Total cost of coverage for members in California's marketplace.

ABSTRACT:

Introduction

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.

Method

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.

Results

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-

SUBMITTER: Kohn E 

PROVIDER: S-EPMC12322486 | biostudies-literature | 2025 Aug

REPOSITORIES: biostudies-literature