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Health Plan Choice and Premiums in the 2015 Health Insurance Marketplace

Publication Date
Dec 3, 2014

Updated January 8, 2015

Since open enrollment began on November 15, 2014, millions of Americans can once again shop for high-quality, affordable health care coverage in the Health Insurance Marketplace established by the Affordable Care Act.1 Our research indicates that the Affordable Care Act is working to enhance competition, expand choice and promote affordability among Marketplace health insurance plans in 2015.2

This year, the Marketplace is welcoming new consumers as well as encouraging those who enrolled last year to come back, update their information and select the plan that best meets their needs. All plans in the Marketplace cover essential health benefits and recommended preventive care, and do not exclude people based on preexisting conditions. Consumers can see detailed information about each health insurance plan offered in their area before they apply. Factors they may consider in choosing a health insurance plan include premiums, deductibles, out-of-pocket costs, provider network, formulary, customer service and more.3 Consumers may be eligible for financial assistance to help pay for the cost of premiums. In fact, 85 percent of consumers who selected a Marketplace plan in 2014 received financial assistance.4

This brief presents analysis of Qualified Health Plan (QHP) data in the Marketplace for 35 states, providing a look at the plan choice and premium landscape that new and returning consumers will see for 2015.5 It also examines plan affordability in 2015 after taking into account premium tax credits. The findings presented here include states for which sufficient plan data were available for both 2014 and 2015.

Key Findings

  • The Affordable Care Act is increasing competition and choice among affordable Marketplace health insurance plans in 2015.
  • There are over 25 percent more issuers participating in the Marketplace in 2015. About 91 percent of consumers will be able to choose from 3 or more issuers—up from 74 percent in 2014. Consumers can choose from an average of 40 health plans for 2015 coverage—up from 30 in 2014—based on analysis at the county level.
  • Premiums for the benchmark (second-lowest cost) silver plan will increase modestly, by 2 percent on average this year before tax credits, while premiums for the lowest-cost silver plan will increase on average by 5 percent. The plans offering the lowest prices have sometimes changed from 2014 to 2015, so consumers should shop around to find the plan that best meets their needs and budget.
  • More than 7 in 10 current Marketplace enrollees can find a lower premium plan in the same metal level before tax credits by returning to shop. To illustrate the significance of shopping we consider the following example: if all consumers switched from their current plan to the lowest-cost premium plan in the same metal level, the total savings in premiums would be over $2 billion. These savings represent the sum of savings to consumers and taxpayers.
  • For customers returning to the Marketplace, the vast majority of enrollees have low cost plans available to them. If they look across all metal levels, fully 79 percent of current Marketplace enrollees can get coverage for $100 or less, after any applicable tax credits, in 2015.
  • Sixty-five percent of current Marketplace enrollees can get coverage for $100 or less for 2015, after tax credits, if they shop for a more affordable plan within their current metal level, compared to 50 percent of current Marketplace enrollees who can get coverage for $100 or less, after any applicable tax credits, if they stay in the same plan in 2015.

1 The Health Insurance Marketplace includes the Marketplaces established in each of the states (and the District of Columbia) and run by the state or the federal government. This report addresses the individual market Marketplaces that use the HealthCare.gov eligibility and enrollment system in both 2014 and 2015.

2 It is important to note that this brief uses only information on individuals who selected a Marketplace individual market health plan, and the analysis excludes stand-alone dental plans.

3 This brief does not analyze consumers’ final expenses, after considering other health plan features, such as deductibles and copayments. Consumers may examine all elements of health insurance plans in order to estimate expected total out-of-pocket costs. Moreover, while premium tax credits can be applied to a plan in any metal tier with the exception of catastrophic plans, cost-sharing reductions are available only for silver plans.

4 This represents the percentage of individuals who selected a Marketplace plan and qualified for an advance premium tax credit (APTC), with or without a cost-sharing reduction. See: U.S. Department of Health and Human Services, “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period,” ASPE Issue Brief, ASPE, May 1, 2014, available at: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/i…

5 The 35 states for which sufficient data in the individual market were available in both 2014 and 2015 for this analysis are listed in the methodology section at the end of this brief. References to the Marketplace in this report refer to the individual market Marketplaces that use the HealthCare.gov eligibility and enrollment system in both 2014 and 2015. The small group Marketplace, also known as SHOP, is not included in this brief.

