The Affordable Care Act (ACA) aims to make private health insurance affordable for low-income individuals, but those with incomes above 250 percent of the federal poverty level (FPL) face limited cost-sharing protections. While Marketplace plans achieve premiums 15 to 23 percent lower than employer-sponsored insurance, they often do so through high cost-sharing requirements. Our goal in this brief was to analyze deductibles and out-of-pocket maximums in plans offered by insurers and evaluate a proposed reform designed to enhance coverage affordability.

Silver plan deductibles typically exceed $5,000, while bronze plans approach $7,500—representing up to 21 percent of annual income for those at 250 percent of FPL. Out-of-pocket maximums are generally above $9,000 at both metal tiers. While higher-premium options offer lower deductibles, they often include substantial prescription drug deductibles. A proposed ACA reform would shift the benchmark plan from silver to gold coverage and expand cost-sharing subsidies, reducing out-of-pocket spending by an average of 24 percent at an estimated annual federal cost of $15 billion.

We examined plan features in silver and bronze plans, comparing the lowest and highest premium options from representative insurers. We analyzed deductibles and out-of-pocket maximums and estimated reform impacts using the Health Insurance Policy Simulation Model.