How Would Adjusting the Marketplace Coverage Benchmark to a Gold Plan Affect Affordability?

Changing the Affordable Care Act benchmark plan — which is used to calculate premium subsidies — from silver to gold could lower the national median deductible and annual median out-of-pocket maximum for individual coverage, according to a recent analysis by The Commonwealth Fund.

The bill S.499, introduced by Sen. Jeanne Shaheen (D–N.H.), would set the second-lowest-cost gold plan as the benchmark plan going forward. That would have the biggest impact on people who receive minimal or no cost-sharing reductions. Based on 2022 marketplace data, the median deductible in gold plans was $1,450 — three times less than traditional silver plans with no cost-sharing reductions. Moving the benchmark to gold could also lower the median out-of-pocket maximum to $7,500.

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Jinghong Chen

Jinghong Chen Reporter

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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