Simulating Variation in Families' Spending across Marketplace Plans.

Abstract

To examine variations in premium and cost-sharing across marketplace plans available to eligible families. 2011-2012 Medical Expenditure PanelSurvey (MEPS), 2014 health plan data from healthcare.gov, and the 2011 Medicare Part D public formulary file. 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. 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. 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. Our simulations show substantial variations in net premium and out-of-pocket payments across marketplace plans, even within a plan tier.