New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV

February 5, 2016

A new Kaiser Family Foundation analysis finds that people living with HIV could benefit from looking beyond premium costs when shopping for a health plan in the marketplace – as plans with the lowest premiums are often not the most cost-effective option. People with HIV can find lower cost plans by conducting a more comprehensive cost assessment that includes other factors such as deductibles, drug costs, and out-of-pocket maximums.
The analysis explores 300 possible enrollment scenarios for five plans in five states that together account for about 50 percent of the national HIV epidemic. 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.

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