ASSISTANT SECRETARY FOR HEALTH POLICY
PLANNING AND EVALUATION January 13, 2022

ge ASPE rence ISSUE BRIEF

Health Insurance Deductibles Among
HealthCare.Gov Enrollees, 2017-2021

Deductibles among HealthCare.gov enrollees vary widely by metal tier and receipt of
cost-sharing reduction subsidies. The median individual deductible after subsidies
decreased from $1,000 in 2017 to $750 in 2021 among Open Enrollment Period
enrollees. This fell even more dramatically during the 2021 Special Enrollment Period
after passage of the American Rescue Plan, which increased premium tax credits and
enabled many consumers to select more generous plans.

D. Keith Branham, Christie Peters, Nancy De Lew, and Benjamin D. Sommers

 

KEY POINTS

e Cost-sharing reduction subsidies (CSRs) provide substantial financial protection to eligible Marketplace
enrollees who enroll in silver metal tier plans, by lowering deductibles, copayments, coinsurance, and
out-of-pocket maximums.

e Median and average deductibles, after CSRs, differ substantially among HealthCare.gov enrollees. The
median deductible decreased from$1,000 to $750 between 2017 and 2021 (prior to implementation
of the American Rescue Plan (ARP)), while the average deductible increased from $2,405 to $2,825.
The difference between median and average deductibles is primarily driven by the fact that the
majority of enrollees are eligible for and select CSR-silver plans; the average deductible is driven up by
the smaller share of enrollees enrolled in plans without CSRs.

© Deductibles for consumers receiving CSRs and the overall median deductible on HealthCare.gov are
generally lower than employer coverage deductibles, while the average deductible in bronze plans
without CSRs is higher than the average employer coverage deductible.

e Slightly over half of HealthCare.gov enrollees - 51 percent in the 2021 open enrollment period and 58
percent of new plan selections during the 2021 special enrollment period (from February to August) -
receive CSRs, making a CSR planthe median HealthCare.gov offering. The average silver CSR
deductible, after subsidy, has been well below $1,000 for the past 5 years, and is even lower for those
with incomes below 200 percent of the federal poverty level who qualify for more generous CSRs.

e Among those not receiving CSRs, the average HealthCare.gov bronze plan deductible generally
remained steady between 2017 and 2021, with an average deductible of $6,094 in 2021. The average
silver non-CSR deductible grew from $3,491 to $4,500 over the same time.

e The ARP contains provisions that reduce premiums for many Marketplace eligible individuals. Among
new consumers enrolling during the 2021 HealthCare.gov Special Enrollment Period, median
deductibles fell from $450 to $50 after the ARP premium provisions were implemented on April 1,
2021, indicating most new consumers are opting into CSR silver plans.

 

 

January 2022 ISSUE BRIEF 1
INTRODUCTION

The Affordable Care Act (ACA) provides premium subsidies for Marketplace-eligible individuals to improve
health insurance affordability, as well as cost-sharing reductions (CSRs) for many enrollees that limit out-of-
pocket spending such as deductibles. While research shows that collectively these provisions have
substantially improved access to affordable coverage!?4.5-with a combined 12 million individuals enrolled in
HealthCare.gov states and State-based Marketplaces during the 2021 Open Enrollment Period (OEP)® and more
than 13.8 million since the start ofthe 2022 OEP'-financial barriers for coverage and access tocare still exist
for some Marketplace consumers. This Issue Brief assesses trends in deductibles among HealthCare.gov
enrollees* from the 2017-2021 OEPs and discusses the effects of the American Rescue Plan (ARP),
implemented on April 1, 2021 for coverage in the same calendar year.

BACKGROUND

The consumer financial assistance and protections provided in the ACA for Marketplace eligible individuals
include Advanced Premium Tax Credit (APTC) payments for premiums, CSR payments for out-of-pocket (OOP)
costs, andlimits on the annual maximum OOP (MOOP) costs. Additionally, the ACA includes actuarial value
(AV) requirements based on plan metal tiers that define the percentage of total average costs covered by a
plan. Combined, these provisions are designed to allow consumers who are unable to obtain affordable,
comprehensive coverage from other sources (such as employer coverage) to do so throughthe Marketplace.
The AV of a health plan is the average percentage of total costs of in-network essential health benefits (EHB),
as defined by ACA, covered by the health plan.* The available AV of Marketplace plans ranges from 60 percent
for bronze plans, 70 percent for silver plans, 80 percent for gold plans, and 90 percent for platinum plans. AV
can vary within a de minimis range by -4/+2 percentage points; for expanded bronze plans', the allowable
variation is -4/+5 percentage points - though CMS has proposed reducing the de minimis range for 2023.§

