Pending Changes to Marketplace Plans Could Increase Cost Sharing for Consumers

(By Matthew Rae, Justin Lo, Matt McGough, and Cynthia Cox for The Kaiser Family Foundation Published: Jun 23, 2025)

Changes to Marketplace plans recently finalized by the Centers for Medicare and Medicaid Services (CMS) may incentivize insurers to make their plans less generous. With less generous plans, consumers could face higher out-of-pocket costs. However, these changes could also lower premiums for those who don’t qualify for premium assistance (roughly 8% of Marketplace enrollees). Plans sold on the Affordable Care Act (ACA) Marketplaces and sold in the small group market are grouped into metal tiers—bronze, silver, gold, and platinum—based on their actuarial value (AV), or the average share of health care costs the plan covers for a standard population. Bronze plans require the highest cost sharing, paying only 60% of expected costs, followed by silver plans (70%), gold plans (80%), and platinum plans (90%). “Expanded” bronze plans have a somewhat higher actuarial value and are required to cover some services before the deductible is met. Continue reading here…

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