Health Reform WK-EDGE QHP landscape data shows progress in costs, choices
Monday, October 31, 2016

QHP landscape data shows progress in costs, choices

By Anthony H. Nguyen, J.D.

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) continues to promote affordability and choices in the individual marketplace. Analysis of qualified health plan (QHP) data in the individual marketplace for states that use the marketplace platform and state-based marketplaces where data is available found that more than 7 in 10 (72 percent) of current Marketplace enrollees can find a plan for $75 or less in premiums per month, after applicable tax credits in 2017. Nearly 8 in 10 (77 percent) current Marketplace enrollees can find a plan for $100 or less in premiums per month, after applicable tax credits in 2017. According to the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) data brief, marketplace tax credits adjust to match changes in each consumer’s benchmark silver plan premium, which results in a consumer paying almost the same for a benchmark plan in 2017 as one purchased in 2016 (ASPE Data Brief, October 24, 2016).

The plan and premium data reported by ASPE are from the marketplace QHP landscape individual market health plan files, which are publicly available at The analysis focused on the 39 states which were included in the 2017 marketplace landscape file. HHS noted that thanks in large part to the marketplace, in early 2016, the share of Americans without health insurance fell to 8.6 percent, the lowest level in U.S. history.

Marketplace premiums and tax credits. Although there are higher benchmark premium increases than in previous years, the majority of consumers will continue to have access to affordable coverage because they are protected by the combination of financial assistance and the ability to shop. Specifically, 77 percent of returning marketplace consumers will be able to find a plan for $100 per month or less and 72 percent will be able to find a plan for $75 or less per month, similar to previous years.

Of the uninsured, the 84 percent that are eligible for coverage through the marketplaces have incomes between 100 percent and 400 percent of the federal poverty level (FPL) and may be eligible to receive tax credits for plan year 2017. The ASPE estimated that as many as 2.5 million people currently purchasing off-marketplace individual market coverage could be eligible for financial assistance if they purchase 2017 coverage through the marketplaces. In total, about 78 percent of all consumers who are uninsured, who purchase Marketplace coverage, or who purchase individual market coverage outside the Marketplace have incomes making them potentially eligible for advance premium tax credits.

Of the nearly 1.3 million consumers who did not receive tax credits in 2016, 22 percent have benchmark premiums and incomes in the range that may make them eligible for tax credits in 2017. In addition, an estimated 2.5 million consumers currently paying full price for individual market coverage off-marketplace have incomes indicating they could be eligible for tax credits.

Plan choices. The ASPE noted that if all consumers switched from their current plan to the lowest premium plan in the same metal level, the average 2017 Marketplace premium after tax credits would be $28 per month less than the average 2016 Marketplace premium after tax credits – a 20 percent reduction.

In addition, nearly 8 out of 10 (79 percent) consumers returning to the marketplace will be able to choose from 2 or more issuers for 2017 coverage. This year, consumers will have the option to choose from an average of 30 plans. Similar to last year, there will be an average of 10 plans per issuer. Four out of five (79 percent of) consumers will also be able to choose between multiple issuers, and all consumers will be able to choose among plans with different combinations of premiums, out-of-pocket costs, networks of hospitals and physicians, and prescription drug coverage options. Conversely, among people with employer sponsored health insurance coverage, plan choice is often considerably narrower, with 30 percent of employees who were offered health insurance only having one plan from one issuer.

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