APTCs reduce net premiums for millions of Marketplace consumers.® APTC protections were further
strengthened by the ARP for 2021-2022 coverage by lowering premium contributions for eligible consumers
and removing the upper income limit of 400 percent of the Federal Poverty Level (FPL) on APTC eligibility, as
well as providing access to zero- and low-premium plans for millions more uninsured individuals and
HealthCare.gov enrollees.?-7°11 Notably, the vast majority of HealthCare.gov consumers receive APTC financial
assistance-88 percent among HealthCare.gov enrollees during the 2021 OEP and 93 percent of new
HealthCare.govenrollees during the 2021 special enrollment period (SEP).®12

Beyond premiums, consumers also face OOP costs including deductibles, coinsurance, and copays. For eligible
individuals, generally those with household incomes between 100 and 250 percent FPL,** CSRs help to reduce
OOP costs for low-income Marketplace enrollees if they enroll in silver metal level plans. These CSRs enhance
silver plan AV from 70 percent to 73, 87, or 94 percent, depending on household income. While available to a
narrower income range than APTCs, CSRs reduce consumer OOP costs for a substantial proportion of the

 

*HealthCare.gov enrollees are those enrolled in plans offered in states using the federal platform HealthCare.gov. These include both Federally-
facilitated Marketplaces and State-based Marketplaces that choose to use the HealthCare.gov platform for enrollment.

TEHBs are a set of ten service types health insurance plans must cover under the ACA, including: preventive care, ambulatory services,
inpatient and outpatient hospital care, prescription drugs, maternal andinfant care, pediatric services, mental health services, lab services,
and rehabilitative care. For more information visit: https://www.healthcare .gov/glossary/essential-health-benefits/.

* Expanded bronze are bronze plans that cover and pay for at least one major service, otherthan preventive services, before the deductible or
meet the requirements to be a high deductible health plan within the meaning of section 223(c)(2) of the Internal Revenue Code.

5 CMS has proposed 2023 changes that would reduce the de minimis ranges to -2/+2 percentage points for platinum, gold, and non-expanded
bronze, +2/0 for silvernon-CSR, and+1/0 for silver CSR plans. For more information visit: https://www.govinfo.gov/content/pke/FR-2022-01-
05/pdf/2021-28317.pdf.

"CSRs are generally available to consumers with incomes up to $32,200 for a single adult and $66,250 for a family of four. American Indians
and Alaskan Natives can qualify for CSRs at higher incomes and can receive CSRs when enrolled in plans at any metal level.

 

January 2022 ISSUE BRIEF 2
Marketplace enrolled population - 51 percent of HealthCare.gov enrollees during the 2021 OEP and 58
percent of new plan selections during the 2021 SEP.° However, both enrollees not eligible for CSRs andthose
who are eligible but do not select a silver CSR plan may face higher OOP costs- including higher deductibles -
when they utilize health care services.

The vast majority of HealthCare. gov enrollees select plans in the bronze (37 percent in the 2021 OEP) or silver
(56 percent in the 2021 OEP-51 percent in CSR silver, and 5 percent in non-CSR silver) metal levels.° Gold
plans represent the next largest share of HealthCare.govenrollees (7 percent in 2021) with few enrollees
selecting catastrophic (1 percent in 2021) or platinum plans (less than 1 percent in 2021).® During the 2021
SEP, among all states, new plan selections were shifted even more towardsilver plans (62 percent), with
bronze plans having the next highest share (30 percent), and most remaining plan selections in gold (8
percent).

A deductible is a set amount that consumers must pay toward their medical costs before a health plan starts
paying for most services. Growthin healthinsurance deductibles has been a general trend across all types of
private insurance, including Marketplace coverage, non-group insurance sold off the Marketplace, and
employer coverage, the latter of which remains the most common source of health insurance coverage in the
U.S. The Commonwealth Fund estimated that between 2010 and 2019, employer coverage deductibles grew
from approximately 3.3 percent to 4.7 percent as a share of median income; when combined with premium
contributions, total deductible and premium contributions grew from 9.1 percent to 11.5 percent as a share of
median income.?? The Kaiser Family Foundation found that, between 2009 and 2019, both premiums and
deductibles among those with employer coverage rose faster than worker wages andinflation. During this
time period, deductibles rose by 162 percent and premiums by 54 percent, while wages only grew by 26
percent and inflation by 20 percent.*4 Further, in a 2019 survey of small business owners, respondents cited
deductibles and copays nearly as often as premiums (30 percent vs. 34 percent) when asked what was the
most important factor they considered when picking a health plan.+°

In this report, we assess trends in Marketplace deductibles by examining differences in median and average
deductibles over time and by metal tier in HealthCare.gov states. We also compare HealthCare. gov deductible
trends to those with employer coverage, for both large and small firms, toexamine relative change over time.

