LAUSR

Key Points Question What are enrollee risk scores and health spending by metal tier (bronze, silver, gold, platinum) in the Patient Protection and Affordable Care Act individual marketplace? Findings In this cross-sectional study including 1.3 million enrollees, large variation in health spending and out-of-pocket costs by metal tier were observed. Individual risk was associated with enrollment in plans with higher actuarial value; however, many enrollees in low-value plans were classified as high risk and faced substantial out-of-pocket costs. Meaning The findings of this cross-sectional study suggest metal tier is associated with both enrollee risk and future health spending, which may reflect variation in benefit generosity, enrollee’s perceptions of future health needs, or access barriers.