Why is hiding its most affordable plans?

Many low-income consumers may be missing out on Silver plans with super-low deductibles

Consumer Reports, November 21, 2014

One little-known feature of the Affordable Care Act is the availability of special health plans with low deductibles and copays to consumers whose incomes are low, but not low enough to be enrolled in Medicaid. (For 2015 that's up to $29,175 for a single person, $39,325 for a couple, and $59,624 for a family of four. Details here.)

Unfortunately, many people eligible to buy these plans may never realize it because of the way, the site that sells health insurance to individuals in 38 states, displays plan results. Instead, they may end up with plans that, although their premiums are slightly lower, have extremely high deductibles that could put health care out of reach financially.

The plans they’re missing are special versions of the mid-priced Silver plans, the most popular of the four “metal tiers”—Bronze, Silver, Gold, and Platinum—sold on the state Health Insurance Marketplaces.

Whereas regular Silver plans cover about 70 percent of the average person’s health care costs, the special Silver plans cover 73, 87, or 94 percent, depending on the person’s income. That translates into much lower deductibles, copays and coinsurance. The Silver 87 plan is more generous than a regular Gold plan, and the Silver 94 plan is more generous than a Platinum plan. But the customer doesn't pay a higher premium for these plans than for the standard version of the plan. In other words, they’re a fantastic deal.

Here’s the problem. When people in the eligible income range window-shop on, the only clue they have that the special plans are available is the fine print on the initial eligibility page. It says, “This household may also be eligible for a cost-sharing reduction on a Silver plan that reduces the out-of-pocket expenses paid for deductibles, copayments, and coinsurance.”