Take Two Aspirin: An Examination of Physician Visit Cost Sharing and Benefit Design in the New Health Insurance Marketplaces

To better understand the nature of coverage available to consumers through the Exchanges, Breakaway Policy Strategies partnered with the Robert Wood Johnson Foundation to collect detailed information on premiums, network composition, deductibles, out-of-pocket limits, and cost-sharing for every 2014 Silver Exchange plan in all 50 states and the District of Columbia. This report takes a closer look at cost-sharing for primary care physician (PCP) and specialist visits, including application of plan deductibles, copayment and coinsurance amounts, and the unique plan design features that may lead some enrollees to think twice before scheduling their next appointment with a doctor.