METHODS

Data for HealthCare.gov states were obtained from the Health Insurance Marketplaces 2021 Open Enrollment
Deductibles and Health Savings Account Enrollment supplemental tables produced by the Centers for
Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO).64647.18
Data for employer coverage were obtained from the Kaiser Family Foundation (KFF) 2021 Annual Employer
Health Benefits Survey and associated report, the most recent year of data available.19

We assessed annual overall median and average deductibles from 2017 to 2021 and compared them to the
average deductible for single workers with employer coverage. We analyzed the average employer coverage
deductible because information on the employer coverage median deductible was not available.

We then analyzed silver plan median and average deductibles by year, separately for non-CSR enrollees and
for each CSR silver variant among HealthCare.govenrollees from 2017 to 2021, alongside average employer
coverage deductibles by firm size (large vs. small firm). Finally, we examined median and average deductibles
overall and by metal tier among HealthCare.gov enrollees in non-CSR plans from 2017 to 2021.

For simplicity, analyses focused on individual deductibles (i.e., single coverage), rather than family deductibles.

 

January 2022 ISSUE BRIEF 3
Limitations

The data and approach used have several notable limitations. First, we only examined states using the
HealthCare. gov platform (39 states from 2017 through 2019, 38 states in 2020, and 36 states in 2021); the
analysis does not necessarily reflect trends in deductibles in State-based Marketplaces. This may also affect the
direct comparability of the Marketplace results tothose from employer coverage plans (which are from all 50
states). Additionally, geographic variability-for example at the state, county, or rating area level-is not
reflected in the analysis. Plan options and associated deductibles may vary widely depending on wherea
person lives. Finally, the analysis does not account for services offered before the deductible or separate drug
deductibles, though we discuss the former issue later in this report.

RESULTS

Overall Deductible Trends

Figure 1 shows overall median and average deductibles {including CSRs) for individual coverage for

HealthCare. gov enrollees from 2017 to 2021, and overall average deductibles for single workers with employer
coverage from 2017 to 2021.

Figure 1: HealthCare.gov OEP Individual Deductibles After Subsidies vs. Employer Individual Worker
Deductibles, 2017 to 2021

 

 

 

$3,000
$2,825
$2,500
$2,405
Overall HC.gov
$2,000 Average
$1,500 - = Overall HC.gov
_ aos 91,434 Median
~
$1,221 o ~
of ~
1,000 7 Se = = =
> $1,000 ~s
~ Overall Employer
™ $750 Average
$500
So
2017 2018 2019 2020 2021

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.
Source: Kaiser Family Foundation (KFF) 2021 Annual Employer Health Benefits Survey.

Note: Healthcare.gov states use the federal platform, Healthcare.gov, for consumers to enroll in Marketplace plans. 2021 estimates only represent OEP
plan selections and do not reflect the impacts of subsidies in the American Rescue Plan.

The overall average HealthCare.gov deductible increased by $420 between 2017 and 2021 (from $2,405 to
$2,825, or 4.1 percent per year), while the overall median deductible decreased by $250 (from $1,000 to $750,
or -6.9 percent per year) over the same time period. The average employer coverage deductible increased by

 

January 2022 ISSUE BRIEF 4
$213 between 2017 and 2021 (from $1,221 to $1,434, or 4.1 percent per year). Taken together, these results
indicate that more than half of HealthCare.gov enrollees have subsidized deductibles below average employer
coverage deductibles (reflected in the median), but those without CSRs face relatively large deductibles (which
pulls up the average). Meanwhile, the relative growth rates in the average HealthCare.gov deductible and
average deductibles among those with employer coverage were similar over this time period.

The gap between average and median deductibles on HealthCare.govis driven by deductibles for non-CSR
variant plans, as presented in Figures 2 and 3 below.

Silver Plan Deductible Trends

Figure 2 shows median and average individual deductibles for silver metal plans by CSR variant over time for
HealthCare.gov enrollees from 2017 to 2021, and average deductibles for single workers with employer
coverage by firm size from 2017 to 2021.

