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Insurers submit filings every year to state regulators detailing their plans to participate in the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of rate review information public.

This analysis looks at lowest-cost bronze, second lowest-cost silver, and lowest-cost gold premiums in the 50 states and the District of Columbia. (Our analyses from 2018, 2017, 2016, 2015, and 2014 examined changes in premiums and participation in these states and major cities since the exchange markets opened nearly four years ago.) The second lowest-cost silver plan serves as the benchmark for premium tax credits (which subsidize premiums for low and modest income exchange enrollees) and is the only plan that offers reduced cost sharing for lower-income enrollees. About 63% of marketplace enrollees are in silver plans this year, and 29% are enrolled in bronze plans.

Rates and plan offerings for 2019 have been finalized, and Open Enrollment is underway. Open Enrollment for ACA-compliant coverage for 2019 runs from November 1st through December 15th in most states.

Premium Changes

The tables below show final 2018 and 2019 premiums for a major city in each of the 50 states and Washington, D.C.

Table 1 below shows monthly premiums before applying a tax credit for the lowest-cost bronze, second lowest-cost silver, and lowest-cost gold plans insurers are offering on the ACA exchanges for 2019.

Table 1: Monthly Unsubsidized Bronze, Benchmark, and Gold Premiums for a 40 Year Old Non-Smoker
 State
 Major City Lowest Cost Bronze
Before Tax Credit
2nd Lowest Cost Silver
Before Tax Credit
Lowest Cost Gold
Before Tax Credit
2018 2019 % Change from 2018 2018 2019 % Change from 2018 2018 2019 % Change from 2018
Alabama Birmingham $372 $327 -12% $546 $525 -4% $612 $616 1%
Alaska Anchorage $526 $461 -12% $709 $696 -2% $759 $655 -14%
Arizona Phoenix $405 $333 -18% $513 $426 -17% $621 $574 -8%
Arkansas Little Rock $309 $320 4% $378 $381 1% $424 $469 11%
California Los Angeles $247 $281 14% $360 $376 4% $398 $405 2%
Colorado Denver $338 $336 -1% $413 $466 13% $459 $480 5%
Connecticut Hartford $306 $297 -3% $484 $428 -12% $545 $542 -1%
Delaware Wilmington $473 $449 -5% $591 $685 16% $706 $672 -5%
DC Washington $271 $316 17% $324 $393 21% $385 $426 11%
Florida Miami $297 $332 12% $442 $447 1% $456 $476 4%
Georgia Atlanta $371 $316 -15% $421 $440 5% $465 $497 7%
Hawaii Honolulu $336 $361 7% $456 $503 10% $449 $469 4%
Idaho Boise $290 $282 -3% $463 $479 3% $464 $480 3%
Illinois Chicago $305 $328 8% $411 $384 -7% $488 $442 -9%
Indiana Indianapolis $323 $350 8% $366 $377 3% $501 $498 -1%
Iowa Cedar Rapids $570 $429 -25% $702 $724 3% $781 $528 -32%
Kansas Wichita $344 $375 9% $484 $529 9% $445 $485 9%
Kentucky Louisville $282 $274 -3% $397 $370 -7% $446 $506 13%
Louisiana New Orleans $363 $336 -7% $409 $384 -6% $509 $484 -5%
Maine Portland $337 $335 -1% $513 $485 -5% $570 $582 2%
Maryland Baltimore $314 $298 -5% $456 $419 -8% $449 $408 -9%
Massachusetts Boston $233 $251 8% $305 $321 5% $347 $334 -4%
Michigan Detroit $219 $225 3% $332 $333 0% $341 $355 4%
Minnesota Minneapolis $259 $238 -8% $327 $300 -8% $410 $343 -16%
Mississippi Jackson $492 $474 -4% $551 $542 -2% $687 $648 -6%
Missouri St. Louis $281 $325 16% $465 $421 -9% $636 $566 -11%
Montana Billings $334 $321 -4% $503 $522 4% $561 $499 -11%
Nebraska Omaha $532 $473 -11% $752 $821 9% $753 $586 -22%
Nevada Las Vegas $291 $292 0% $384 $369 -4% $416 $404 -3%
New Hampshire Manchester $391 $303 -23% $475 $402 -15% $524 $444 -15%
New Jersey Newark $322 $279 -13% $411 $348 -15% $646 $538 -17%
New Mexico Albuquerque $258 $241 -7% $401 $342 -15% $331 $334 1%
New York New York $416 $421 1% $510 $587 15% $595 $697 17%
North Carolina Charlotte $491 $361 -26% $667 $536 -20% $703 $548 -22%
North Dakota Fargo $254 $277 9% $298 $388 30% $382 $392 3%
Ohio Cleveland $244 $264 8% $319 $327 3% $376 $400 6%
Oklahoma Okla. City $377 $334 -11% $685 $686 0% $690 $486 -30%
Oregon Portland $271 $296 9% $380 $414 9% $401 $439 9%
Pennsylvania Philadelphia $401 $370 -8% $636 $465 -27% $539 $517 -4%
Rhode Island Providence $198 $215 9% $311 $336 8% $300 $323 8%
South Carolina Columbia $393 $405 3% $562 $603 7% $590 $607 3%
South Dakota Sioux Falls $346 $330 -5% $453 $448 -1% $509 $521 2%
Tennessee Nashville $351 $342 -3% $585 $486 -17% $824 $813 -1%
Texas Houston $270 $286 6% $399 $393 -2% $426 $476 12%
Utah Salt Lake City $283 $271 -4% $517 $510 -1% $578 $584 1%
Vermont Burlington $422 $426 1% $505 $622 23% $569 $584 3%
Virginia Richmond $327 $379 16% $482 $499 4% $719 $499 -31%
Washington Seattle $264 $319 21% $339 $380 12% $406 $436 7%
West Virginia Huntington $410 $475 16% $478 $531 11% $623 $683 10%
Wisconsin Milwaukee $434 $372 -14% $568 $563 -1% $666 $570 -14%
Wyoming Cheyenne $534 $531 -1% $796 $796 0% $657 $660 0%
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders

Table 2 shows the monthly premium tax credit for a 40-year-old making $30,000 per year living in a major city in each of the 50 states and Washington, D.C.

Table 2: Monthly Advanced Premium Tax Credit Amount for a 40 Year Old Non-Smoker Making $30,000 / Year
State Major City 2018 2019 % Change from 2018
Alabama Birmingham $344 $319 -7%
Alaska Anchorage $550 $525 -5%
Arizona Phoenix $310 $220 -29%
Arkansas Little Rock $177 $173 -2%
California Los Angeles $158 $170 8%
Colorado Denver $214 $260 21%
Connecticut Hartford $283 $224 -21%
Delaware Wilmington $388 $478 23%
DC Washington $117 $181 55%
Florida Miami $241 $241 0%
Georgia Atlanta $216 $233 8%
Hawaii Honolulu $265 $315 19%
Idaho Boise $261 $272 4%
Illinois Chicago $209 $177 -15%
Indiana Indianapolis $163 $171 5%
Iowa Cedar Rapids $501 $518 3%
Kansas Wichita $283 $322 14%
Kentucky Louisville $177 $164 -7%
Louisiana New Orleans $207 $177 -14%
Maine Portland $311 $278 -11%
Maryland Baltimore $250 $215 -14%
Massachusetts Boston $104 $115 11%
Michigan Detroit $131 $127 -3%
Minnesota Minneapolis $126 $94 -25%
Mississippi Jackson $349 $336 -4%
Missouri St. Louis $263 $214 -19%
Montana Billings $302 $316 5%
Nebraska Omaha $551 $614 11%
Nevada Las Vegas $182 $162 -11%
New Hampshire Manchester $273 $196 -28%
New Jersey Newark $209 $141 -33%
New Mexico Albuquerque $200 $134 -33%
New York New York $308 $369 20%
North Carolina Charlotte $465 $330 -29%
North Dakota Fargo $97 $180 86%
Ohio Cleveland $116 $120 3%
Oklahoma Okla. City $484 $480 -1%
Oregon Portland $174 $205 18%
Pennsylvania Philadelphia $434 $259 -40%
Rhode Island Providence $109 $129 18%
South Carolina Columbia $359 $397 11%
South Dakota Sioux Falls $252 $242 -4%
Tennessee Nashville $381 $280 -27%
Texas Houston $198 $186 -6%
Utah Salt Lake City $313 $300 -4%
Vermont Burlington $341 $453 33%
Virginia Richmond $281 $292 4%
Washington Seattle $135 $177 31%
West Virginia Huntington $262 $305 16%
Wisconsin Milwaukee $366 $356 -3%
Wyoming Cheyenne $595 $589 -1%
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders

