents who could purchase exchange plans. It did not include individuals who are older than 65, who are eligible for Medicaid in 2019, or who are undocumented.


    The researchers found that premium subsidies would completely cover the cost of bronze-level exchange plan premiums for 27% of the 15.9 million uninsured U.S. residents included in the analysis, meaning those approximately 4.2 million individuals would pay $0 in premiums for such plans. The researchers noted that bronze-level plans are the lowest-cost exchange plan option, and they typically carry annual deductibles of about $6,258 on average.

    In addition, the researchers found that many U.S. residents who would be eligible for the $0 premiums also would qualify for cost-sharing assistance to help them purchase silver-level exchange plans. The researchers found unmarried U.S. residents with annual incomes below 200% of the federal poverty line could purchase benchmark silver-level health plans for an average premium of $20 to $130 per month after cost-sharing assistance is taken into account. According to the researchers, average deductibles for those plans range from $239 to $3,169 in 2019 and have reduced copayment and coinsurance requirements.

    The researchers wrote, "It is therefore important for potential enrollees, particularly those with significant health needs, to not only consider the premium, but also the significant cost-sharing assistance that is only available if they enroll in a silver plan."


    The Hill reports that the availability of health plans with $0 premiums could drive U.S. residents to sign up for exchange coverage.

    However, Larry Levitt, senior vice president for health reform at KFF, in a tweet wrote, "The question is, will [U.S. residents] find out about [the $0 premiums] and sign up before the December 15 deadline in most states" (Baker, "Vitals," Axios, 12/12; Sullivan, The Hill, 12/11; Fehr et al., KFF analysis, 12/11).

    Cheat sheet: What you need to know about the ACA


    The Patient Protection and Affordable Care Act, otherwise known as the ACA, is the comprehensive health care reform bill passed by Congress in March, 2010. The law reshapes the way health care is delivered and financed by transitioning providers from a volume-based fee-for-service system toward value-based care.

    Download the ACA cheat sheet to get a quick overview of this significant U.S. health care legislation.

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