Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance
Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance
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DOI：
10.1377/hlthaff.2016.0472
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发表时间：
2017-01-01
期刊：
影响因子：
9.7
通讯作者：
Hsu, John
中科院分区：
文献类型：
--
作者：
Fung, Vicki;Liang, Catherine Y.;Hsu, John
《平价医疗法案》包括财政援助，减少低收入美国人的保费和费用分摊金额，以提高医疗保险和护理的可负担性。要获得这两种类型的援助，参保者必须通过公共保险交易所购买合格的健康计划，而那些有资格获得费用分摊减免的人必须购买银级计划。我们估计，在加州可能有资格获得财政援助的个人市场登记者中，有31%购买了非银级或未在该州交易所出售的计划，因此错过了获得保费或费用分摊援助或两者兼而有之的机会。与选择合格计划的人相比，选择不符合补贴条件的计划的低收入投保人在一年内报告难以支付保费和自付费用的几率高出两到三倍。无论个人市场的结构在未来几年如何演变，都可能需要努力引导低收入参与者远离财务上次优的计划选择。
The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices.