By Brian Craig, J.D.
Consumers in states using HealthCare.gov exchanges will have more options in the upcoming open enrollment period for 2019, while the average monthly premiums for the benchmark plan will decrease by two percent, according to a brief released by the HHS Assistant Secretary for Planning and Evaluation (ASPE). The report showed that issuer participation in the exchanges increased with 155 total state level issuers for the 2019 open enrollment period, compared to 132 issuers in 2018. Although the average monthly premium for the benchmark plan decreased, there is considerable variation by state and premiums are still 85 percent higher than 2014 (ASPE Report, October 26, 2018).
In the study, the ASPE analyzed information on qualified health plans (QHPs) available in states that rely on the HealthCare.gov eligibility and enrollment platform. The brief also included estimates for issuer participation, consumer options, average premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP in 2014. In total, there are 35 states that participate in the HealthCare.gov exchanges.
Issuer participation. Overall issuer participation increased for the 2019 OEP with more consumer options. Exchanges in HealthCare.gov states increased with 155 total state level issuers in 2019, up from 132 issuers in 2018. Five states in 2019 will have only one issuer compared to eight states having just one issuer in 2018. The five states with only one issuer for 2019 include Alaska, Delaware, Mississippi, Nebraska, and Wyoming. In total, 20 percent of current enrollees will have only one issuer to choose from, down from 29 percent in 2018. The average number of qualified health plans (QHPs) available to enrollees is 26 for 2019, up from 25 in 2018. Alaska and Mississippi enrollees will have the fewest QHPs in 2019, while Florida will have the highest. The average number of QHPs available to enrollees had decreased every year since the inception of the HealthCare.gov exchanges in 2015.
Average premiums. The study also showed that the overall average premiums will decrease for 2019; however, there is considerable variation by state. The average monthly premium for the second-lowest cost silver plan (SLCSP), also called the benchmark plan, for a 27-year-old decreased by two percent from 2018 ($412) to 2019 ($405). Wyoming has the highest average premium while Indiana has the lowest average premium for the benchmark plan in 2019. North Dakota will have the highest percentage increase in the average premium for the benchmark plan in 2019 with a 21 percent increase from last year. Tennessee will have the greatest percentage decrease in the average premium for the benchmark plan in 2019 with a decrease of 26 percent. The average monthly premium for the benchmark plan in 2019 ($405) will be 85 percent higher than in 2014 ($218).
Subsidization. The study also analyzed the subsidy utilization and costs for estimates of the percentage of enrollees in exchange plans to which advance premium tax credits (APTCs) were paid and had cost-sharing reductions (CSRs) across all HealthCare.gov states. The estimated average monthly APTC for current enrollees is $544 for 2019, a three percent decrease from 2018 ($558). A 27-year-old with a household income of $25,000 is estimated to receive an average monthly APTC of $265. Meanwhile, a family of four with a household income of $60,000 is estimated to receive an average monthly APTC of $1,155 for 2019, a three percent decrease from 2018.
Lowest-cost plan available. Finally, the brief examined the lowest-cost plan available to enrollees across all HealthCare.gov states. The percentage of current enrollees with access to a plan for $200 per month decreased five percent for 2019, compared to a six percent decrease for 2018. If enrollees were to stay within their current metal level, only two percent of enrollees will have access to coverage with premiums of $200 or less for 2019. The percentage of enrollees with access to a plan for which they are responsible for paying less than $75 of the premium also slightly decreased for 2019 compared to 2018.
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