Figure 2: HealthCare.gov OEP Individual Silver Metal Tier and CSR Variant Deductibles (2017 to
2021) and Employer Individual Worker Deductibles by Firm Size (2017 to 2021)

 

 

$5,000
4,800
? $
$4,500 ee $4,500
7
4,000 7
° - =" 7-s--= =~ 7 === Silver Non-CSR Average
- =
$3,500 $3,491 -= = = = Silver Non-CSR Median
= - @- =
93,300 = eete = Silver 73% AV CSR Average
3,000 err ,
° 233 == =. 7 - © Silver 73% AV CSR Median
$2,800 ~.-4
$2,500 @=- Employer Small Firm Average
o= Employer Large Firm Average
2,000 $2,009
° _--- > === Silver 87% AV CSR Average
$1,500 °2631 - = Silver 87% AV CSR Median

 

$1,201 === Silver 94% AV CSR Average
$1,000 $1,049 ==

$500 §500 = = - zae0

189 $69
So

=- -@ Silver 94% AV CSR Median

$0
2017 2018 2019 2020 2021

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.
Source: Kaiser Family Foundation (KFF) 2021 Annual Employer Health Benefits Survey.
Note: Median and average deductible estimates for CSR silver variants are after application of the subsidy.

Silver CSR variant plan deductibles with 94 percent AV were the lowest of any plan type throughout the study
period. Median and average deductibles, after CSRs, were SO and $69 in 2021, both representing a decline of
at least $100 since 2017 (or -100.0 and -22.3 percent per year, respectively). Similarly, average deductibles for
silver CSR variant plans with 87 percent AV decreased from $661 to $530 (or -5.4 percent per year) between
2017 and 2021, while median deductibles decreased from $500 to $450 (or -2.6 percent per year) over the
same time.

 

January 2022 ISSUE BRIEF 5
In comparison, deductibles increased between 2017 and 2021 for silver CSR variant plans with 73 percent AV,
with the median deductible increasing from $2,800 to $3,300 (or 4.2 percent per year), and the average
deductible from $2,863 to $3,115 (or 2.1 percent per year). Similarly, non-CSR silver plan deductibles also
increased between 2017 and 2021, with the median deductible increasing from $3,300 to $4,800 (or 9.8
percent per year), and the average deductible increasing from $3,491 to $4,500 (or 6.6 percent per year).

Employer coverage single worker deductibles were higher, on average, for small firms ($2,009 in 2021)
compared to large firms ($1,201 in 2021). Percentage increases between 2017 and 2021 were 5.3 percent and
3.4 percent per year, respectively. Employer average deductibles for both small and large firms fell between 73
percent AV CSR silver and 87 percent AV CSR silver deductibles across all years of data.

Non-CSR Plan Deductible Trends for All Metal Levels
Figure 3 shows median and average individual deductibles for non-CSR plans by metal tier over time for
HealthCare. gov enrollees from 2017 to 2021.

Figure 3: HealthCare.gov OEP Individual Deductibles in Non-CSR Plans by Metal Tier (2017 to 2021)

$7,000 -~_-=S->-- $7,000

$6650 = = eo To Le ew

$6,327 -- -

 

$6,000 $6,094
$5,000 $4,800 === Bronze Average
$4,500 = © Bronze Median
$4,000 Silver Non-CSR Average
3.491 Silver Non-CSR Median
3/300
$3,000 == Gold Average

== = Gold Median

Platinum Average

 

$2,000
$1,458 Platinum Median
SS $1,450

- =- ,

$1,000 2103 = ee
184 $68
0) ° 8 SO

2017 2018 2019 2020 2021

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.
Note: Platinum plans are not offered in many rating areas, therefore the estimates represent a subset of the HealthCare.gov population.

From 2017 to 2021, the average bronze plan deductible fluctuated between $6,000 and $6,500, while the
median bronze plan deductible fluctuated between $6,500 and $7,000. Non-CSR silver plan premiums
increased between 2017 and 2021, with the median deductible increasing from $3,300 to $4,800 (9.8 percent
per year), and the average deductible increasing from $3,491 to $4,500 (6.6 percent per year). The gold plan
median deductible had an uptick in 2020 ($1,200) and 2021 ($1,450), up from $1,000 from 2017 to 2019. The
average gold plan premium was similar to the median in 2017 and 2021, increasing from $1,003 to $1,458 (9.8
percent per year). Platinum plans are included in the figure for reference, but these plans are not offered in
many rating areas and represent a very small proportion of HealthCare.govenrollees.

