HHS report defends ACA deductibles as reasonable

A new analysis from HHS argued against the perception that deductibles and out-of-pocket costs for insurance plans offered on Affordable Care Act exchanges are too high.

HHS said the median deductible for an individual covered by a marketplace plan is $850, down from $900 in 2015.

Other studies have given much higher figures, such as a November 2015 analysis from the Kaiser Foundation that placed the average deductible for a mid-level plan at $3,064. The difference, according to HHS, is other studies don’t take into account financial subsidies available under the ACA.

“As with marketplace premiums, many consumers’ deductibles are well below the deductible that would apply without financial assistance, so ignoring financial assistance gives a misleading picture of what consumers actually pay,” HHS said.

While HHS emphasizes the median figure, the same analysis also shows 43 percent of enrollees on the marketplace have an average deductible of $2,500 or more.

The analysis also emphasizes what services marketplace plans cover before meeting the deductible. HHS said those policies cover an average of seven services completely or with a co-pay, like generic drugs or primary care visits.

“This means that even though a health plan has a deductible, it might not matter for the services used most frequently, like primary care visits or prescription drugs,” HHS said. “In other words, just looking at the deductible—even after accounting for cost-sharing reductions—does not provide an accurate picture of marketplace consumers’ access to care.”

HHS added that a third of marketplace customers are enrolled in a plan that covers 10 or more services before the deductible.