Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014. II. Overview of Premiums in the 2014 Individual Health Insurance Marketplace


Section II Highlights

Overview of Premiums for the Second-Lowest Cost Silver Plans:

  • 82 percent of people eligible to purchase a Marketplace plan live in rating areas with 3 to 11 issuers; 96 percent live in rating areas with 2 to 11 issuers.
  • On average, consumers eligible to purchase a Marketplace plan can choose from 5 health plan issuers and 47 Marketplace plans across all metal levels—of which, approximately 16 are silver plans.
  • The national average for the second-lowest cost silver plan premium rate is $226 per month for a 27-year-old, ranging between a low of $127 to a high of $406.
  • Second-lowest cost silver plan premium rates were comparable for rating areas located in both Federally-facilitated Marketplace (FFM) and State-based Marketplace (SBM) states and those located in states that chose to expand their Medicaid programs under the Affordable Care Act and those states that did not choose to expand.

Rating areas are geographic markets where insurers compete on premiums and other factors for customers in the Marketplace. The number of rating areas14 varies by state from a low of one rating area in smaller states like Rhode Island or Vermont to a high of 67 rating areas in Florida—corresponding to each of Florida’s 67 counties. However, rating areas are often an aggregation of counties. On average, there are approximately 10 rating areas per state for the 50 states and the District of Columbia.

There were a total of 266 issuers by state15 offering Marketplace plans, ranging from a low of one issuer in New Hampshire and West Virginia to a high of 16 issuers in New York. New issuers16 represent almost 26 percent of all state issuers. Among the new entrants, the majority had a history as Medicaid issuers and now offer commercial coverage through the Marketplace. New entrants also include consumer-operated and oriented plans (CO-OPs) authorized by section1322 of the Affordable Care Act.17

On average, there are approximately five health plan issuers per rating area, ranging from one to 11 issuers. The rating areas with the most choice as measured by the number of issuers are located in New York and Oregon; the rating areas with the most choice as measured by the number of Marketplace plans available are located in Wisconsin and Florida. On average, consumers shopping in the Marketplace can choose from approximately 47 Marketplace plans.

TABLE 5 Summary of Rating Areas, Health Plans, and Health Plan Issuers by Rating Area or State, 2014 Health Insurance Marketplace

  Average Minimum Maximum
Rating Areas per State 10 1 67
Marketplace Plans (excluding Catastrophic Plans) 47 6 165
Bronze Plans 14 1 42
Silver Plans 16 2 67
Gold Plans 13 2 45
Platinum Plans 5 1 23
Issuers 5 1 11

Source: ASPE computations of plan and premium data from the following publicly available sources:, state rate filings (where available), and State-based Marketplace websites. Averages are weighted by the QHP-eligible18 population in each rating area estimated using the 2011 American  Community Survey Public Use Microdata Sample.


As displayed on Figure 4, 82 percent of the people eligible to purchase a Marketplace plans live in rating areas with at least three issuers of Marketplace plans and 96 percent live in areas with at least two issuers. Fifty six percent can choose from plans offered by five or more issuers. This compares favorably with those covered by employer-sponsored insurance. One study found that approximately 46 percent of employees could choose from more than two issuers, while 25 percent had two issuer options, and the remaining 24 percent had only one issuer of plans from which to choose.19 In addition, prior to the implementation of the Marketplace, the individual market was dominated by one or two different issuers in most states. In 2012, 11 states had 85 percent of the individual market covered by the largest two issuers in the state. In 29 states, more than half of all enrollees in the individual market were covered by only one issuer and in 46 states (including DC)—two issuers covered more than half of the individual market.20


FIGURE 4: Percent of QHP-Eligible Population by Number of Issuers in a Rating Area, 2014 Health Insurance Marketplace


Source: Source: ASPE computations of plan and premium data from the following publicly available sources:, state rate filings (where available), and State-based Marketplace websites.

14  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 Marketplace plan in every rating area within a state, however, so the number of available issuers and Marketplace plans varies by rating area. These totals exclude catastrophic plans, which are not available to all enrollees.

15  This is the number of unique issuer-state combinations nationally. For example, Aetna offers coverage in both Arizona and Florida, which is considered as two issuer-state combinations. Therefore, although Aetna is one company, it would be counted twice in the summation of issuer-state combinations for the total of 266 nationally.

16  New issuers are defined as issuers participating in the individual market for the first time in a given state.

17  The Consumer-Operated and Oriented Plan (CO-OP) program was created by the Affordable Care Act to provide support for the creation of nonprofit, member-controlled health insurance plans that offer ACA-compliant policies in the individual and small business markets.

18  For the purposes of this analysis, we define “QHP eligible” as U.S. citizens and others lawfully present who have only individual market coverage or are uninsured and have incomes that are: above 133 percent of the FPL for adults in Medicaid expansion states; above 100 percent of the FPL for adults in  non-expansion states; and above 250 percent of the FPL for children (age 0-18) in all states. These estimates do not take into account the eligibility requirements relating to other minimum essential coverage.

19  Meredith B. Rosenthal, Bruce E. Landon, Sharon-Lise T. Normand, Richard G. Frank, Thaniyyah S. Ahmad, Arnold M. Epstein. 2007. “Employer’s Use of Value-Based Purchasing Strategies.” JAMA. 2007 Nov 21. 298(19):2281-8.

20  The White House, "Early Results: Competition, Choice, and Affordable Coverage in the Health Insurance Marketplace in 2014,” Available at: .

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