The Affordable Care Act’s expansion of access to preventive services without copayments reduced out-of-pocket costs while the eliminations of annual and lifetime maximums provided financial protection to those with the highest medical costs. In California, the maximum out-of-pocket cost for metal-tiered plans is $8,550 for individuals and $17,100 for families in 2023. Gold, Platinum, and Silver 94 plans have zero pharmacy deductibles and medical deductibles are absent from the Gold and Platinum plans.
"Current health insurance incentives make it so that there's never been a better time to be an entrepreneur." - Shawn Shahpari
"People who are offered employer-sponsored plans are mostly ineligible to receive assistance when purchasing health insurance through the state exchange market", says Shawn Shahpari, an 8-year veteran of the health insurance industry and an agency manager with Covered California. "The only way someone with a job can receive assistance when purchasing insurance through the state exchange is if one of two conditions are met: either the employer’s plan does not meet the federal minimum value requirement standards (coverage offered pays at least 60%of the total allowed cost of the benefit it provides), or it doesn't meet the affordability requirement which states premiums greater than 9.83% of household income." These requirements apply even if the employee is not enrolled in that particular plan. "Current health insurance incentives make it so that there's never been a better time to be an entrepreneur."
Further, the study found that between 1996 and 2006, out-of-pocket spending increased significantly for most Americans even after adjusting for inflation. Since 2006, however, out of pocket spending has diverged and rapidly decreased. Since 2001, high-income households have experienced a 70% increase in their annual out of pocket spending, while lowest income households’ out-of-pocket spending has halved.