 

January 2022 ISSUE BRIEF 6
DISCUSSION

Our analysis of Marketplace deductibles on HealthCare.gov reveals several key results.

First, Marketplace deductibles vary widely by metaltier and the presence or absence of CSRs. In general,
enrollees receiving CSRs - who represent just over half of HealthCare.gov enrollees - experience deductibles
that are substantially lower than typical deductibles in employer plans, while those without CSRs generally
have higher deductibles than typical employer plans. CSRs provide substantial protection to lower income
Marketplace enrollees who choose to enroll in silver metal tier CSR variant plans on HealthCare.gov by
lowering deductibles, copayments, coinsurance, and out-of-pocket maximums. CSRs provide the greatest
protection from high OOP costs for those with incomes between 100 and 200 percent FPL. Median and
average deductibles for enrollees in these CSR silver variant plans have decreased over time, while most other
metal tiers have experienced increases similar in size to recent deductible growth in employer coverage. CSRs
provide some OOP cost protection for those with incomes between 200 and 250 percent FPL, but some may
still face high deductible costs.

Second, while trends over time in both employer coverage and Marketplace plans without CSRs are towards
higher deductibles, this is not the case for many of those receiving CSRs in HealthCare. gov states. For those in
87 percent and 94 percent AV silver plans, deductibles have in fact fallen since 2017, and as a result, the
overall median HealthCare.gov deductible has also decreased since 2017. The majority of enrollees in
HealthCare.gov Marketplace plans in 2021 had deductibles at or below $750, down from a median of $1,000 in
most previous years from 2017-2020.

Meanwhile, consumers ineligible for CSRs face higher deductibles, especially if they select silver or bronze
plans. Whether this is a barrier to health care access depends on their individual healthcare needs and
utilization. For example, younger and healthier enrollees obtaining coverage primarily for preventive care
(which is covered without cost-sharing under the ACA, even for those with a deductible) may not need to meet
their deductible, and non-CSR silver or bronze plans may provide the access they need at an affordable
premium. However, studies have found that enrollees in high-deductible employer coverage plans reduce their
health care expenditures, including those for highly beneficial preventive care, in response to high

deductibles .12.3.45.29 Older and less healthy CSR ineligible enrollees may be at greatest financial risk with high
deductible plans. These enrollees may find gold plans with a higher AV and lower deductibles that provide a
better financial option than non-CSR silver plans. However, this should be weighed in conjunction with
premium differences. More broadly, deductibles are just one element of plan design, and consumer choices
should be informed by considerations including premiums, cost-sharing, provider networks, and benefit
design.

Coverage Benefits Before Reaching the Deductible Limit

 

As noted above, there are ACA benefits available before a
Preventive services suchas deductible contribution, which are especially important for
immunizations, annual well consumers with high deductibles. Preventive services such as

_«. . immunizations, annual well care visits, and screenings (e.g.,
care visits, a nd screenings from breast cancer, colorectal cancer, diabetes) from in-network
in-network providers must be providers must be provided without any cost-sharing - meaning
provided without cost-sharing deductibles do not apply to these services .21-22 Inaddition, OOP
- meaning deductibles do not payments made by consumers for in-network care are basedon

insurer-negotiated rates, which are generally significantly lower

apply to these services. than prices for those without health insurance.

 

January 2022 ISSUE BRIEF 7
Itis alsoimportant to consider other OOP costs toconsumers beyond deductibles (e.g., coinsurance and
copays). These, in combination with premiums (after APTC), affect overall health care costs for HealthCare.gov
enrollees. While ACA MOOP limits offer enrollees some financial protection overall for OOP costs, few
enrollees reachthe MOOP, so this provision generally only protects very high utilization enrollees.

American Rescue Plan and Other Policy Options

The ARP enhanced APTCs for those with household incomes between 100 and 400 percent FPL and extended
them to individuals with incomes above 400 percent FPL, ensuring that all eligible enrollees do not pay more
than 8.5 percent of their income toward benchmark premiums (second-lowest cost silver) in 2021 and 2022.

