Affordability and Access Challenges Among Subscribers to Non-Group Insurance Plans


Boston, MA – The Affordable Care Act (ACA) has expanded access to non-group health insurance through the creation of insurance marketplaces that include subsidies and decision support, but challenges remain.

A new study by researchers at the Harvard Pilgrim Health Care Institute examines families’ cost-related experiences with non-group health insurance plans purchased in or out of the market. The results were published in the JAMA Health Forum on February 18, 2022.

“We conducted this survey to assess the cost-related experiences of families in non-group plans that were purchased on or off the market,” said lead author Alison Galbraith, associate professor of population medicine at Harvard Medical. School and at Harvard Pilgrim Health. Institute of care. “Our results showed that despite the drop in out-of-pocket spending among grant-eligible Marketplace enrollees, negative cost-related experiences persist.”

The study population, drawn from a single insurer, included more than 1,200 enrollees who had purchased non-group health insurance in or out of ACA markets in Massachusetts, Maine, and New Hampshire. Study results showed that affordability issues were common among out-of-group enrollees. For low-income families eligible for subsidies, enrollment in Marketplace plans was associated with a lower risk of high out-of-pocket and high total expenses compared to non-Marketplace enrollment, although delayed or abandoned care due to cost and financial burden were not. to differ. Using brokers or browsers was associated with a lower likelihood of high payouts, but otherwise experiences were no better with decision support.

Regarding possible next steps, Dr. Galbraith adds: “Our findings suggest that building on the ACA’s coverage gains by expanding eligibility and grant size could address the remaining affordability issues facing the ACA. registrants and families outside the group are confronted”.

About the Harvard Pilgrim Health Care Institute Department of Population Medicine

The Harvard Pilgrim Health Care Institute Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Point32Health is the parent company of Harvard Pilgrim Health Care and Tufts Health Plan. Established in 1992, it is the first medical school department in the United States based on a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems and public health agencies. .

Galbraith AA, Hero JO, Peltz A, Kingsdale J, Gruver RS, Sinaiko AD. Affordability and access challenges among US subscribers of non-group insurance plans. JAMA Health Forum. 2022;3(2):e215141. doi:10.1001/jamahealthforum.2021.5141

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