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Tracking 2019 Premium Changes on ACA Exchanges

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 preliminary 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.

This year, we are updating this review of preliminary rates as data become available for additional states.

States will continue to review premiums and participation, so the preliminary data in this report could very well change by the time rates and participation are final in late summer or early fall.

Preliminary Premium Changes

The tables below show premiums for a major city in each state with currently public data. These tables will be updated as preliminary premiums for additional states are made available.

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 intend to offer on the ACA exchange in 2019. This table includes only states for which enough public data are currently available to determine an individual’s premium.

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
DC Washington $271 $313 15% $324 $393 21% $385 $426 10%
Maine** Portland $337 $375 11% $513 $557 8% $570 $624 9%
Maryland Baltimore $314 $443 41% $456 $622 36% $449 $606 35%
Michigan Detroit $219 $225 3% $332 $333 0% $341 $355 4%
Minnesota Minneapolis $259 $246 -5% $327 $302 -8% $410 $328 -20%
New York New York $416 $447 7% $510 $594 16% $595 $697 17%
Oregon Portland $271 $309 14% $380 $425 12% $401 $458 14%
Rhode Island Providence $198 $215 9% $311 $336 8% $300 $323 8%
Vermont Burlington $422 $443 5% $505 $645 28% $569 $608 7%
Virginia Richmond $327 $373 14% $482 $516 7% $719 $584 -19%
Washington Seattle $264 $349 32% $339 $379 12% $406 $435 7%
*2019 premiums are still preliminary and subject to change.
**Rates assume Maine’s reinsurance program is not implemented.
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators

Table 2 shows the monthly premium tax credit for a 40-year-old making $30,000 per year living in a major city in states where enough public data are currently available to determine an individual’s premium.

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
DC Washington $123 $187 52%
Maine Portland $312 $351 12%
Maryland Baltimore $255 $416 63%
Michigan Detroit $131 $127 -3%
Minnesota Minneapolis $126 $96 -24%
New York New York $309 $388 25%
Oregon Portland $179 $219 22%
Rhode Island Providence $110 $130 18%
Vermont Burlington $304 $439 44%
Virginia Richmond $281 $310 10%
Washington Seattle $138 $173 26%
*2019 premiums are still preliminary and subject to change.
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators

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 have proposed offering next year. This table also includes only states for which enough public data are currently available to determine an individual’s premium.

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
DC Washington $148 $125 -15% $201 $206 2% $263 $238 -9%
Maine Portland $25 $24 -2% $201 $206 2% $258 $273 6%
Maryland** Baltimore $59 $27 -54% $201 $206 2% $194 $190 -2%
Michigan Detroit $88 $97 11% $201 $206 2% $211 $228 8%
Minnesota Minneapolis $133 $150 13% $201 $206 2% $284 $232 -18%
New York New York $107 $59 -44% $201 $206 2% $286 $310 8%
Oregon Portland $92 $90 -2% $201 $206 2% $222 $239 8%
Rhode Island Providence $88 $86 -3% $201 $206 2% $190 $193 2%
Vermont*** Burlington $118 $5 -96% $201 $206 2% $264 $169 -36%
Virginia Richmond $46 $63 36% $201 $206 2% $437 $274 -37%
Washington Seattle $127 $176 39% $201 $206 2% $268 $262 -2%
*2019 premiums are still preliminary and subject to change.
**Rates assume Maine’s reinsurance program is not implemented.
***Vermont offers additional state subsidies (not reflected above).
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators.

As insurers set rates for 2019, they are taking into account repeal of the individual mandate penalty (which goes into effect this coming year) and the likely proliferation of short-term, limited duration health plans (STDL). 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 STDL 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 some cases, insurers may have already factored in expected non-enforcement of the individual mandate in their 2018 premiums, and thus would not need to factor it in — at least to the same degree — in 2019. Additionally, the Trump administration decision to stop making cost-sharing reduction payments to insurers had an upward effect on 2018 premiums, but some insurers may adjust premiums in 2019 up or down if their 2018 adjustments proved to be inaccurate. Some insurers may be changing which plans are subject to increased premiums to compensate for the loss of cost-sharing reduction payments. In 2018 many insurers increased premiums just on silver marketplace plans – which are the only plans in which consumers can receive cost-sharing reductions — but a small number of states directed insurers to increase individual market premiums across the board.

Table 4 shows the range of proposed rate changes across all ACA-compliant plans offered by insurers that have proposed participating on the exchange in each state. This table includes states in Table 2 as well as additional states that have released average premium increases for all insurers intending to offer exchange plans next year.

Table 4: Proposed 2019 Individual Market Premium Changes, by State
State Number of Exchange Insurers
Submitting 2019 Rates*
 Statewide Average Individual Market Rate Change** Minimum Individual Market
Average Rate Change
Among Exchange-Participating Insurers
Maximum Individual Market
Average Rate Change
Among Exchange-Participating Insurers
DC 2 14.9% 9.5% (CareFirst BlueChoice) 20% (Kaiser)
Maine 2*** 9.2% (MCHO) 9.5% (Harvard Pilgrim)
Maryland 2 30.2% 18.5% (CareFirst Blue Choice) 91.4% (CareFirst CFMI, GHMSI)
Michigan 8*** -2.5% (Priority Health) 11.1% (McLaren)
Minnesota 4 -12.4% (Medica) -7% (UCare)
New Mexico 5*** -0.4% (Molina) 18.5% (Presbyterian)
New York 12 24% -3.2% (HealthNow New York) 38.6% (Fidelis)
Oregon 5 -9.58% (PacificSource) 14.28% (Kaiser)
Pennsylvania Not Available 4.9% Not Available Not Available
Rhode Island 2 8.7% (Neighborhood HP) 10.7% (BCBS of RI)
Vermont 2 7.48% (BCBS of VT) 10.88% (MVP Health Plan)
Virginia 7*** -1.9% (Optima) 64.3% (GHMS)
Washington 5 19.08% 0.9% (BridgeSpan) 29.8% (Kaiser)
*Subsidiaries are grouped by parent insurer. **Statewide individual market average rate change is only shown if an average was provided by the state through a press release. ***The number of insurers in Maine would increase to 3 if the reinsurance program is implemented, as Anthem has indicated it would reenter in that case. Oscar is planning to enter the Michigan marketplace. Presbyterian is planning to reenter the New Mexico marketplace. Virginia Premier is planning to enter the Virginia marketplace.
Note: 2019 premiums and insurer participation are still preliminary and subject to change.
SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators

Methods

Data were collected from health insurer rate filing submitted to state regulators. 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. Filings in most states are still preliminary. 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.