eHealth Analysis: Qualified Health Plan Variations Create Opportunities for Savvy Obamacare Enrollees

eHealth’s analysis finds only 25% of plans cover Rx drugs before medical deductibles are met; HMOs now make up 60% of plans sold on exchange

MOUNTAIN VIEW, Calif.--Dec. 12, 2016-- Today eHealth, Inc. (NASDAQ: EHTH) (, the nation’s first and largest private online health insurance exchange, published an analysis of 2017 Qualified Health Plans (QHPs) available for enrollment using a government subsidy (premium tax credit).

eHealth’s analysis found substantial changes in the plans available in 2017 compared to those available in 2016, as well as notable variations in cost-sharing for prescription drugs.

Depending on which plans they enroll in, consumers could save a significant amount of money in out-of-pocket costs by carefully selecting plans that cover their prescription drugs and using doctors that are part of their health plan’s preferred provider network.

Highlights of eHealth’s analysis include the following:

  • 30% decrease in PPO plans, 39% decrease in POS plans, 10% decrease in HMO plans, and 19% decrease in EPO plans – The total number of QHPs available for consumers to choose from decreased 19% in 2017, with the largest decreases coming in the number of available PPO (Preferred Provider Organization) and POS (Point Of Service) plan options.
  • 75% of plans only cover prescription drugs after medical deductibles are met – QHPs without separate prescription drug deductibles typically do not cover branded prescription drugs until the medical deductible has been satisfied, though many cover generic drugs and some branded drugs with a co-payment.

“There may be fewer Qualified Health Plans to choose from, but the decision is as complex as ever if you want to save money and get the coverage you need,” said Tom Tsao, eHealth’s President, Small Business, Individual & Family Products. “Excellent decision support tools, like those we offer at, and support from licensed health insurance agents, can make all the difference when it comes to picking the right plan.”

Qualified Health Plans by metal level (Catastrophic, Bronze, Silver, Gold, and Platinum)

Overall, the total number of QHPs available declined 19% in 2017. The number of catastrophic-level health plans (available primarily to those under age 30) decreased by 15%, while all other metal levels declined as well. The largest decline was in the number of platinum plans, which decreased by 63%.

Metal level       2016       2017       2016-2017
        plans       plans       change
Bronze       1,185       996       -16%
Catastrophic       268       229       -15%
Gold       851       530       -38%
Platinum       139       51       -63%
Silver       1,427       1,320       -7%
All metals       3,870       3,126       -19%

Health plans by type (HMO, PPO, EPO and POS)

From 2016 to 2017, the number of QHP PPO plans and POS plans declined 30% and 39%, respectively. The number of HMO plans and EPO plans also declined. The number of HMO plans available fell by 10% while the number of EPO plans fell by 19%.


HMO & PPO Plan Count Data

HMO       2016       2017      


      PPO plans       2016       2017      


plans       HMO       HMO      


              PPO       PPO      


        plans       plans      


              plans       plans      


Bronze       638       591      


      Bronze       308       242       -21%
Catastrophic       149       125       -16%       Catastrophic       72       66      


Gold       465       332       -29%       Gold       231       127       -45%
Platinum       84       28       -67%       Platinum       26       6      


Silver       735       792       +8%       Silver       385       275       -29%
All metals       2,071       1,868       -10%       All metals       1,022       716       -30%

POS & EPO Plan Count Data

POS       2016       2017      


      EPO plans       2016       2017      


plans       POS       POS      


              EPO       EPO      


        plans       plans      


              plans       plans      


Bronze       146       81       -45%       Bronze       93       82       -12%
Catastrophic       32       27       -16%       Catastrophic       15       11       -27%
Gold       85       29       -66%       Gold       70       42       -40%
Platinum       19       9       -53%       Platinum       10       8       -20%
Silver       154       120       -22%       Silver       153       133       -13%
All metals       436       266       -39%       All metals      





Health plans with separate prescription drug deductibles by metal level

The number of QHPs that offer a separate (and typically smaller) deductible for prescription drugs declined in 2017. In 2016, one-in-three plans (33%) covered prescription drugs before the medical deductible was met. In 2017, the number of plans that cover prescriptions before the medical deductible fell to one-in-four (25%).

Without a separate prescription drug deductible, consumers are typically required to meet their entire medical deductible before their health plan covers the cost of prescription drugs, though tier-one generic medications are often covered with a copay before any deductible is paid.


Metal Level       2016 plans       2017 plans      


        without a separate       without      


        Rx deductible       a separate Rx      




Bronze       91%       90%       -1%
Catastrophic       100%       100%       0%
Gold       43%       54%       +11%
Platinum       20%       41%       +21%
Silver       57%       69%       +12%
All metals       66%       75%       +9%

Research Methodology

  • Health plans by metal level and by type (HMO, PPO, EPO, and POS): In order to assess year-over-year changes the number of plans of each plan type at various metal levels, eHealth analyzed information on Qualified Health Plans (QHPs) using government-published landscape files for plan years 2016 and 2017 which are available online at:
  • Health plans with separate prescription drug deductibles by metal level: eHealth analyzed information on QHPs using government-published landscape files for plan years 2016 and 2017 to determine how many plans included a separate deductible for prescription drugs and the average deductible for plans at various metal levels.
  • Plan details may vary: The details of individual QHPs, such as how deductibles are calculated and applied, may vary by each individual QHP. For purposes of this analysis, certain assumptions were made about how deductibles and other plan details typically work. Such assumptions may not accurately reflect each QHP’s actual plan details.


eHealth, Inc. (NASDAQ: EHTH) owns, the nation's first and largest private online health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealth offers thousands of individual, family and small business health plans underwritten by many of the nation's leading health insurance companies. eHealth (through its subsidiaries) is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth also offers educational resources and powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online through (, ( and (

For more health insurance news and information, visit eHealth's Consumer Resource Center.


Source: eHealth, Inc.

DMA Communications for eHealth, Inc.
Sande Drew, 916-207-7674
eHealth, Inc.
Nate Purpura, 650-210-3115