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People who buy their own individual health coverage may pay less than they would for employer plan coverage but get leaner benefits.
Analysts at the U.S. Government Accountability Office published figures supporting that conclusion in a new report comparing Affordable Care Act public exchange plans with employer plan coverage.
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People who bought their own coverage through HealthCare.gov in 2022 paid an average of $109 per month in premiums out of pocket, after taking ACA premium tax credit subsidies into account.
Workers paid an average of $150 per month for their share of the premiums for employer plan coverage.
This table shows how cost-sharing provisions for the employer plans and the individual plans compared:
| Employer Plans | Individual Plans | |
| Annual deductible for in-network care | $1,902 | $2,536 |
| Annual limit on out-of-pocket spending for in-network care | $4,715 | $2,536 |
| Copayment for a general physician office visit | $28 | $28 |
The GAO report: The GAO is an arm of Congress that helps lawmakers analyze government operations. GAO analysts compared individual coverage and employer plan coverage at the request of Rep. Virginia Foxx, chair of the House Education and the Workforce Committee.
Drawing firm conclusions from the report about differences between individual coverage and employer plan coverage is difficult because many different sources of error could have skewed the data used, John Dicken, the GAO's health care director, wrote in a summary of the GAO team's findings.
The backdrop: President Barack Obama signed the two bills that created the Affordable Care Act into law in 2010.
The ACA drafters tried to strengthen the commercial health insurance market by creating "public health insurance exchange programs," or web-based health insurance shopping malls
Before 2014, when ACA health insurance underwriting and pricing rules took effect, federal law let health insurers reject applications from people who had cancer or were obese. Insurers could charge more for coverage when they did accept applicants with health problems.
Consumers can now buy individual and family coverage without worrying about whether their health will affect their ability to buy the coverage or how much their health will affect the premiums.
Employers are using a new type of health account, the individual coverage health reimbursement arrangement (ICHRA), to provide cash that workers can use to buy their own exchange plan coverage.
Some health policy specialists, including Theo Merkel, an analyst at Paragon Health, have argued that one obstacle to the spread of ICHRAs is the skimpiness of exchange plan benefits and provider networks.
Related: Small employers need better ICHRA options, Senate Finance hearing witness
Andrew Slavitt, the former acting administrator of the Centers for Medicare and Medicaid Services, that agency that oversees HealthCare.gov, told health insurance company executives at a conference in 2016 that he believed exchange plan buyers strongly preferred paying less for coverage to getting richer benefits.
Metal levels: Under ACA rules, carriers in the individual market sell plans with standardized benefits richness levels.
- Bronze plans cover only about 60% of the actuarial value of a standardized health benefits package
- Silver plans pay about 70% of the actuarial value of the standard benefits package
- Gold plans pay about 80% of the actuarial value
The GAO report shows how coverage parameters differ for plans at different metal levels as well as how employers plans differ from exchange plans.
For the enrollee's share of the premiums, for example, the average cost was $125 for bronze plans, $77 for silver plans and $276 for gold plans.
The average for silver plans was low because of the effects of the ACA premium tax credit subsidy program on what buyers of silver plans pay out of pocket for their coverage.
For 2022 deductibles for in-network care, the average was $2,536 for bronze plans, $4,439 for silver plans with no extra subsidies and $1,411 for gold plans.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
