The Affordable Care Act (ACA) is forcing structural change to the way that healthcare coverage is provided in the United States, affecting everything from the cost of health insurance to the way that insurers manage risk and design certain health benefits. In addition to new regulations primarily instituting consumer protections, the health insurance marketplaces (Exchanges) offering consumers an organized marketplace in which to compare plan choices, stand to broadly influence how Americans obtain health insurance and the way in which insurance companies design, price and market their products.
In an effort to understand the potential impact of the changes, it helps to start with understanding the some vital statistics of the products offered and the consumers participating in the first enrollment period.
- There are 282 payors filing on the public exchanges.
- Health plans on the exchanges are offered in a tiered format with several plans in each tier to choose from. Plan tiers are based on metal levels that are based on the percentage the plan pays of the average overall cost of providing essential health benefits to members:
- Bronze (60 percent of costs covered)
- Silver (70 percent)
- Gold (80 percent)
- Platinum (90 percent)
- Payors offered a total of 20,818 on-exchange products across the metal tiers.
- These products included 2,366 unique provider networks.
- The vast majority of exchange networks (93 percent) are offered on the silver tier.
- The silver tier is only one in which income-eligible consumers can receive both federal premium and cost- sharing subsidies.
- HHS has reported that approximately 20.8 million people are now enrolled in insurance because of the law. That includes 8 million who enrolled in private insurance through the exchanges, 4.8 M now covered by Medicaid and the Children's Health Insurance Program, 5 M who bought coverage outside the state and federal exchanges and 3 M adults younger than 26 now covered through their parents' insurance. (1)
- More than 60% of all consumers who enrolled in an exchange product chose one in the silver tier.(2)
- The median monthly premium on the Federal exchange for a Silver plan was $255 for a 27-year-old and $431 for a 55-year-old. (3)
- The ACA limits the amount that plans can require people to pay out-of-pocket each year for in-network deductibles, copayments and coinsurance on covered services to $6,350 for individuals ($12,700 for a family).
- Eighty-five percent of those who enrolled in private health insurance through the state and federal exchanges between Oct. 1 and April 15 received federal subsidies to help pay for it.
- There are currently approximately 149 million people covered in the employer-sponsored insurance market. (4)
- Only two of the 36 states that relied on the federal insurance exchange this year -- Idaho and New Mexico -- plan to set up their own online marketplaces in time for the next open enrollment beginning Nov. 15. And one (Oregon) will flip the other other way. 35 states will rely on the federal website this fall — far more than envisioned when the law was approved in 2010. (5)
- The states performing the best in terms of the enrollment (Vermont, Rhode Island, Connecticut, California, Idaho) enrolled an average of 32% of potential participants while those in the bottom tier (Massachusetts, South Dakota, Iowa, North Dakota, Oklahoma) enrolled an average of 6.2% of eligible participants. (6)
(4) Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 2013 Annual Survey