Tuesday, January 06, 2015

Not quite the Harvard plan, but....

The NYT's Robert Pear reports that Harvard profs are up in arms because a small deductible and copays have been added to the university health plan, taking the actuarial value all the way down to... 91%.

Pear contrasts this to the 70% AV mandated for silver ACA plans, the "most popular" metal level. Which is fine, except...more than half of silver plan buyers qualify for Cost Sharing Reduction (CSR) at a level strong enough to take the AV up to 87% or 94%, depending on income level.

I have a post coming up on healthinsurance.org that teases out of enrollment stats published by New York State and HHS the likely percentages of ACA private plan buyers who access the higher levels of CSR, and the overall percentages of direct ACA beneficiaries who have obtained high-AV insurance.

The broader point: clunky or overly complex as the ACA's subsidy and means-tested benefit formulas may seem, they do work broadly to keep out-of-pocket costs relatively low for low-income beneficiaries.

Hope you'll tune in to the healthinsurance.org piece.

Update: The New York enrollment numbers also show that only 18% of silver plan buyers in the state had no CSR at all. I tend to discount the value of CSR to buyers with income between 200-250% FPL, for whom CSR boosts the silver plan AV to just 73%.  But it's really inaccurate to say that silver plans "typically" cover 70% of costs. That's probably true for less than a quarter of silver plan buyers.

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