Monthly caps as a matter of affordability and equity

While the United States celebrates a record-low uninsured rate (8.3%) due to pandemic-related policies, a lurking issue remains: nearly 25% of working-age adults remain underinsured.

As part of a series with Health Affairs, Paul Shafer, David M. Anderson, Michal Horný, and Stacie B. Dusetzina discuss the potential impact of switching from annual to monthly cost sharing caps on insurance affordability. Monthly caps take what have historically been annual limits, like deductibles and out-of-pocket maximums, and turn it into a single, more manageable amount that represents the maximum that enrollees would be responsible for out-of-pocket each month.

From the piece:

“Monthly caps are a simple and intuitive way to internalize that annual cost-sharing limits have become decoupled from what most Americans can afford, not serving as an incentive to shop for care but instead as a significant barrier to use of any care. Whether a person has a one-time event—such as a car accident—or chronic needs, monthly caps may reduce the financial strain associated with receiving care as well as help those who need to switch plans mid-year…”

Read the whole piece for details here!

Research for this piece was supported by Arnold Ventures.

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