The ARP's APTC enhancements likely will make silver CSR plans even more appealing to many eligible
consumers, as they substantially decrease premiums for these plans. This is especially appealing to those with
incomes between 100 and 150 percent FPL, who will pay zeroor near zero premiums toward the benchmark
silver plan.** Paired with CSRs, these enrollees may find low premium silver plans with higher AV and lower
deductibles than standard silver plans. This notion is supported by the recently released 2021 Marketplace
Special Enrollment Period Report for February 15 throughJuly 31, 2021, which showed that the median
deductible for new consumers fell from $450 to $50 after the expanded APTC amounts were implemented on
HealthCare.govon April 1, 2021.23 It is important to note that special enrollment period consumers differ along
multiple dimensions compared to OEP enrollees, so these deductible amounts should not be directly
compared to the OEP estimates inthis report - but the marked decline post-ARP within the same special
enrollment period strongly suggests the ARP is leading consumers to enroll in plans with lower cost-sharing
requirements. As noted earlier, 58 percent of new enrollees during this period received CSRs, anincrease from
51 percent during the 2021 OEP. 12.24

A policy option to further improve affordability of care for those with Marketplace coverage would be to
enhance and extend CSRs ina similar way to the ARP's premium subsidies. Another policy option is changing
the benchmark plan to the gold metal tier (rather than silver), which would increase the AV of plans for subsidy
eligible enrollees by increasing APTCs. Future research describing the characteristics of individuals selecting
high deductible Marketplace plans and actual realized costs may help inform the overall benefits of these
types of policy options.

CMS alsorecently announced in its proposed 2023 Notice of Benefit and Payment Parameters, a proposal to
adopt standardized plan design options on HealthCare.gov. Adoption of standardized plans would create more
consistency in costs by metal level across Marketplace plans offered in the same rating area, including
deductibles, as well as actuarial value, maximum out-of-pocket, and other cost-sharing.2° The aim of
standardizing plans, as proposed in the 2023 rule, is to reduce consumer choice overload and improve
enrollees' ability to distinguish between plan benefit designs. The deductible amounts for the proposed
standardized options include $9,100 for traditional "non-expanded" bronze plans, $5,800 for non-CSR silver
plans, $800 for 87 percent AV silver plans, and SO for 94 percent AV silver plans. All plans other than the non-
expanded bronze also include coverage of services suchas primary care, specialty care, behavioral health, and
many prescription medications before the deductible.

 

+ APTC can only be applied to the portion of the premium that covers ACA EHBs. Ifa silver CSR plan covers non-ACA EHB services, the
consumer is responsible for that portion of the premium. Additionally, underthe ARP, the expected contribution toa benchmark plan is zero
percent for eligible enrollees between 100-150 percent FPL, therefore the vast majority of this population will have nopremiumcontribution
for the benchmarkplan.

 

January 2022 ISSUE BRIEF 8
Conclusion

The general trend towards higher deductibles in private insurance plans over the past decade has been offset
for more than half of Marketplace enrollees by the ACA's generous CSRs, as median deductibles have been
decreasing. HealthCare.gov enrollees with CSRs generally have smaller deductibles than employer coverage,
while those without CSRs face larger deductibles that are growing at rates similar to deductibles in employer
coverage. The ARP has led to a shift towards plan enrollment with lower deductibles, offering even greater
financial protection to consumers.

 

January 2022 ISSUE BRIEF 9
APPENDIX: DETAILED DATA TABLES
Appendix Table 1: Data for Figure 1

 

 

 

 

 

 

 

Overall HealthCare. gov Overall HealthCare. gov Overall Employer
Average Median Average
2017 $2,405 $1,000 $1,221
2018 $2,685 $1,400 $1,350
2019 $2,719 $1,000 $1,396
2020 $2,835 $1,000 $1,364
2021 $2,825 $750 $1,434

 

 

 

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.
Source: Kaiser Family Foundation (KFF) 2021 Annual Employer Health Benefits Survey.

Appendix Table 2: Data for Figure 2

 

 

 

 

 

 

 

Sil Sil Silver Silver Empl Empl Silver Silver Silver Silver
Non-CSR Non-cSR 73% AV 73% AV Loree tire Small tir 87% AV 87%AV 94%AV 94% AV
Average Median CSR CSR Avera e Average CSR CSR CSR CSR
6 Average Median 8 6 Average Median Average Median
2017 $3,491 $3,300 $2,863 $2,800 $1,049 $1,631 S661 $500 $189 $100
2018 $3,970 $3,700 $2,945 $2,900 $1,159 $1,818 $710 S675 $231 $100
2019 $4,056 $4,000 $2,913 $2,625 $1,184 $1,896 $567 $500 $131 so
2020 $4,181 $3,700 $3,128 $3,250 $1,187 $1,819 $517 $450 $105 so
2021 $4,500 $4,800 $3,115 $3,300 $1,201 $2,009 $530 $450 $69 so

 

 

 

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.
Source: Kaiser Family Foundation (KFF) 2021 Annual Employer Health Benefits Survey.

