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Posted September 7, 2017

stabilizing marketplace


Dealing with uncertainty surrounding the ACA exchanges remains a prominent concern now as there is no new movement on federal repeal and replace legislation currently. Just as the employer market is gearing up for open enrollment, so are insurers and states considering their participation in exchange markets across the U.S. Questions are arising about the stability of the marketplace based on how many plans will participate and how fast premiums will increase.

Insurer participation will not be finalized until the fall, however expert analysis of premium increases for proposed 2018 premium changes in the exchanges are ranging from -5% decrease to 49% increase with common double digit increases for benchmark silver plans. These proposed increases might in part stem from ambiguous federal government statements around the $7 billion in cost-sharing reduction (CSR) subsidies and the enforcement of the individual mandate.

Counties across the states need to have an exchange insurer, otherwise consumers will have to purchase individual plans outside the marketplace and therefore, without federal subsidies. Many people received advanced premium tax credits (APTCs), making their coverage more affordable by lowering their monthly premiums costs and/or CSR subsidies to help lower their out-of-pocket expenses on Silver plans.

In 2017, 84% of all enrollees (8.7 million people) received APTCs and 57% of enrollees (5.9 million people) received CSR subsidies. Some people receive both APTCs and CSRs, while there are an estimated 6.5 million people who buy individual ACA compliant plans and aren’t subsidized who would feel the effect of these increases if some of the uncertainty isn’t resolved.

According to recent Health Research Institute insights, some states and insurers are entering the ACA individual market to offer plan options, stability and longer enrollment periods. With this extra effort, all counties should potentially have health plans available on the marketplace. Continued attention remains imperative to keep millions of people covered with affordable plans.

Source: PwC Health Research Institute. Weekly Regulatory and Legislative Updates. 8/21/17.

Kaiser Family Foundation. Counties at a Risk of Having No Insurer on the Marketplace (Exchange) in 2018. 8/24/17.


WEX Health

WEX Health