JAMA: Marketplace versus Medicaid Utilization and Costs for Low-Income Adults: 5 Things to Know

  1. Mean number of emergency department visits: 0.26 for those with Marketplace coverage versus 0.36 for those with Medicaid coverage
  2. Mean number of office (outpatient) visits: 2.22 for those with Marketplace coverage versus 1.73 for those with Medicaid coverage
  3. Difference in the mean number of ambulatory care–sensitive hospitalizations was insignificant: 0.004 for Marketplace coverage vs. 0.007 for Medicaid coverage
  4. Mean total costs: 83% higher for those with Marketplace coverage compared to those with Medicaid coverage ($4553 vs. $2484)
  5. Mean out-of-pocket costs: over 10 times higher for those with Marketplace coverage than those with Medicaid coverage ($569 vs. $45)
Notes: From an article entitled, "Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults" by Heidi Allen, PhD, MSW; Sarah H. Gordon, PhD, MS; Dennis Lee, BA; et. al. Participants included 8,182 low-income adults enrolled in Medicaid or Marketplace coverage during the 2014 to 2015 period, with incomes between 134% and 143% of the Federal Poverty Level.

Source: JAMA Network, January 6, 2021 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774583

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