Cost-Sharing Insurance Plans May Not Lead to Overall Savings, Study Finds

A new study from healthcare business advisory company Avalere Health has found low-income consumers enrolled in cost-sharing insurance plans may face high coinsurance for prescription drugs.

Under the Patient Protection and Affordable Care Act, state- and federally-run health insurance exchanges are required to provide low-income insurance enrollees — earning between 100 and 250 percent the federal poverty level — with cost-sharing reductions.

Plans have broad discretion in how they meet the actuarial value targets for cost-sharing. Therefore, while almost all health insurance plans offered on the exchanges offered reduced deductibles and out-of-pocket caps in cost-sharing reduction plans, the study found many low-income consumers face very high coinsurance for prescription drugs.

The study found one-third of the cost-sharing reduction plans have coinsurance greater than 30 percent for tier three drugs, and one-fifth of those plans require the same coinsurance for tier four drugs.

Although the coinsurance for many cost-sharing reduction plans appear high, more than half of the standard silver plans have at least 30 percent coinsurance for tier three drugs, and 21 percent of standard silver plans have more than 30 percent coinsurance for tier four drugs.

Despite receiving cost-sharing subsidies, because of the high coinsurance costs, "low-income consumers may face barriers accessing brand-name drugs," according to the study.

More Articles on Premium Subsidies:

Report: Enrollees Have Qualified for $10B in PPACA Premium Subsidies
4 Findings on PPACA's Impact on Insurance Prices, Enrollment Beyond 2014
Hospitals Look to Cut Charity Care

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