How Affordable are 2019 ACA Premiums for Middle-Income People?

We analyzed data from the 2019 Individual Market Medical files to determine premiums and the benchmark amounts to calculate premium tax credits for the scenarios presented. These files are available at data.healthcare.gov. Premiums for the 12 state-based Marketplaces are from KFF analysis of data received from Massachusetts Health Connector and KFF analysis of data published by HIX Compare from the Robert Wood Johnson Foundation. All premiums are displayed as the full price, rather than just the portion that covers essential health benefits.

The lowest-cost plan is a bronze plan in all but 14 counties where a silver plan is cheaper. In those 14 counties, the silver plan is used as the lowest-cost plan for this analysis. This analysis only includes on-exchange plans. Off-exchange plans generally have similar premiums to on-exchange plans with the exception of silver plans, which often include an additional premium load on-exchange only to account for cost-sharing reductions insurers must provide to some exchange enrollees.

All averages are weighted by county-level 2018 plan selections. 2018 plan selections come from the 2018 Marketplace Open Enrollment Period County-Level Public Use file provided by CMS, available here. In states running their own exchanges, we gathered county-level plan selection data where possible and otherwise estimated county plan selections based on the county population in the 2010 Census and total state plan selections in the 2018 OEP State-Level Public Use File provided by CMS, available here. Metro/Non-Metro county classifications are based on definitions from the Federal Office of Rural Health Policy.

Issue Brief