Assessment of cost sharing in the Pima County Marketplace

- Premium competition in the Pima County Marketplace is intense for presumed healthy individuals under 30 years of age.
- Plans with low cost sharing tend to have higher premiums and vice versa.
- Evaluating health plans on premium alone is insufficient.
- Understanding cost-sharing is vital to effectively evaluating an insurance plan on a marketplace.
- Web tools could provide consumers information on physician networks, medication coverage, and costs.

The Patient Protection and Affordable Care Act established health insurance marketplaces to allow consumers to make educated decisions about their health care coverage. During the first open enrollment period in 2013, the federally facilitated marketplace in Pima County, Arizona listed 119 plans, making it one of the most competitive markets in the country. This study compares these plans based on differences in consumer cost sharing, including deductibles, co-pays and premiums. Consumer costs were reviewed using specific cases including a normal delivery pregnancy, the management of Type II Diabetes, and the utilization of specialty drugs to treat Hepatitis C. Total cost of care was calculated as the cost of managing the condition or event plus the cost of monthly premiums, evaluated as a single individual age 27. Evaluating a plan on premium alone is not sufficient as cost sharing can dramatically raise the cost of care. A rating system and better cost transparency tools could provider easier access to pertinent information for consumers.