Individual Market - Research and Data from KFF

Private Insurers Expect to Pay $1 Billion in Rebates to Consumers This Year for Setting Premiums Too High Relative to Medical Costs

Jun 1, 2022

News Release

Private insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years. This year’s total is roughly half the size of last year’s $2 billion, in part because 2021 was a less profitable year and because…

For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

May 18, 2022

Policy Watch

Most customers with coverage through Affordable Care Act's marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

Many Privately Insured People with Diabetes Could Save Money if Congress Caps Insulin Costs

Mar 24, 2022

News Release

Several legislative proposals in Congress propose a $35 per month cap on what people with health insurance would have to pay out of pocket for insulin, a life-saving hormone taken regularly by many people with diabetes to maintain their health. Such a cap could provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance, a new KFF analysis of insurance claims data finds. In the large…

County-Level Analysis Finds ACA Premiums are Falling in Many Areas of the Country, Though Changes Vary by County and Type of Plan

Dec 7, 2021

News Release

Premiums for the Affordable Care Act Marketplace benchmark silver plan are decreasing 3.1 percent on average across the country – the fourth year in a row that benchmark premiums have fallen – though the changes vary by county, a new KFF county-by-county analysis finds. The benchmark plan premiums are important because they are used to determine the tax credits available to people who buy their own insurance through the Marketplaces. What people would have to…

Insurer Filings Suggest COVID-19 Pandemic Will Not Drive Health Spending In 2022

Oct 18, 2021

Issue Brief

This brief reviews initial 2022 premium rate filings for Marketplace-participating individual market insurers in 13 states and the District of Columbia. Most expect health utilization patterns to return to pre-pandemic levels and therefore not factoring in any impact on their 2022 premiums.

Navigator Funding Restored in Federal Marketplace States for 2022

Sep 29, 2021

Issue Brief

This data notereviews the data from CMS about its funding awards to Navigator programs serving consumers in the federal marketplace states during the 2022 open enrollment season, as well as funding trends over time and funding by state.

Most Insurers Participating in the Marketplaces Don’t Expect COVID to Affect Their 2022 Costs

Jul 19, 2021

News Release

After a tumultuous year of unpredictable COVID-19 changes to utilization and spending, a review of early rate filings for individual market insurers participating in the Affordable Care Act Marketplace finds that most are expecting a return to normal in 2022 without the pandemic playing a large role. The review of insurers’ preliminary rate filings in 13 states and the District of Columbia reveals that most expect health utilization patterns to return to their pre-pandemic levels…

A Closer Look at the Uninsured Marketplace Eligible Population Following the American Rescue Plan Act

May 27, 2021

Issue Brief

This analysis examine key demographic characteristics of the uninsured population eligible for subsidies to buy Marketplace coverage following the American Rescue Plan.

Analysis Suggests Health Insurers Remained Profitable Across Markets Amid Pandemic in 2020

May 3, 2021

News Release

A new analysis of health insurers’ financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease in health spending and utilization in the spring as the COVID-19 pandemic led to massive shutdowns.

Private Insurers Are Expected to Pay $2.1 Billion in Rebates to Consumers This Year for Excessive Health Insurance Premiums Relative to Health Care Expenses

Apr 12, 2021

News Release

Private insurance companies are expecting to pay out $2.1 billion in rebates to consumers this fall, the second highest amount ever issued under the Affordable Care Act, according to a new KFF analysis. The rebates, which are calculated based on the share of premium revenues that insurance companies paid out for health care expenses and quality improvement, are roughly $400 million lower than last year’s record high of $2.5 billion, but more than 50 percent…

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