Duke University Margolis Center for Health Policy, Durham, North Carolina.
RAND Corporation, Santa Monica, California.
JAMA Health Forum. 2021 Jul 16;2(7):e211642. doi: 10.1001/jamahealthforum.2021.1642. eCollection 2021 Jul.
The American Rescue Plan increases premium subsidies for health insurance marketplace enrollees, potentially leading to situations in which enrollees could switch to other health care plans with lower premiums and less cost sharing (ie, deductibles and copayments). Current policy defaults enrollees to their current health care plan if they automatically renew their coverage, which may cause them to stay in health care plans that, because of the American Rescue Plan, are now dominated in that they have higher premiums and cost sharing than other options.
To estimate the extent to which a smart default policy could reduce US health insurance marketplace enrollees' cost sharing and premiums.
Using 2018 individual enrollment data and 2021 premium data from California's marketplace and the American Rescue Plan premium tax credit subsidy schedule, this economic analysis estimated the characteristics of enrollees' default health care plans if they defaulted into 2021 health care plans under current and smart default policies. The analysis was conducted from March 20 to April 8, 2021.
Characteristics of enrollees' default health care plans under current and smart default policies, including net premiums, plan levels, and cost sharing.
The analytic sample consisted of 748 087 Covered California enrollees from 2018 (mean [SD] age, 44.80 [13.72] years; 408 410 [54.6%] women). Under current policy with the enhanced subsidies implemented under the American Rescue Plan, 5.8% of sample enrollees would default into dominated health plans. Of these enrollees, 98.0% would have incomes below 250% of the federal poverty level. A smart default policy would lead to a mean $102.47 decrease in monthly premiums (95% CI, $103.84-$101.10), a mean $1960 reduction in individual annual medical deductibles (95% CI, $1991-$1928), and a $49.56 reduction in specialty prescription copays (95% CI, $49.77-$49.34).
The findings of this economic analysis suggest that a smart default policy could avoid defaulting lower-income marketplace enrollees to objectively inferior health care insurance plans and may lead to large reductions in lower-income enrollees' deductibles, copayments, and maximum out-of-pocket amounts. Implementation of a smart default policy could enable marketplace administrators to reduce the prevalence of underinsurance among lower-income marketplace enrollees.
美国救援计划增加了医疗保险市场参保者的保费补贴，这可能导致参保者转而选择保费较低、成本分担（即免赔额和共付额）较少的其他医疗保险计划。现行政策规定，如果参保者自动续保，他们将默认选择当前的医疗保险计划，这可能导致他们继续留在医疗保险计划中，而这些计划由于美国救援计划的实施，保费和成本分担比其他选择更高。
评估智能默认政策如何降低美国医疗保险市场参保者的自付费用和保费。
设计、设定和参与者：本经济分析使用了 2018 年个人参保数据和 2021 年加州市场和美国救援计划保费税收抵免补贴计划的保费数据，估计了如果参保者按照现行和智能默认政策默认选择 2021 年医疗保险计划，他们的默认医疗保险计划的参保者特征。分析于 2021 年 3 月 20 日至 4 月 8 日进行。
现行和智能默认政策下参保者默认医疗保险计划的特征，包括净保费、计划级别和成本分担。
分析样本包括 2018 年 748087 名加州参保者（平均[标准差]年龄为 44.80[13.72]岁；408410[54.6%]为女性）。在实施了美国救援计划增强补贴的现行政策下，5.8%的样本参保者将默认选择主导型医疗保险计划。其中，98.0%的参保者收入低于联邦贫困线的 250%。智能默认政策将导致每月保费降低 102.47 美元（95%置信区间，103.84-101.10 美元），个人年度医疗保险免赔额降低 1960 美元（95%置信区间，1991-1928 美元），专科处方共付额降低 49.56 美元（95%置信区间，49.77-49.34 美元）。
这项经济分析的结果表明，智能默认政策可以避免将收入较低的市场参保者默认选择客观上较差的医疗保险计划，并可能大幅降低低收入参保者的免赔额、共同支付额和最高自付额。实施智能默认政策可以使市场管理机构能够降低低收入市场参保者保险不足的发生率。
