Simulating Variation in Families' Spending across Marketplace Plans

Health Serv Res. 2018 Aug;53(4):2285-2302. doi: 10.1111/1475-6773.12831. Epub 2018 Feb 14.


Objective: To examine variations in premium and cost-sharing across marketplace plans available to eligible families.

Data sources: 2011-2012 Medical Expenditure Panel Survey (MEPS), 2014 health plan data from, and the 2011 Medicare Part D public formulary file.

Study design: We identified a nationally representative cohort of individuals in the MEPS who would have been eligible for marketplace coverage. For each family, we simulated the total out-of-pocket payment (premium plus cost-sharing) under each available plan in their county of residence, assuming their premarketplace use.

Data collection/extraction methods: Confidential state and county of residence identifiers were merged onto MEPS public use files and used to match MEPS families to the plans available in their county as reported in the publicly available data from

Principal findings: We found substantial variation in total family health care spending, especially premium component, across marketplace plans. This is true even within a plan tier of the same minimum actuarial value, and for families eligible for subsidies. Variation among families with income below 250 percent of the FPL is larger than variation among families with higher income.

Conclusions: Our simulations show substantial variations in net premium and out-of-pocket payments across marketplace plans, even within a plan tier.

Keywords: Health insurance exchanges; health insurance marketplace; simulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cost Sharing*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Insurance Exchanges*
  • Health Services Accessibility
  • Humans
  • Income / statistics & numerical data
  • Insurance Coverage / statistics & numerical data*
  • Male
  • Medicare
  • Middle Aged
  • Patient Protection and Affordable Care Act
  • United States
  • Young Adult