Matt McGough
@mattmcgough.bsky.social
Health policy analyst @kff.org posting about the ACA, affordability, and a bit of pop culture | Hopkins alum | Views own🏳️🌈
https://www.kff.org/person/matt-mcgough/
https://www.kff.org/person/matt-mcgough/
To learn more about changes actuarial values and the effect on consumers, check out our new
@kff.org analysis here: www.kff.org/policy-watch...
@kff.org analysis here: www.kff.org/policy-watch...
Pending Changes to Marketplace Plans Could Increase Cost-Sharing for Consumers | KFF
This brief looks at changes to Marketplace plans recently finalized by the Centers for Medicare and Medicaid Services (CMS) that may incentivize insurers to make their plans less generous. With less g...
www.kff.org
June 23, 2025 at 6:35 PM
To learn more about changes actuarial values and the effect on consumers, check out our new
@kff.org analysis here: www.kff.org/policy-watch...
@kff.org analysis here: www.kff.org/policy-watch...
What could this decrease mean for consumers? Those enrolled in a standard silver plan could see their deductibles rise by $1,750 or their coinsurance increase by 25 percentage points, and still be within the actuarial value range for standard silver plans.
June 23, 2025 at 6:35 PM
What could this decrease mean for consumers? Those enrolled in a standard silver plan could see their deductibles rise by $1,750 or their coinsurance increase by 25 percentage points, and still be within the actuarial value range for standard silver plans.
Currently, plans must cover between 70-72% of health care costs to be considered a standard silver plan.
But under the new CMS rule (and OBBB as passed by the House), Marketplace plans could cover 66% of costs on average and still be considered a standard silver plan.
But under the new CMS rule (and OBBB as passed by the House), Marketplace plans could cover 66% of costs on average and still be considered a standard silver plan.
June 23, 2025 at 6:35 PM
Currently, plans must cover between 70-72% of health care costs to be considered a standard silver plan.
But under the new CMS rule (and OBBB as passed by the House), Marketplace plans could cover 66% of costs on average and still be considered a standard silver plan.
But under the new CMS rule (and OBBB as passed by the House), Marketplace plans could cover 66% of costs on average and still be considered a standard silver plan.
The percent of expected costs that a plan covers is called the actuarial value (AV). AVs vary by metal level.
For example, bronze plans cover on average 60% of expected costs, silver 70%, gold 80%, and platinum (90%).
In hitting these targets, insurers are given flexibility.
For example, bronze plans cover on average 60% of expected costs, silver 70%, gold 80%, and platinum (90%).
In hitting these targets, insurers are given flexibility.
June 23, 2025 at 6:35 PM
The percent of expected costs that a plan covers is called the actuarial value (AV). AVs vary by metal level.
For example, bronze plans cover on average 60% of expected costs, silver 70%, gold 80%, and platinum (90%).
In hitting these targets, insurers are given flexibility.
For example, bronze plans cover on average 60% of expected costs, silver 70%, gold 80%, and platinum (90%).
In hitting these targets, insurers are given flexibility.