"

Consumer Choice among Health Insurance Issuers in 2014 and 2015

The Affordable Care Act is working to create a dynamic, competitive Marketplace, with more choice and affordable premiums in 2015. This offers new opportunities for consumers to comparison shop to select the plan that best meets their needs and budget. More choice also means more competition between plans that in turn results in downward pressure on premiums. Consumers who bought a 2014 plan and decide to shop actively for a comparable 2015 plan will often be able to find lower premiums.

There are 25 percent more issuers participating in the Marketplace in 2015, compared with 2014.6 During the 2014 open enrollment period, 74 percent of the people who enrolled in a qualified health plan lived in counties with three or more issuers offering plans in the Marketplace; for 2015 this percentage has increased to 91 percent.

Figure 1 shows the distribution of the 2014 Marketplace enrollees by the number of issuers in their county.

FIGURE 1

Enrollee Choice of Marketplace Issuers in 35 States in 2014 and 2015

Figure 1: Enrollee Choice of Marketplace Issuers in 35 States in 2014 and 2015

Source: Information on plans and issuers is from the plan landscape files as of November 2014 for 35 states.

Note: See “Methods and Limitations” section for more details regarding data and methods used. “Enrollees” refers to those people who selected a qualified health plan in the Marketplace in 2014 and is based on active plan selections in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014. The number of issuers available to those who selected a Marketplace plan in 2014 is based on the number of issuers offering qualified health plans in 2015 in the county of residence of those persons.


Consumers can also choose from among more plans for 2015 coverage. On average, there are 40 plans available per county, including catastrophic plans. This is an increase from an average of 30 total plans per county last year. Note that previous ASPE issue briefs on plan choice and availability presented analyses at the rating area level. Because plans available in some part of a rating area are not always available in all parts of a rating area, conducting the analysis at the county level better captures the set of options consumers will see when they shop and thus more closely matches consumers’ shopping experience.

The average number of plans per county in the bronze, silver, gold, and platinum metal tiers—which signify different levels of plan actuarial value or how much of every claim dollar the plan covers—has also increased from 2014 (see Table 1).

TABLE 1

Summary of Marketplace Health Plans and Issuers for 35 States, 2014 and 2015

 2014 Average2015 Average
Issuers per State57
Issuers per County34
Total Qualified Health Plans (excluding catastrophic)2837
Total Health Plans3040
    Catastrophic Plans32
    Bronze Plans912
    Silver Plans1015
    Gold Plans89
    Platinum Plans12


6 The increase in total number of issuers in the 35 states is calculated based on identifying an issuer by its unique five-digit Health Insurance Oversight System (HIOS) ID. In some cases, issuers with different HIOS IDs belong to the same parent company. An issuing entity’s HIOS issuer ID is specific to the state in which it operates, such that a company offering QHPs through the Marketplace in two states would be counted twice—once for each state.

Marketplace Health Plan Premiums in 2014 and 2015

The Marketplace enables consumers to comparison shop for a plan that meets their needs and budget. Many will receive financial assistance to help with the cost of their monthly premiums. In 2014, 64 percent of individuals who selected a plan in the Marketplace selected the lowest cost (43 percent) or second-lowest cost plan (21 percent) in their metal tier—indicating that many Marketplace consumers shop on price.7

Consumers who return to the Marketplace will see that premiums for the benchmark plan (the second-lowest cost silver plan in each market) increased modestly, by 2 percent on average this year before tax credits. For example, the average premium for the benchmark silver plan for a 27-year-old increased from $218 in 2014 to $222 in 2015 before tax credits.8 The benchmark silver plan premiums are significant because the premium tax credits that are available to help make Marketplace coverage more affordable are calculated based on the premium for those plans.9 The lowest-cost silver plan in each market saw modest growth of 5 percent on average before tax credits.

