Out-of-Pocket Costs

The Wall Street Journal cited some of our research in their recent article “High Deductibles Fuel New Worries of Health-Law Sticker Shock.” The larger study from which the data was derived was released this morning. For each metal plan (i.e. bronze, silver, gold, and platinum), the study examined the average cost for:

  • Individual and family deductibles
  • Primary care visit charges
  • Specialist charges
  • Individual and family maximum out-of-pocket costs per year

One of the surprising findings was that the average deducible amount found for each metal plan did not progress downward across metal plans evenly. This finding was surprising because the actuarial value differences among the plans are consistently 10% more medical costs covered for each higher level of metal plan. For example, the bronze health plan covers 60% of medical costs for a typical enrollee population and the average deductible for a bronze plan across 34 state exchanges was $5,081. The platinum health plan, in contrast, covers 90% of medical costs for a typical enrollee population but had an average deductible of only $347.


Assuming that actuarial certifications for all plans were correct, why would bronze plans that cover one third less medical costs than a platinum plan have an average deductible that was nearly 15 times higher than the average deductible for the platinum plan? The short answer is because the two plan categories are distributing cost-sharing in different areas. However, this answer does not explain the heavy reliance on deductible for cost-sharing among bronze plans.

The findings our of our study help illuminate why it is so important for consumers to include their anticipated healthcare use within health plan comparisons. Shopping by premium alone could result in higher annual costs for healthcare if a person has moderate use of healthcare services.

The full research can be reviewed in our InfoStat “Deductibles, Out-Of-Pocket Costs, and the Affordable Care Act.”

By Kevin Coleman