Report: Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV
For people with HIV, health plans with the lowest premiums often aren't the most cost-effective. A new
Kaiser Family Foundation analysis
shows that people with HIV can find lower cost plans by conducting a more comprehensive cost assessment that includes factors such as deductibles, drug costs, and out-of-pocket maximums.
The analysis explores 300 possible enrollment scenarios for five plans in five states, including California. It provides estimates of the costs HIV positive consumers might expect to face when enrolling in a Marketplace plan. Among the options assessed, it finds that an HIV positive enrollee could save, on average, about $4,000 by taking into account a fuller range of costs.
For enrollees with incomes low enough to qualify for the most generous cost-sharing subsidies, silver plans provided the lowest expected costs, but for enrollees with higher incomes, the metal level plan providing the lowest cost was highly variable across markets.
In addition, the analysis finds those with the lowest incomes paid a greater share of their income toward health care than did those with the highest income and highlighted the important role the Ryan White HIV/AIDS Program plays in moderating costs for consumers.