Table 3 shows monthly premiums after applying a tax credit for the lowest-cost bronze, second lowest-cost silver, and lowest-cost gold plans insurers are offering for 2019.

Table 3: Monthly Subsidized Bronze, Benchmark, and Gold Premiums for a 40 Year Old Non-Smoker Making $30,000 / Year
 State
 Major City Lowest Cost Bronze
After Tax Credit
2nd Lowest Cost Silver
After Tax Credit
Lowest Cost Gold
After Tax Credit
2018 2019 % Change from 2018 2018 2019 % Change from 2018 2018 2019 % Change from 2018
Alabama Birmingham $27 $8 -70% $201 $206 2% $268 $297 11%
Alaska Anchorage $1 $1 0% $159 $171 8% $209 $130 -38%
Arizona Phoenix $96 $113 18% $203 $206 1% $311 $354 14%
Arkansas Little Rock $132 $147 11% $201 $208 3% $248 $296 19%
California Los Angeles $89 $111 25% $201 $206 2% $239 $236 -1%
Colorado Denver $124 $77 -38% $200 $206 3% $246 $221 -10%
Connecticut Hartford $23 $73 217% $201 $204 1% $262 $318 21%
Delaware Wilmington $86 $0 -100% $203 $206 1% $319 $194 -39%
DC Washington $154 $135 -12% $207 $213 3% $269 $245 -9%
Florida Miami $56 $91 63% $201 $206 2% $215 $236 10%
Georgia Atlanta $156 $82 -47% $205 $206 0% $249 $263 6%
Hawaii Honolulu $71 $46 -35% $191 $187 -2% $184 $154 -16%
Idaho Boise $29 $10 -66% $202 $207 2% $203 $208 2%
Illinois Chicago $96 $151 57% $202 $206 2% $279 $265 -5%
Indiana Indianapolis $160 $179 12% $203 $206 1% $338 $327 -3%
Iowa Cedar Rapids $69 $0 -100% $201 $206 2% $280 $11 -96%
Kansas Wichita $62 $52 -16% $201 $206 2% $162 $162 0%
Kentucky Louisville $104 $110 6% $219 $206 -6% $269 $342 27%
Louisiana New Orleans $156 $158 1% $201 $206 2% $302 $306 1%
Maine Portland $26 $57 119% $203 $206 1% $259 $303 17%
Maryland Baltimore $64 $83 30% $206 $204 -1% $199 $193 -3%
Massachusetts Boston $129 $136 5% $201 $206 2% $243 $219 -10%
Michigan Detroit $88 $98 11% $201 $206 2% $211 $228 8%
Minnesota Minneapolis $133 $144 8% $201 $206 2% $284 $249 -12%
Mississippi Jackson $143 $138 -3% $201 $206 2% $338 $312 -8%
Missouri St. Louis $18 $110 511% $201 $206 2% $373 $351 -6%
Montana Billings $32 $5 -84% $201 $206 2% $259 $184 -29%
Nebraska Omaha $0 $0 0% $201 $206 2% $202 $0 -100%
Nevada Las Vegas $109 $130 19% $201 $206 2% $233 $242 4%
New Hampshire Manchester $118 $107 -9% $201 $206 2% $250 $248 -1%
New Jersey Newark $113 $137 21% $202 $207 2% $438 $397 -9%
New Mexico Albuquerque $58 $107 84% $201 $208 3% $131 $199 52%
New York New York $108 $52 -52% $202 $218 8% $287 $328 14%
North Carolina Charlotte $26 $31 18% $201 $206 2% $238 $219 -8%
North Dakota Fargo $157 $96 -39% $201 $208 3% $286 $212 -26%
Ohio Cleveland $128 $143 12% $203 $206 1% $259 $279 8%
Oklahoma Okla. City $0 $0 0% $201 $206 2% $206 $6 -97%
Oregon Portland $97 $91 -6% $206 $209 1% $227 $234 3%
Pennsylvania Philadelphia $0 $111 NA $201 $206 2% $105 $258 146%
Rhode Island Providence $89 $86 -3% $202 $207 2% $191 $194 2%
South Carolina Columbia $34 $9 -74% $203 $206 1% $230 $211 -8%
South Dakota Sioux Falls $94 $88 -6% $201 $206 2% $257 $279 9%
Tennessee Nashville $2 $63 3050% $204 $206 1% $443 $533 20%
Texas Houston $72 $100 39% $201 $206 2% $228 $290 27%
Utah Salt Lake City $0 $0 0% $204 $210 3% $265 $284 7%
Vermont Burlington $81 $0 -100% $164 $169 3% $228 $131 -43%
Virginia Richmond $47 $87 85% $201 $206 2% $438 $207 -53%
Washington Seattle $130 $142 9% $204 $203 0% $272 $259 -5%
West Virginia Huntington $148 $169 14% $216 $226 5% $361 $377 4%
Wisconsin Milwaukee $68 $16 -76% $202 $206 2% $300 $213 -29%
Wyoming Cheyenne $0 $0 0% $201 $206 2% $62 $70 13%
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders

