Consumers in 38 states can use HealthCare.gov to shop for health insurance. Their health insurance options change every year as health insurance issuers (referred to here as “issuers”) decide whether to enter or leave the marketplace, change the number and types of health plans they offer, or change the monthly premium costs they charge. Consumers who use HealthCare.gov have the opportunity to choose among these offerings during an annual Open Enrollment Period. Returning consumers have the option during this time to let their current plans automatically renew, or to go to HealthCare.gov and purchase a new plan. Those interested in getting the best value may want to consider shopping for new plans at HealthCare.gov instead of letting their current plans automatically renew.
To illustrate year-to-year changes in plan choices and monthly premium costs, this ACA Spotlight compares available plan data from HealthCare.gov by county for 2015 and 2016. Due to data constraints, this ACA Spotlight does not currently include data for four states – Hawaii, New Mexico, Nevada, and Oregon – where consumers can use HealthCare.gov to shop for health insurance. In the remaining 34 HealthCare.gov states, only partial data may be available in certain areas. See the background section for more details about health plan options and the methodology section for more information on the data used.
|State||Marketplace Type*||Enrollment Website**|
|District of Columbia||State-based Marketplace||dchealthlink.com|
|Hawaii||Federally-supported State-based Marketplace||healthcare.gov|
|Nevada||Federally-supported State-based Marketplace||healthcare.gov|
|New Hampshire||State-Partnership Marketplace||healthcare.gov|
|New Jersey||Federally-facilitated Marketplace||healthcare.gov|
|New Mexico||Federally-supported State-based Marketplace||healthcare.gov|
|New York||State-based Marketplace||healthcare.gov|
|North Carolina||Federally-facilitated Marketplace||healthcare.gov|
|North Dakota||Federally-facilitated Marketplace||healthcare.gov|
|Oregon||Federally-supported State-based Marketplace||healthcare.gov|
|Rhode Island||State-based Marketplace||healthsourceri.com|
|South Carolina||Federally-facilitated Marketplace||healthcare.gov|
|South Dakota||Federally-facilitated Marketplace||healthcare.gov|
|West Virginia||State-Partnership Marketplace||healthcare.gov|
* See Kaiser Family Foundation here.
** See healthcare.gov here.
The Affordable Care Act established HealthCare.gov as a resource for people in states that do not have a state-based health insurance marketplace to purchase and enroll in Qualified Health Plans (QHPs) (referred to here as “plans”). As of November 2015, 38 states use HealthCare.gov for their residents to purchase and enroll in plans.
People can purchase and enroll in plans during the annual Open Enrollment period. Plan choices and costs vary by county and can change each Open Enrollment period in multiple ways. New issuers and plans may become available, providing new choices for consumers. Conversely, existing issuers and plans may become unavailable, leaving their enrollees with no option other than to change plans. As the number of issuers increase or decrease in a county, the corresponding increase or decrease in issuer competition can also affect how much issuers charge for their plans. For existing plans that continue being offered from a previous Open Enrollment period, their issuers may still change monthly premium costs and other factors that are significant to consumers. Additionally, the lowest cost plan of a plan category in the previous Open Enrollment period may no longer be the lowest cost plan of that category in the next Open Enrollment Period, which may matter for those who choose a plan based on lowest cost.
All of these possible changes can also mean that a different plan may become the second-lowest cost silver plan (referred to here as “benchmark silver plan”). This is notable because the second-lowest cost silver plan in a given area is used as the benchmark for determining the formulas for the federal subsidies available to qualified enrollees.
Any of these changes may influence returning consumers to shop for a new plan rather than allow their current plans to automatically renew, especially in counties with significant changes. Consumers that receive premium tax credits may be particularly interested in exploring their coverage options when there has been a change in the benchmark silver plan in their area, as the amount of the premium tax credit -- and therefore the net cost of their coverage -- may also have changed.
The infographics in this ACA Spotlight compare HealthCare.gov’s 2015 and 2016 plan choices and monthly premium costs by county. Spotlight users first select if they want to compare by “choice”, “age”, or “plan category”.
Users that select “choice” then select the data they want to see from these options:
- Total number of 2016 issuers. Users can see for each county the total number of 2016 issuers, the total number of 2016 plans, and the number of plans in each plan category.
- Change in total number of issuers. Users can see for each county the total number of issuers in 2015 and 2016 and the net difference in the total number of issuers.
- Total number of 2016 plans. Users can see for each county the total number of 2016 plans and the number of plans in each plan category.
- Change in total number of plans. Users can see for each county the total number of plans in 2015 and 2016 and the net difference in the total number of plans
- Change in total number of catastrophic, bronze, silver, gold, or platinum plans. Users can see for each county the number of plans in 2015 and 2016 and the net difference in the number of plans for the plan category selected.
- Change in the benchmark silver plan. Users can see for each county whether or not the benchmark silver plan changed from 2015 and 2016 and the names of the plan and issuer.
Users that select “age” then select the benchmark silver plan data they want to see. Users can see for each county for either a 21 year old or a 40 year old:
- The name of the issuer of the 2016 benchmark silver plan and the monthly premium cost for the selected age, or
- The benchmark silver plan monthly premium costs in 2015 to 2016 and the percent change between them.
Users that select “plan category” then select among one of the following categories: catastrophic, bronze, silver, gold, or platinum. For each plan category, users can see for each county the difference between the lowest and highest monthly premium cost plan for a 21 year old or 40 year old. Note that since catastrophic plans are only available to consumers 30 years old or younger, the data on catastrophic plans are only available for a 21 year old.
Social Interest Solutions (SIS) produced the data and infographics using the MAGI Cloud platform. The MAGI Cloud platform includes a comprehensive rules engine that can generate ACA eligibility results across all states and across the full spectrum of health insurance options, including Medicaid, the Children’s Health Insurance Program (CHIP), and QHPs with and without premium tax credits and cost-sharing reduction subsidies. To learn more about the MAGI Cloud platform, click here.
To calculate the comparisons in plan choices and monthly premium costs, the MAGI Cloud platform compares HealthCare.gov’s 2015 and 2016 plan data based on the choice or cost parameters the Spotlight user specifies.
This ACA Spotlight provides plan choice and cost data for 34 of the 38 states in which consumers can use HealthCare.gov to shop for health insurance. As of November 2015, 2016 HealthCare.gov data for Hawaii, Nevada, New Mexico, and Oregon are not yet available. In the other 34 HealthCare.gov states, certain data may be unavailable:
- Catastrophic and/or platinum plans are not offered in certain areas.
- As of November 2015, some 2016 HealthCare.gov data from Pennsylvania are not yet available.
Data used in this Spotlight are available upon request. Please email requests to email@example.com.
- Centers for Medicare and Medicaid Services
- Georgetown University Health Policy Institute’s Center for Children and Families
- The Henry J. Kaiser Family Foundation
- McKinsey & Company
- Robert Wood Johnson Foundation