Last Updated- December 2016:

HealthCare.gov Plan Choice and Cost

How have plan choices and costs changed for consumers using HealthCare.gov?

FOR THE PREVIOUS VERSION OF THIS ACA SPOTLIGHT, CLICK HERE
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Overview

Consumers in 39 states can use HealthCare.gov to shop for health insurance, also known as the Federally-facilitated Marketplace; individuals in the remaining 11 states plus the District of Columbia can use their State-based Marketplaces. Their health insurance options change every year as health insurance issuers (referred to here as “issuers”) decide whether to enter or leave the Marketplaces, 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 the available plan choices during an annual Open Enrollment Period. Consumers who are already enrolled may renew their coverage every year. They can either remain in their current plan (if still available for the following year) by letting it automatically renew, or they can shop and compare among the plans offered for next year and enroll in a different plan. Because the number of plans and the cost of the plans change every year, consumers are encouraged to shop and compare plans available in their Marketplace.


This ACA Spotlight provides and compares data on the number of issuers, number of plans, and the average premium costs of plans offered through HealthCare.gov in 2015, 2016, and 2017. See the background section for more details about health plan options and the methodology section for more information on the data used.

At-A-Glance: State Marketplace Decisions

State Marketplace Type* Enrollment Website**
Alabama Federally-facilitated Marketplace healthcare.gov
Alaska Federally-facilitated Marketplace healthcare.gov
Arizona Federally-facilitated Marketplace healthcare.gov
Arkansas State-based Marketplace-Federal Reform healthcare.gov
California State-based Marketplace coveredca.com
Colorado State-based Marketplace connectforhealthco.com
Connecticut State-based Marketplace accesshealthct.com
Delaware State-Partnership Marketplace healthcare.gov
District of Columbia State-based Marketplace dchealthlink.com
Florida Federally-facilitated Marketplace healthcare.gov
Georgia Federally-facilitated Marketplace healthcare.gov
Hawaii Federally-facilitated Marketplace healthcare.gov
Idaho State-based Marketplace yourhealthidaho.org
Illinois State-Partnership Marketplace healthcare.gov
Indiana Federally-facilitated Marketplace healthcare.gov
Iowa State-Partnership Marketplace healthcare.gov
Kansas Federally-facilitated Marketplace healthcare.gov
Kentucky State-based Marketplace-Federal Reform healthcare.gov
Louisiana Federally-facilitated Marketplace healthcare.gov
Maine Federally-facilitated Marketplace healthcare.gov
Maryland State-based Marketplace marylandhealthconnection.gov
Massachusetts State-based Marketplace mahealthconnector.org
Michigan State-Partnership Marketplace healthcare.gov
Minnesota State-based Marketplace mnsure.org
Mississippi Federally-facilitated Marketplace healthcare.gov
Missouri Federally-facilitated Marketplace healthcare.gov
Montana Federally-facilitated Marketplace healthcare.gov
Nebraska Federally-facilitated Marketplace healthcare.gov
Nevada State-based Marketplace-Federal Reform healthcare.gov
New Hampshire State-Partnership Marketplace healthcare.gov
New Jersey Federally-facilitated Marketplace healthcare.gov
New Mexico State-based Marketplace-Federal Reform healthcare.gov
New York State-based Marketplace healthcare.gov
North Carolina Federally-facilitated Marketplace healthcare.gov
North Dakota Federally-facilitated Marketplace healthcare.gov
Ohio Federally-facilitated Marketplace healthcare.gov
Oklahoma Federally-facilitated Marketplace healthcare.gov
Oregon State-based Marketplace-Federal Reform healthcare.gov
Pennsylvania Federally-facilitated Marketplace healthcare.gov
Rhode Island State-based Marketplace healthsourceri.com
South Carolina Federally-facilitated Marketplace healthcare.gov
South Dakota Federally-facilitated Marketplace healthcare.gov
Tennessee Federally-facilitated Marketplace healthcare.gov
Texas Federally-facilitated Marketplace healthcare.gov
Utah Federally-facilitated Marketplace healthcare.gov
Vermont State-based Marketplace healthconnect.vermont.gov
Virginia Federally-facilitated Marketplace healthcare.gov
Washington State-based Marketplace wahealthplanfinder.org
West Virginia State-Partnership Marketplace healthcare.gov
Wisconsin Federally-facilitated Marketplace healthcare.gov
Wyoming Federally-facilitated Marketplace healthcare.gov

* See Kaiser Family Foundation here.

** See healthcare.gov here.

Background

The ACA established health insurance Marketplaces, either through State-based Marketplaces or the Federally-facilitated Marketplace available via HealthCare.gov, for uninsured consumers to purchase and enroll in Qualified Health Plans (QHPs) (referred to here as “plans”). As of November 2016, 39 states use HealthCare.gov for their residents to purchase and enroll in plans.


Consumers can shop and compare plans during the annual Open Enrollment period. Plan choices and their premium and out-of-pocket costs vary by county and year to year. New issuers and plans may become available, providing new plan choices for consumers. Conversely, existing issuers and plans may not be available in the next coverage year, requiring current enrollees of those plans to choose a new plan or have a new plan chosen for them automatically. As the number of issuers increase or decrease in a county, the corresponding increase or decrease in issuer competition can affect how much issuers charge for their plans.


Changes in plan options year to year can also result in changes to which available plan is 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, thus impacting the affordability of a plan.


Methodology

The infographics in this ACA Spotlight compare by county the number of issuers, the number of plans offered, and the average monthly premium costs of plans offered in HealthCare.gov for the years 2015, 2016, and 2017.


Spotlight users first select if they want to see single year data (2015, 2016, or 2017) or see changes from year to year (Changes 2015-2016 or Changes 2016-2017).


Users that select to see single year data then select the data they want to see from these options:


  • Number of plans and issuers. Users can see for each county the total number of issuers, the total number of plans, and the number of plans in each plan category.
  • Cost of plans. Users can see for each county the average cost of a plan for each category, as well as the cost of the benchmark (second lowest cost) silver plan (for an individual adult aged 30).

Users that select to see changes from year to year then select the data they want to see from these options:


  • Change in number of plans and issuers. Users can see for each county the change in the total number of issuers, the change in the total number of plans, the change in the number of plans in each plan category, and whether or not the benchmark (second lowest cost) silver plan changed.
  • Change in cost of plans. Users can see for each county the change in the average cost of a plan for each plan category, as well as the change in the cost of the benchmark (second lowest cost) silver plan (for an individual adult aged 30).

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, 2016, and 2017 plan data based on the choice or cost parameters the Spotlight user specifies.


This ACA Spotlight provides plan choice and cost data for the states in which consumers can use HealthCare.gov to purchase and enroll in plans. States that have changed Marketplace types since the Open Enrollment Period for 2015 plans will not have data available for the Open Enrollment Periods the state did not use HealthCare.gov as its Marketplace.


Not all plan categories are offered in certain areas, especially catastrophic, gold, and/or platinum plans. Additionally, in areas where there is only one silver plan available, the one silver plan is selected as the benchmark silver plan for the area. In areas where there are only two silver plans available, the higher cost plan is selected as the benchmark silver plan for the area.


Data used in this Spotlight are available upon request. Please email requests to info@socialinterest.org.

Additional Resources