As insurers set rates for 2019, they considered the repeal of the individual mandate penalty (which goes into effect this coming year) and the proliferation of short-term, limited duration (STLD) health plans. In the absence of a penalty for not purchasing insurance, some people currently purchasing individual market insurance are expected to either stop purchasing any insurance or switch to non-ACA compliant STLD plans. It is likely that those who leave the regulated individual insurance market will be relatively healthy on average, which will increase premiums in 2019 more than would otherwise be the case.

In a separate analysis of what insurers explicitly reported in their 2019 rate filings, we find that premiums for all ACA-compliant plans — including those sold both on- and off-exchange — will on average be 6 percent higher than they otherwise would have been if it were it not for the repeal of the individual mandate penalty and the expansion of short-term and association health plans. In particular, ACA silver-level plans sold in the marketplaces will cost an average of 16 percent more than they otherwise would have, due to the combined effects of the loss of ACA cost-sharing reduction payments, the repeal of the ACA’s individual mandate penalty, and the expansion in the availability of more loosely-regulated plans. For example, the 2019 benchmark silver plan premiums for a 40-year-old on healthcare.gov would have averaged $427 per month in 2019, instead of the $495 per month recently reported by the Department of Health and Human Services. The analysis also finds that the average rate increase due to individual mandate uncertainty in 2018 was 5 percent among insurers who reported factoring in expected non-enforcement of the individual at the time.

Methods

Data were collected from health insurer rate filing submitted to state regulators, healthcare.gov, and state plan finders. These submissions are publicly available for the states we analyzed. Most rate information is available in the form of a SERFF filing (System for Electronic Rate and Form Filing) that includes a base rate and other factors that build up to an individual rate. In states where filings were unavailable, we gathered data from tables released by state insurance departments. All premiums in this analysis are at the rating area level, and some plans may not be available in all cities or counties within the rating area. Rating areas are typically groups of neighboring counties, so a major city in the area was chosen for identification purposes.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.