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Health Insurance Cost Sharing

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Much of what we know about the effects of cost sharing derives from the landmark RAND Health Insurance Experiment of the 1970s, which examined consumer use of care across numerous levels of cost sharing. More recent RAND research in this area has explored consumer-directed health plans, which aim to reduce spending by giving consumers options but also making them more financially invested in their care.

Testimony
Health Care Price Transparency: Opportunities to Improve Affordability and Data Effectiveness
Significant progress has been made to increase the transparency of health care prices at the federal and state levels, but much more needs to be done to leverage price transparency data. Enabling broader use of these data can help address price variation and health care spending.
May 16, 2023
Research Brief
Increasing Subsidies and Expanding Health Insurance Options in Connecticut: Findings Without the Build Back Better Act
Researchers examined policy options for increasing the affordability of insurance in Connecticut once subsidies under the American Rescue Plan end.
Mar 31, 2022

Explore Health Insurance Cost Sharing

Commentary
The Importance of Getting the Affordable Part of the Affordable Care Act Right
The ACA's expansion of Medicaid and the marketplaces that sell subsidized policies have helped decrease the uninsured rate. Research on being underinsured shows that affordability at the point of care is central to keeping people healthy. For example, a new study found a significant relationship between having health insurance and better asthma control.
Jun 17, 2022
Report
Expanding Connecticut State Employee Health Plan to Others Could Increase Insurance Coverage More Than Other Options
Creating a version of the Connecticut state employee health plan for small businesses would insure the most people at the lowest cost to the state. This approach holds promise for stabilizing or reducing consumer costs, improving plan generosity, and bringing more people into the market.
Mar 31, 2022
News Release
Expanding State Employee Health Plan to Others May Do More Than Other Options to Expand Insurance Coverage in ...
Among options to increase health insurance coverage in Connecticut, making a version of the state's employee health plan available to small businesses and some other employers would insure the most people at the lowest cost to the state.
Mar 31, 2022
Journal Article
Tiered Cost-Sharing for Primary Care Gatekeeper Clinics
We analyze data from a long-standing tiered cost-sharing system for primary care gatekeeper clinics. We find that when choosing a primary care clinic, consumers are responsive to the clinic's tier.
Sep 9, 2021
News Release
Republicans May Be Less Likely to Make Use of Federal Subsidies When Buying Individual Health Insurance Policies
Republicans who buy individual health plans may be less likely to shop through marketplaces created under the federal Affordable Care Act, leading them to forgo subsidies provided by the federal government.
Sep 8, 2021
Commentary
How Insurance Marketplace Regulators Can Help Consumers Enroll in Better Coverage
The Affordable Care Act simplified shopping for health care by creating the individual health insurance marketplaces where plans are categorized into labeled tiers. Consumers rely on these labels when comparing plans. But the labels don't tell consumers everything they need to know.
Aug 2, 2021
Dissertation
Three Essays In Health Policy and Economics: Surprise Out-of-Network Medical Bills and Out-of-Network Health Care Provider Payment in the United States
Three essays addressing surprise out-of-network medical bills and out-of-network health care provider payment.
Jul 16, 2020
Report
The Effects of Limiting Payments to Hospitals for Out-of-Network Care
There is growing interest among U.S. policymakers to use out-of-network payment limits to curb surprise medical bills and as a tool to control rising health care costs. How might such limits affect negotiated in-network prices and total payments for hospital care?
Mar 12, 2020
News Release
Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options
Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps. Because such an approach has the possibility to sharply cut hospital revenues, any cap would need to be set carefully as to not overly disrupt hospital operations.
Mar 12, 2020
Brochure
Effecting Change, Improving Health
The RAND Corporation is dedicated to transforming the wellbeing of all people by improving health care systems in the United States and abroad.
Feb 7, 2020
Report
Medicare for 50-to-64-Year-Olds
Allowing Americans aged 50 to 64 to buy into Medicare would lower health care premiums for the group. But it would also drive up costs for younger people who buy health insurance on Affordable Care Act exchanges.
Nov 18, 2019
News Release
Opening Medicare to Americans Aged 50 to 64 Would Cut Their Insurance Costs, but Drive Up Insurance Prices for Younger ...
Opening Medicare to Americans aged 50 to 64 would lower health care premiums for the group, but also drive up costs for younger people who buy health insurance on exchanges created under the federal Affordable Care Act.
Nov 18, 2019
Report
Options for Reinvesting Savings from Restored Federal Cost-Sharing Reduction Payments: Examining the Effects of Two Policy Alternatives on Spending and Enrollment in the Individual Health Insurance Market
The authors of this report examine the impact of providing additional health insurance subsidies or financing reinsurance from the savings resulting from restored federal cost-sharing reduction payments to insurers under the Affordable Care Act.
Sep 10, 2019
Report
Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading
In this report, the authors assess the effects of disallowing the current practice of increasing only the premiums of silver-tiered individual market plans in response to discontinued federal payments of cost-sharing reductions (silver loading).
Jun 3, 2019
Commentary
Addressing Surprise Medical Bills Without Raising the Cost of Health Care
Patients who try to stay within their insurers' networks can be hit with surprise bills when they unknowingly receive care from out-of-network physicians. How much should a physician be paid for providing a service that is critical but rendered without the patient's ready ability to choose an in-network provider?
Apr 1, 2019
Multimedia
The Potential Impacts of Single-Payer Health Care
Controlling costs while improving health care access dominates policy debates in Congress. In this Congressional Briefing, Jodi Liu discusses what policymakers need to know about
Jan 23, 2019
Commentary
Medicare for All: Sounds Good, but What Does It Mean?
Traditional Medicare is popular and therefore can lend a good brand name to coverage expansion proposals, but its limits can be significant for some patients. Those proposing and evaluating “Medicare for All” proposals should consider whether and how these limits are addressed.
Nov 19, 2018
Commentary
Misconceptions About 'Medicare for All'
Medicare for All is a talking point for both major U.S. political parties. Would it be free? Would people have to switch doctors? Would waits be long? Misconceptions abound about single-payer proposals and their likely effects. Here are the facts.
Oct 26, 2018

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Researcher Spotlight

Erin Audrey Taylor

Senior Policy Researcher

Erin Taylor (she/her) is a senior policy researcher at the RAND Corporation. Her research addresses a broad range of health care insurance, prescription drug, and care quality issues, including the impact of insurance benefit design on use of opioids and specialty drugs. Taylor is currently…
Christine Buttorff

Policy Researcher

Christine Buttorff (she/her) is a policy researcher at the RAND Corporation. Her primary research interests are in health insurance benefit design and prescription drug policy. She uses both qualitative and quantitative methods for the evaluation of policy interventions.

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