Monthly out-of-pocket caps substantially increase actuarial value for high-deductible health plans: a simulation study
David M Anderson, Paul R Shafer · 2026
Read Monthly out-of-pocket caps substantially increase actuarial value for high-deductible health plans: a simulation study by David M Anderson, Paul R Shafer (2026) in the Tower of Babel, a free online library of public-domain works preserved in clean, searchable text. No sign-up. The full text is served as a plain-text file at a predictable URL, where text is present: https://antarctic-labs.com/tower-of-babel/pmc-13235736.txt.
Description
David Anderson and Paul Shafer simulated a health plan design change in a 2026 study. High-deductible plans expose patients to large upfront costs, and underinsurance persists despite coverage gains. A proposed federal rule would let catastrophic plans cap what patients pay each month at one twelfth of the annual maximum. The idea echoes a Medicare drug benefit feature that spreads costs across the year.
Little was known about how monthly caps change a plan's actuarial value, the share of costs the plan covers. The authors simulated value across many pairings of annual and monthly limits. Their headline result: monthly caps raise actuarial value substantially for high-deductible plans. The study speaks to regulators weighing the 2027 marketplace rule.
Catalog record
| CREATOR | David M Anderson, Paul R Shafer |
|---|---|
| YEAR | 2026 |
| COLLECTION | PAPERS |
| FORMAT | TXT |
| FILE SIZE | 10 KB |
| VERSION | 1.0 |
| LICENSE | CC BY 4.0 |
| RIGHTS | CC BY |
| SOURCE | Europe PMC |