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Half of Americans with individual health plans could gain better coverage under the ACA
Date:5/25/2012

May 23, 2012, New York, NYMore than half of Americans with individual market health insurance coverage in 2010 were enrolled in so-called "tin" plans, which provide less coverage than the lowest "bronze"-level plans in the Affordable Care Act, and therefore would not be able to be offered in the health insurance exchanges that are being created under the law, according to a Commonwealth Fundsupported study published today as a Web First in the journal Health Affairs. The analysis suggests that once the state-based exchangesset up to make it easier for individuals and small businesses to shop for health insurancego into effect in 2014, many of these Americans will be able to purchase plans that offer better coverage. In addition, many will be eligible for premium subsidies that will help offset the cost of the plans.

Compared with people enrolled in individual market plans, a majority of those enrolled in employer group plans have far more comprehensive coverage with less cost-sharing. Most group plans had an actuarial value of 80 percent to 89 percent, qualifying them as "gold" plans to be sold in the exchanges, compared with an actuarial value of below 60 percent for the "tin" plans, according to the study. Actuarial value is the proportion of the medical bill that the insurer pays, compared with what the insured person pays out of pocket in deductibles, copayments, and other cost-sharing.

"People who buy individual coverage often get low value for plans that do not offer essential benefits, such as maternity care," said lead author Jon Gabel, a senior fellow for the social science research organization NORC at the University of Chicago. "This study suggests that by the year 2014 these Americans will be able to buy much better plans that offer more financial protection."

Minimum Standards

Under the Affordable Care Act, insurance plans sold through the exchange will have to meet certain basic standards. Non-grandfath
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
Source:Eurekalert

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