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 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 | ||||||||||
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State
|
Major City | Lowest Cost Bronze Before Tax Credit |
2nd Lowest Cost Silver Before Tax Credit |
Lowest Cost Gold Before Tax Credit |
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| 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% |
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SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders
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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% |
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SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders
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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 |
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| 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% |
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SOURCE: Kaiser Family Foundation analysis of premium data from insurer rate filings to state regulators, healthcare.gov, and state plan finders
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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.