Copayments and Coinsurance Rise Under the ACA

Medical Records & StethoscopeCopayments and co-insurance fees for drugs in the individual insurance market increased 34% compared to before the Affordable Care Act (ACA). All of the four metal health plan categories under the ACA had drug cost-sharing increases. Bronze health insurance plans had the highest increase at 58% while Platinum health insurance plans had the lowest increase at 15%.

Plan enrollees who use brand name drugs and specialty drugs face the greatest burden from the increases in copayments and co-insurance fees while enrollees who use medications infrequently are not likely to notice the cost-sharing increases.

The 34% increase in copayments and co-insurance fees does not mean that consumers will spend 34% more on drugs. Drug spending is also affected by deductible amounts, out-of-pocket caps, and what drugs are included within a health plan’s list of covered medications.

Before the Affordable Care Act, nearly one-out-of-five private individual health insurance plans had no prescription drug coverage while all new health plans in the individual market include a drug benefit. In addition, patients can get over-the-counter drugs, such as aspirin, folic acid, and iron supplements, with no out-of-pocket cost when used as preventive medicine.

“With copayments and co-insurance fees rising, consumers must shop health plans more carefully. Copayments, deductible amounts, and limits on annual drug spending should not be ignored. Consumers can also discuss with their doctors whether there are alternative drugs that have lower costs but equivalent therapeutic results,” said Kev Coleman, Head of Research & Data at HealthPocket. For more information, visit

Last Updated 08/10/2022

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul