Access and Affordability in Low- to Middle-Income Individuals Insured Through Health Insurance Exchange Plans: Analysis of Statewide Data

Abstract

Individuals in states that expanded Medicaid eligibility under the Affordable Care Act are Medicaid-eligible if their income is < 138% of the federal poverty level (FPL). Above this threshold, those with incomes up to 400% FPL purchasing individual coverage on Health Insurance Exchanges (HIEs) may receive sliding-scale subsidies to offset premium costs. In addition, those with incomes up to 250% FPL who select benchmark Bsilver^ HIE plans receive sliding-scale subsidies which offset out-of-pocket (OOP) expenses. We compared measures of access and affordability between Medicaid recipients in Ohio (an expansion state) and low/middle-income Ohioans whose incomes qualified them for HIE cost sharing subsidies.