Trends in Deductibles Among Affordable Care Act Marketplace Plans

Updated 2/17/2023: This article has been updated to reflect a correction to the original data. The previous version of this article said that 26 percent of ACA plans had deductibles between $4,501 to $6,000 and the same share amounted to $6,001 to $7,500. The KFF data was corrected and this article now reflects that each share should be 21 percent. Minor adjustments were also made in accordance with the graph updatees.

Affordable Care Act marketplace deductibles became more expensive in 2023 when compared to the previous year, according to an annual analysis from Kaiser Family Foundation (KFF).

The researchers downloaded data for the four metal tiers from Healthcare.gov and used simple averages and distributions without weighting the results for enrollment.

All of the metal tiers primarily included plans that combined the prescription drug deductible and medical deductible. Bronze plans—which included expanded bronze plans in this analysis—were the most likely to combine deductibles in 2023. Ten percent of the bronze plans kept the medical and prescription drug deductibles separate. Platinum plans were the most likely to separate the deductibles (31 percent).

In plans that combined the prescription drug and medical deductibles, bronze plans had the highest average deductible amount ($7,481), followed by silver plans ($4,890) and gold plans ($1,650). The plans with the lowest average combined deductible amount were the platinum plans, with an average deductible of $45.

Among the minority of plans that separated medical and prescription drug deductibles in 2023, silver plans had the highest average deductible amounts ($3,191). These were followed distantly by gold and bronze plans, with average deductibles of $1,462 and $1,373 respectively.

The researchers found that, overall, medical deductibles were higher in 2023 than in 2022. Whereas 65 percent of bronze deductibles amounted to $6,001 or higher in 2022, 78 percent of plans fell in this range the following year.

In 2022, 12 percent of average bronze plan medical deductibles fell between $1 and $4,500, but in 2023 only three percent of plans’ deductibles fell in this bracket. Additionally, in 2022, bronze plans were slightly more likely to have a zero-dollar deductible (10 percent) than in 2023 (8 percent).

While the average medical deductible for silver plans declined slightly across most cost brackets, it shot up significantly in the range of $4,501 to $6,000. In 2022, less than 30 percent of bronze plans had an average medical deductible in this range. While it was still the most common deductible amount, it paled compared to the following year in which 45 percent of bronze plan medical deductibles fell in this bracket.

Across all Affordable Care Act marketplace plans, medical deductibles tended to be higher in 2023 than in 2022. Fewer health plans had deductibles between $1 and $1,500 or $3,001 and $4,500.

Significantly more plans had deductibles amounting to $4,501 or more in 2023: 21 percent cost between $4,501 and $6,000, another 21 percent amounted to $6,001 and $7,500, and 20 percent were $7,501 or more. The previous year, none of these brackets contained more than 20 percent of Affordable Care Act marketplace plans.

Individuals with lower incomes had access to silver plans with significantly reduced combined medical and prescription drug deductibles in 2023.

For individuals with incomes between 100 percent and 200 percent of the federal poverty level, a plan in which the government covered 94 percent of the population costs—a cost-sharing reduction worth 94 percent of the actuarial value—the average combined medical and prescription drug deductible cost $97.

Individuals in silver plans with no cost-sharing reductions whose incomes amounted to 250 percent of the federal poverty level or more faced an average combined deductible of $4,890.

Average medical deductibles in plans that separated medical and prescription drug deductibles were slightly lower for higher-income brackets and slightly higher for low-income brackets.

For individuals with cost-sharing reductions of 94 percent of the actuarial value and incomes between 100 and 150 percent of the federal poverty level, the average separated medical and prescription deductible cost $108. For those with incomes over 250 percent of the federal poverty level in silver plans with no cost-sharing reductions and separated medical and prescription drug deductibles, the average deductible cost $3,191.

The average out-of-pocket healthcare spending limit for silver plan enrollees with the highest incomes was more than six times the average out-of-pocket healthcare spending limit for silver plan enrollees at the opposite end of the wealth spectrum.

The Affordable Care Act marketplace is not the only area of the health insurance industry to see a boost in cost-sharing. Separate research indicated that between 2013 and 2020 employee-only deductibles rose by 13 percent and real deductibles for family coverage rose by 10 percent in employer-sponsored health plans.

Americans hold deductibles responsible for the high out-of-pocket healthcare spending. Almost 40 percent of respondents to a PhRMA survey reported that deductibles formed their primary out-of-pocket healthcare spending barrier.