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Health Serv Res. 2018 Aug;53(4):2285-2302. doi: 10.1111/1475-6773.12831. Epub 2018 Feb 14.

Simulating Variation in Families' Spending across Marketplace Plans.

Author information

1
Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA.
2
Lister Hill National Center for Biomedical Communications (LHNCBC), National Library of Medicine (NLM), National Institutes of Health (NIH), Bethesda, MD.
3
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.

Abstract

OBJECTIVE:

To examine variations in premium and cost-sharing across marketplace plans available to eligible families.

DATA SOURCES:

2011-2012 Medical Expenditure Panel Survey (MEPS), 2014 health plan data from healthcare.gov, and the 2011 Medicare Part D public formulary file.

STUDY DESIGN:

We identified a nationally representative cohort of individuals in the MEPS who would have been eligible for marketplace coverage. For each family, we simulated the total out-of-pocket payment (premium plus cost-sharing) under each available plan in their county of residence, assuming their premarketplace use.

DATA COLLECTION/EXTRACTION METHODS:

Confidential state and county of residence identifiers were merged onto MEPS public use files and used to match MEPS families to the plans available in their county as reported in the publicly available data from healthcare.gov.

PRINCIPAL FINDINGS:

We found substantial variation in total family health care spending, especially premium component, across marketplace plans. This is true even within a plan tier of the same minimum actuarial value, and for families eligible for subsidies. Variation among families with income below 250 percent of the FPL is larger than variation among families with higher income.

CONCLUSIONS:

Our simulations show substantial variations in net premium and out-of-pocket payments across marketplace plans, even within a plan tier.

KEYWORDS:

Health insurance exchanges; health insurance marketplace; simulation

PMID:
29446065
PMCID:
PMC6051972
DOI:
10.1111/1475-6773.12831

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