Appendix Table 3: Data for Figure 3

 

 

 

 

 

 

 

Bronze Bronze Silver Non- Silver Non- Gold Gold Platinum Platinum

Average Median CSR Average CSR Median Average Median Average Median
2017 $6,327 $6,650 $3,491 $3,300 $1,003 $1,000 $184 so
2018 $6,153 $6,500 $3,970 $3,700 $1,243 $1,000 $146 sO
2019 $6,376 $6,550 $4,056 $4,000 $1,225 $1,000 $120 so
2020 $6,446 $6,800 $4,181 $3,700 $1,319 $1,200 $101 so
2021 $6,094 $7,000 $4,500 $4,800 $1,458 $1,450 $68 SO

 

 

 

Source: HealthCare.gov Marketplaces 2021 Open Enrollment Deductibles and HSA Enrollment: Supplemental Tables.

 

January 2022 ISSUE BRIEF 10
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7 Marketplace 2022 Open Enrollment Period Report: National Snapshot. Washington, DC: Center for Consumer
Information and Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services (CMS). January 10, 2022.
Available at: httos://www.cms.gov/newsroom/fact-sheets/marketplace-2022-open-enrollment-period-report-december-
national-snapshot.

® Branham DK, Conmy AB, DeLeireT, Musen J, Xiao X, Chu RC, Peters C, and Sommers BD. Accessto Marketplace Plans
with Low Premiums on the Federal Platform, Part |: Availability Among Uninsured Non-Elderly Adults and HealthCare.gov
Enrollees Priorto the American Rescue Plan (Issue Brief No. HP-2021-07). Washington, DC: Office of the Assistant
Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. March29, 2021. Available at:
https: //aspe .hhs.gov/system/files/odf/265291/low-premium-plans-issue-brief.pdf.

° Branham DK, Conmy AB, DeLeireT, Musen J, Xiao X, Chu RC, Peters C, and Sommers BD. Accessto Marketplace Plans
with Low Premiums on the Federal Platform, Part II: Availability Among Uninsured Non-Elderly Adults Under the American
Rescue Plan (Issue Brief No. HP-2021-08). Washington, DC: Office of the Assistant Secretaryfor Planning and Evaluation,
U.S. Department of Health and Human Services. April 1, 2021. Available at:

https: //aspe.hhs.gov/system/files/pdf/265321/ASPE%20ACA%20Low%20Premium%20Plans%20|ssue%2 OBrief%20Il.pdf.
10 Branham DK, Conmy AB, DeLeireT, Musen J, Xiao X, Chu RC, Peters C, and Sommers BD. Accessto Marketplace Plans
with Low Premiums on the Federal Platform, Part Ill: Availability Among Current HealthCare.gov Enrollees Under the
American Rescue Plan (Issue Brief No. HP-2021-09). Washington, DC: Office of the Assistant Secretary for Planning and
Evaluation, U.S. Department of Health and Human Services. April 13, 2021. Available at:

 

it Branham DK, Conmy AB, DeLeireT, Musen J, Xiao X, Chu RC, Peters C, and Sommers BD. Accessto Marketplace Plans
with Low Premiums on the Federal Platform, Count Estimates of Zero- and Low-Premium Plan Availability, HealthCare.Gov
States Pre and Post American Rescue Plan. Washington, DC: Office of the Assistant Secretaryfor Planning and Evaluation,
U.S. Department of Health and Human Services. April 13, 2021. Available at:
https://aspe.hhs.gov/pdf-report/count-estimates-of-zero-and-low-premium-plan.

12 2021 Final Marketplace Special Enrollment Period Report. Washington, DC: Center for Consumer Information and
Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services (CMS). September 4, 2021. Available at:
https://www.hhs.gov/sites/default/files/2021-sep-final-enrollment-report.pdf.

13 Collins SR, Radley DC, Baumgartner JC. State Trends in Employer Premiumsand Deductibles, 2010-2019.
Commonwealth Fund. November 2020. Available at: https://doi.org/10.26099/7 n7x-sj69.

44 BenchmarkEmployer Survey Finds Average Family Premiums Now Top $20,000. Kaiser Family Foundation. September
25,2019. Available at: httos://www.kff.org/health-costs/press-+elease/benchmark-employer-survey-finds-average-family-

premiums-now-top-20000/.

