Dr Sara Collins Discusses Enrollees Passing Up ACA Subsidies

People who are purchasing health insurance under the Affordable Care Act (ACA) may be leaving money on the table because they choose plans with less expensive premiums and miss out on government subsidies, said Sara R. Collins, PhD, vice president of Health Care Coverage Access at The Commonwealth Fund.

Transcript (slightly modified)

Why are people thinking so much about the cost of premiums to the point that they’re leaving ACA subsidies on the table?

So we’re seeing in market-based plans that the people we asked in our surveys what drove their decision to choose their plan, what was the most important factor? And about 40% of people told us that their premium was the most important factor in their decision. Only about 22% said that their deductible was important, the most important factor, and about the same percentage said that having their doctor in their plan was the most important factor. So premiums do seem to be the big issue for consumers when they’re choosing the plan.

We are finding that some people do have high deductibles on the marketplaces. There are cost-sharing subsidies available for people whose incomes are under 250% of poverty and we do see the lower deductibles among people who are in silver-level plans who have the cost-sharing subsidies. So people under 250% of poverty, for example, with marketplace plans have deductibles that are in the range, or comparable to what people in that income group have in employer-based policies.

But we are also finding that people who are eligible for the subsidies are choosing bronze-level plans. The subsidies don’t apply to bronze-level plans but they can get a lower premium in a bronze-level plan with premium tax credit that still applies to the bronze-level plans. So they’re leaving the cost-sharing reduction subsidies on the table. The question is whether they are aware that they’re leaving those subsidies on the table. Or, if there isn’t enough information about what their choices are, to inform them about a possible better option, which is the silver-level plan at maybe a slightly higher premium but better cost per cost protection.

And in Kentucky this year—Kentucky is addressing this through their marketplace called Kynect—so when people who are in this income range it makes them eligible for cost-sharing subsidies. When they go to the website for Kynect the first plan that they’ll see are the silver-level plans so just trying to address what may be an information gap in terms of people’s decision-making about what plans to choose.