Health Insurance Marketplace Premiums for 2014, September 2013. Notes

08/09/2014

1 To be eligible to purchase coverage in a Marketplace, you must be a US citizen or legal resident and not be incarcerated.

2 Tax credit eligibility is dependent on several factors in addition to income, including whether an individual is eligible for Minimum Essential Coverage through their employer, Medicaid, or CHIP.

3 A qualified health plan is a plan certified to be offered in a Marketplace. A health insurance issuer may offer multiple qualified health plans. For example, a silver plan and a bronze plan from Blue Cross and Blue Shield would be considered two qualified health plans.

4 The three states missing from this analysis, Massachusetts, Hawaii, and Kentucky, had not released premium information as of September 16, 2013. Idaho and New Mexico, while State-Based Marketplaces, will be using federal systems to display plans, and are therefore included in the 36 states with data submitted to CMS.

5 See http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/ib_premiums_update.cfm for a description of the earlier estimates from the Congressional Budget Office.

6 This total excludes catastrophic plans, which are not available to all enrollees. This analysis includes only the 36 states that submitted data directly to CMS, as that data contains a complete accounting of the number of qualified health plans offered in each rating area in each state.

7 The Affordable Care Act requires that qualified health plans offered on the Marketplace must be one of four tiers, or “metal levels,” based on actuarial value (catastrophic plans are exempt from this requirement). Actuarial value is a measure of health plan generosity. A bronze plan has an actuarial value of approximately 60 percent, a silver plan has an actuarial value of approximately 70 percent, a gold plan has an actuarial value of approximately 80 percent, and a platinum plan has an actuarial value of approximately 90 percent.

8 Rating areas are state-defined pricing regions for issuers. They overlap with the issuer service areas in many, but not all, cases. In general, the number of issuers or plans available in a rating area will be the number of choices available to all individuals and families living in that rating area. Issuers are not required to offer a qualified health plan in every rating area within a state, however, so the number of available issuers and qualified health plans varies by rating area. These totals exclude catastrophic plans, which are not available to all enrollees.

9 A health insurance issuer is a company that may offer multiple qualified health plans. For example, a hypothetical Blue Cross and Blue Shield licensed company would be a health insurance issuer, while its $2000 deductible silver plan would be a qualified health plan. An enrollee may have fewer issuers participating in his or her rating area than the total number participating in that state, because issuers are not required to offer a qualified health plan in every rating area.

10 McKinsey & Company. Emerging exchange dynamics: Temporary turbulence or sustainable market disruption? September 2013.

11 For a discussion of methodology, see http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/ib_premiums_update.cfm.

12 Based on analysis of the the 2011 American Community Survey (ACS), available at http://cms.gov/Outreach-and-Education/Outreach/HIMarketplace/Census-Data-.html?no_redirect=true.  Eligible uninsured is defined as uninsured Americans who are citizens or legal residents under the age of 65 and therefore eligible for coverage either in the Marketplace or through Medicaid. We define Marketplace eligible as the eligible uninsured with incomes above 138% of the Federal Poverty Level in Medicaid expansion states or above 100% of the Federal Poverty Level in non-expansion states. These estimates do not take into account the eligibility requirements relating to other minimum essential coverage.

13 Tax credits are not available for catastrophic plans.

14 This analysis includes only the 36 states that submitted data directly to CMS, as not all 12 of the State-based Marketplaces with available premium data have released catastrophic premiums. 

15 Estimated using the 2011 American Community Survey (ACS) Public Use Microdata Sample.  This estimate includes US citizens and legal residents between the ages of 25 and 30 who are uninsured and may be eligible for the Marketplace or Medicaid in 2014. The estimates do not take into account whether an individual may have access to Minimum Essential Coverage through an employer.

16 This analysis concerns only tax credits and premium costs, but we note that cost sharing reductions are not available in bronze plans except for American Indians and Alaska Natives. Cost sharing reductions are available to individuals and families with incomes below 250 percent of the FPL who enroll in silver plans, and to American Indians and Alaska Natives enrolled in metal level. These cost sharing reductions reduce consumer costs (such as out-of-pocket maximums, copays, and coinsurance) at the point of service, whereas tax credits reduce only premiums.

17 Because the tax credit is calculated as the difference between the cost of the second lowest cost silver plan premium and the maximum payment amount determined by income, those with higher premiums get larger tax credits. Therefore, using tax credits to purchase a bronze plan may yield lower net bronze premiums in higher-cost states or for older individuals and families.

18 See http://aspe.hhs.gov/health/reports/2013/Uninsured/ib_uninsured.cfm.

19 The 36 states included in this analysis are the Supported State-based Marketplaces, State Partnership Marketplaces, and Federally-facilitated Marketplaces, for which ASPE has complete data. We do not include State-based Marketplace data here.

20 Not including catastrophic plans.

21 For the purposes of this analysis, a family of four is defined as one 40-year-old adult, one 38-year-old adult, and two children under the age of 18.

22 After tax credits, bronze premiums for a family of four may be below those for a single individual. This occurs because the tax credit is calculated as the difference between the cost of the second lowest cost silver plan premium and the maximum payment amount determined by income. Because premiums for older individuals and families are higher than those for younger individuals, tax credits are larger for older individuals and families. Therefore, using tax credits to purchase a bronze plan may yield lower bronze premiums for older individuals and families than for younger individuals.

23 Alaska has an alternate Federal Poverty Level, which is used to calculate tax credits here.

24 Not including catastrophic plans.

25 For the purposes of this analysis, a family of four is defined as one 40-year-old adult, one 38-year-old adult, and two children under the age of 18.

26 After tax credits, bronze premiums for a family of four may be below those for a single individual. This occurs because the tax credit is calculated as the difference between the cost of the second lowest cost silver plan premium and the maximum payment amount determined by income. Because premiums for older individuals and families are higher than those for younger individuals, tax credits are larger for older individuals and families. Therefore, using tax credits to purchase a bronze plan may yield lower bronze premiums for older individuals and families than for younger individuals.

27 Alaska has an alternate Federal Poverty Level, which is used to calculate tax credits here.

28 Not including catastrophic plans.

29 For the purposes of this analysis, a family of four is defined as one 40-year-old adult, one 38-year-old adult, and two children under the age of 18.

30 After tax credits, bronze premiums for a family of four may be below those for a single individual. This occurs because the tax credit is calculated as the difference between the cost of the second lowest cost silver plan premium and the maximum payment amount determined by income. Because premiums for older individuals and families are higher than those for younger individuals, tax credits are larger for older individuals and families. Therefore, using tax credits to purchase a bronze plan may yield lower bronze premiums for older individuals and families than for younger individuals.

31 New York premiums are the same for all ages.

32 Vermont premiums are the same for all ages.

33 See http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/ib_premiums_update.cfm

34 See http://www.census.gov/popest/data/counties/asrh/2012/CC-EST2012-ALLDATA.html.

35 For data and further methodological details, see http://cms.gov/Outreach-and-Education/Outreach/HIMarketplace/Census-Data-.html?no_redirect=true.

36 See http://aspe.hhs.gov/poverty/13poverty.cfm.

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