 

January 2022 ISSUE BRIEF 11
 

15 Small Business Health Insurance: Costs, Trends and Insights 2018. eHealth, Inc. April 2019. Available at:
https://news.ehealthinsurance.com/_ir/68/20193/Small%20Business%20Healtth%20Insurance%20Costs%20 Trends%2Olns
ights%202018.pdf.

16 HealthCare.gov Open Enrollment Period Plan Selections: 2014-2021 OEP Deductibles and HSA Enrollment. Washington,
DC: Center for Consumer Information and Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services. April
21,2021. Available at: https://www.cms.gov/research-statistics-data-systems/marketplace-products/2021-marketplace-
open-enrollment-period-public-use-files; https: //www.cms.gov/files/zip/2014-2021-oep-deductibles-and-hsa-
enrollment.zip.

17 2021 HealthCare.gov Qualified Health Plan Choice and PremiumsAppendix. Washington, DC: Center for Consumer
Information and Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services. November 3, 2020. Available
at: https://www.cms.gov/CCllO/Resources/Data-Resources/QHP-Choice-Premiums;
https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/202 1QHPPremiumsChoiceAppendix.xlsx.

18 2022 HealthCare.gov Qualified Health Plan Choice and PremiumsAppendix. Washington, DC: Center for Consumer
Information and Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services. October 25, 2021. Available at:
https://www.cms.gov/CCIIO/Resources/Data-Resources/QHP-Choice-Premiums;
https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/202 2QHPPremiumsChoiceAppendix.xlsx.

192021 Employer Health Benefits Survey. Kaiser Family Foundation. November 10, 2021. Available at:

 
   

February 2020. Available at: https: :
21 Access to Preventive Services without Cost-Sharing: Evidence from the Affordable Care Act. (Issue Brief No. HP-2022-
01). Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human
Services. January 11, 2022. Available at: httos://aspe.hhs.gov/reports/aca-preventive-services-without-cost-sharing.

22 Preventive Services. HealthCare.gov. Available at: https: //www.healthcare.gov/coverage/preventive-care-benefits/.

23 2021 Marketplace Special Enrollment Period Report. Washington, DC: Center for Consumer Information and Insurance
Oversight (CCIIO), Centers for Medicare and Medicaid Services (CMS). August 10, 2021. Available at:
https://www.cms.gov/newsroom/fact-sheets/2021-marketplace-special-enrollment-period-report-4.

74 Health Insurance Marketplaces 2021 Open Enrollment Report. Washington, DC: Center for Consumer Information and
Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services (CMS). April 21, 2021. Available at:
https://www.cms.gov/files/document/health-insurance-exchanges-2021-open-enrollment-report-final.pdf.

25 Chu RC, Rudich J, Lee A, Peters C, De LewN, and Sommers BD. Facilitating Consumer Choice: Standardized Plans in
Health Insurance Marketplaces (Issue Brief No. HP-2021-29). Washington, DC: Office of the Assistant Secretary for
Planning and Evaluation, U.S. Department of Health and Human Services. December 28, 2021. Available at:
https://aspe.hhs.gov/reports/standardized-plans-health-insurance-marketplaces.

 

January 2022 ISSUE BRIEF 12
 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Assistant Secretaryfor Planning and Evaluation

200 Independence Avenue SW, Mailstop 447D
Washington, D.C. 20201

For more ASPE briefs and other publications, visit:
aspe.hhs.gov/reports

mae
[a]
ABOUT THE AUTHORS

D. Keith Branham is a Senior Research Analyst for the Office of
Health Policy in ASPE.

Christie Peters is the Director of the Division of Health Care
Access and Coverage for the Office of Health Policy in ASPE.
Nancy De Lew is the Associate Deputy Assistant Secretaryfor the
Office of Health Policy in ASPE.

Benjamin D. Sommers is the Deputy Assistant Secretaryfor the
Office of Health Policy in ASPE.

SUGGESTED CITATION

Branham DK, Peters C, De LewN, and Sommers BD. Health
Insurance Deductibles Among HealthCare.gov Enrollees, 2017-
2021 (Issue Brief No. HP-2022-02). Washington, DC: Office

of the Assistant Secretary for Planning and Evaluation, U.S.
Department of Health and Human Services. January 13, 2022.

COPYRIGHTINFORMATION

All material appearing in this reportis in the publicdomainand
may be reproducedor copied without permission; citationas to
source, however, is appreciated.

DISCLOSURE
This communication was printed, published, or produced and
disseminated at U.S. taxpayer expense.

 

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January 2022

ISSUE BRIEF

13