Kohn Emily, Wolf Emory, Menashe Isaac, Ravel Katie
Covered California, Sacramento, CA, United States.
Health Aff Sch. 2025 Jul 9;3(8):qxaf135. doi: 10.1093/haschl/qxaf135. eCollection 2025 Aug.
Discussions of coverage affordability within the Affordable Care Act (ACA) marketplaces generally focus on premium costs. However, the total cost of coverage includes out-of-pocket expenses such as copays and deductibles.
Using claims and enrollment data from Covered California, California's ACA marketplace, we document the total cost of coverage for households enrolled in full-year subsidized marketplace coverage as a percent of household income in 2019 and 2022.
In 2022, the average total cost of coverage for households below 400% of the federal poverty line was $2,519, representing 6.6% of household income. In 2019, the average cost of coverage for this population was 8.7%. The decrease was driven by decreases in net premiums, as out-of-pocket costs remained relatively unchanged. We also show that the total cost of coverage as a percent of household income is progressively distributed and varies substantially by plan metal tier.
Overall, our findings indicate that income-adjusted affordability measures established by the ACA have reduced financial burdens for many consumers.
《平价医疗法案》（ACA）市场中关于保险覆盖可负担性的讨论通常聚焦于保费成本。然而，保险覆盖的总成本包括自付费用，如共付额和免赔额。
利用加利福尼亚州ACA市场“Covered California”的理赔和参保数据，我们记录了2019年和2022年全年参加补贴性市场保险的家庭的保险覆盖总成本占家庭收入的百分比。
2022年，联邦贫困线400%以下家庭的平均保险覆盖总成本为2519美元，占家庭收入的6.6%。2019年，这一人群的平均保险成本为8.7%。下降是由净保费下降推动的，因为自付费用相对保持不变。我们还表明，保险覆盖总成本占家庭收入的百分比呈累进分布，并且因保险计划金属层级的不同而有很大差异。
总体而言，我们的研究结果表明，ACA制定的收入调整后的可负担性措施减轻了许多消费者的经济负担。
