Summary Cost Data for Federally-Facilitated Exchanges, 2014 (CRS Report for Congress)
| Release Date |
Revised Aug. 8, 2014 |
| Report Number |
R43484 |
| Report Type |
Report |
| Authors |
Nicholas Elan, Research Associate; Bernadette Fernandez, Specialist in Health Care Financing; Annie L. Mach, Analyst in Health Care Financing |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Premium April 16, 2014 (4 pages, $24.95)
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Summary:
The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) contains a number of provisions that may affect costs associated with plans sold through the health insurance exchanges established under ACA, both in terms of premiums and cost-sharing measures. CRS developed a fact sheet for each of the federally-facilitated exchanges that offer private health plans to individuals and families. Each fact sheet provides summary data about the range of costs and options for plans in a specific state's marketplace.
In general, the ACA provisions that may affect exchange premiums and cost-sharing requirements may also affect plans sold to individuals and families outside of exchanges.
The Department of Health and Human Services established a data website that makes premium and cost-sharing data, for plans offered through federally-facilitated exchanges (FFEs), available to researchers and the general public. CRS developed a fact sheet for each of the 34 FFEs that offer private health plans to individuals and families. Each fact sheet provides summary data about the range of costs and options for plans in a specific state's marketplace.
Given that these fact sheets are data documents, they do not discuss the factors that insurance carriers consider when developing premium rates or cost-sharing requirements. For example, medical claims represent the largest component of premiums by far, but claims costs are subject to a variety of factors, which may range from being plan-specific (e.g., limited provider network) to more general (e.g., market power of the carrier in negotiations with providers). Likewise, there are multiple considerations represented in cost-sharing requirements. For example, a given medical deductible may reflect heavy use of managed care techniques (as is the case in a traditional health maintenance organization [HMO], for example); presence of a separate prescription drug deductible; emphasis on consumer incentives to manage their use of health care services (e.g., a high-deductible plan that is paired with a health savings account [HSA]; and other plan features. Given the variability in the factors underlying both premiums and cost-sharing, caution should be used when comparing amounts across geographic areas and, in certain instances, across plans in the same area.
