Specialist and Primary Care Physician Office Visits

1. Specialist and Primary Care Physician Office
Visits

2. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Primary Care Physician
Visits (deductible may apply first)
1% 2%
1%
32%
10%
4%
39%
73% 83% 92%
24%
13%
10%
6%6% 3% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copay & Coinsurance
Coinsurance
Copayment
No Charge after Deductible
No Charage

3. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayments for Primary Care Physician Visits
$37
$28
$22
$19
$0
$5
$10
$15
$20
$25
$30
$35
$40
Bronze Silver Gold Platinum

4. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayments for Primary Care Physician Visits
1%
15%
20%
25%
17%
12%
28%
26%
18%
50%
45%
47%
40%
12%
4%
1%
14%
10%
3% 1%
10%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $50
>$40 - $50
>$30 - $40
>$20 - $30
>$10 - $20
$10 or less

5. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Primary Care Physician Visits
33%
26%
21% 21%
0%
5%
10%
15%
20%
25%
30%
35%
Bronze Silver Gold Platinum

6. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Primary Care Physician Visits
5%
17%
24%
42%
26%
36%
56%
26%
17%
30%
13%
16%
32%
5%
2%
18%
12%
5%
16%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over 50%
>40% - 50%
>30% - 40%
>20% - 30%
>10% - 20%
10% or less

7. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialist Physician Visits
(deductible may apply first)
34%
11%
4% 1%
33%
70% 81%
91%
30%
18%
13%
8%
3% 2% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copay & Coinsurance
Coinsurance
Copayment
No Charge after Deductible

8. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayments for Specialist Physician Visits
$65
$56
$44
$29
$0
$10
$20
$30
$40
$50
$60
$70
Bronze Silver Gold Platinum

9. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayments for Specialist Physician Visits
3%1% 2%
13%
47%
40%
47%
71%
48%
34%
45%
16%
2%
20%
5%5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $100
>$75 - $100
>$50 - $75
>$25 - $50
>$10 - $25
$10 or less

10. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Specialist Physician Visits
34%
26%
19% 19%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Bronze Silver Gold Platinum

11. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Specialist Physician Visits
5%
16%
28%
52%
25%
34%
56%
22%
18%
31%
11%
13%
31%
6%
2%
0%
20%
14%
4%
13%
1% 0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over 50%
>40% - 50%
>30% - 40%
>20% - 30%
>10% - 20%
10% or less