Affordable Care Act Deductibles Have Risen Steadily
Deductibles for health insurance plans available under the Affordable Care Act have risen steadily since the federal and state exchanges launched in 2014.
- The average median deductible for all bronze, silver, gold and platinum plans grew from $2,528 in 2014 to $3,375 in 2021. The most popular benchmark silver plans saw the greatest increase, growing $1,809 over seven years to $4,879 in 2021.
- The second most popular bronze plans also saw sustained rises, rising $1,674 from launch to $6,992 at present.
- Pricier gold plan deductibles posted only a small increase and the most expensive platinum plan deductibles dropped.1
The rising cost of deductibles under the ACA has been a consistent complaint, but they should be viewed against a backdrop of increasingly pricy deductibles in the much larger employer health benefits market. A Kaiser Family Foundation annual survey, for example, showed that in 2016 the average employer group plan deductible rose 12%.2 The average median deductible for ACA marketplace plans was up in 2016 by the same figure: 12%.
Experts generally point to “cost-shifting” as the reason for rising deductibles. As American healthcare costs have risen, insurers have responded by shifting more of the costs onto enrollees in the form of higher deductibles and out-of-pocket costs. In turn, higher deductibles can reduce health service utilization and hold premiums down.
However, a Kaiser study shows that many lower income people who may be discouraged from purchasing a marketplace plan due to the high deductibles could in fact receive a subsidy that would allow them to purchase a lower deductible silver plan for the same price as a higher deductible bronze plan.3
Kaiser’s study finds that four million uninsured people in the U.S. could get a bronze plan on the ACA Marketplace for nothing, after accounting for their cost-sharing reductions, or CSR subsidies. The same study finds that nearly two-thirds of these people (who earn less than 250% of the Federal Poverty Line) are eligible for much lower deductibles if they buy a silver plan.4 In addition, some residents of over 190 counties (including the entire state of Wyoming) are even eligible for $0 premium gold plans, which have significantly lower deductibles still.5
The populations hardest hit by the ACA’s high deductibles have been those on the higher end of the income spectrum. Millions of people make too much to qualify for subsidies and end up paying the full price for high deductible plans. To address this, the Biden administration boosted subsidies for people whose incomes are below 400% of poverty and expanded eligibility for those above the current 400% cutoff.