The new Marketplace is competitive and dynamic. As described in the last section, the 2015 Marketplace includes many new issuers and plans, and issuers are competing to offer more affordable options to consumers. This means that the plan that was the benchmark or lowest-cost plan in 2014 is often not the benchmark or lowest-cost plan in 2015, so it will be important for returning consumers to shop around in 2015 to ensure that they select the plan that best meets their circumstances.

More than 7 in 10 current Marketplace enrollees can find a lower premium plan in the same metal level by returning to shop. For instance, the average lowest-cost premium for a silver plan available to current silver-level enrollees is $336 for 2015. The average consumer who bought a silver plan last year and decides to shop for a better deal this year can save $41 a month before tax credits—which works out to $492 a year. If all silver plan holders switch to the lowest-cost silver plan for 2015, the total savings for the year would be $1.6 billion. Across all metal levels, the total savings in premiums would be over $2 billion (see Table 2 for all metal levels). These savings represent the sum of savings to consumers and taxpayers.

Eighty-five percent of consumers who selected a plan for 2014 coverage received premium tax credits to help with the cost of monthly premiums. Consumers who receive premium tax credits are protected against excessive rate increases because the Affordable Care Act sets a cap on the amount they pay for the benchmark, second-lowest silver plan. Additionally, during the open enrollment period, all new and returning Marketplace consumers can easily compare plans’ pricing and benefits to shop for a plan with a lower premium.

TABLE 2

Potential Savings from Shopping Based on Premium if Current Marketplace Enrollees Switch to 2015 Lowest-Cost Premium Plan within Metal Level for 35 States

Premiums Before Tax Credits, Current Marketplace Enrollees
BronzeSilverGoldPlatinum
Average Lowest-Cost 2015 Monthly Premium Within Metal Level$265$336$382$439
Average 2015 Monthly Premium Savings if Consumers Switch to Lowest-Cost Plan within Metal Level$36$41$54$55
% of Enrollees Who Could Save on Premium Costs by Switching to the Lowest-Cost Plan in Metal Level78%78%77%71%
ANNUAL Average Potential Savings in Premium Costs per Enrollee$432$492$658$660
MONTHLY Total Amount of Potential Savings in Premium Costs across All Enrollees$28 M$131 M$23 M$11 M
ANNUAL Total Amount of Potential Savings in Premiums Costs Across All Enrollees$336 M$1.6 B$271 M$127 M

Source: Plan information is from the plan landscape files as of November 2014 for 35 states. Enrollment information is based on active plan selections in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014.

Note: Amounts presented here do not take into account potential tax credits. The lowest-cost premium refers to the plan with the lowest premium within the county within each metal tier and is based on all the plans available in 2015. The lowest cost plan does not take into account other cost-sharing features, but refers only to the cost of the premium charged for that plan. In some cases, plans were tied for lowest premium. This analysis includes only enrollees linked to complete plan and premium data for both 2014 and 2015, and excludes tobacco users. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. We assume that all enrollee characteristics are unchanged and calculate premiums based on the same age, family composition, and household income as percentage of the FPL as in 2014. See the “Methods and Limitations” section at the end of this brief for more details.


7 Percentages are based on analysis of 2014 Marketplace plan selections in 36 states. See: Amy Burke, Arpit Misra, and Steven Sheingold, “Premium Affordability, Competition and Choice in the Health Insurance Marketplace, 2014,” ASPE Research Brief, June 2014, available at: http://aspe.hhs.gov/health/reports/2014/Premiums/2014MktPlacePremBrf.pdf

8 Plan and premium information are from the Center for Consumer Information and Insurance Oversight as of November 2014 for 35 states. Amounts represent monthly premiums and do not take into account potential premium tax credits. For averages, each county’s second-lowest cost silver premium is weighted by the number of Marketplace plan selections in each county. See Table 7 at the end of this brief for average premiums by state.

9 The Affordable Care Act specifies that an individual or family with a particular household income who is eligible for the premium tax credit will be required to pay no more than a fixed percentage of their income for the second-lowest cost silver plan available in the Marketplace in their local area. See the “Methods and Limitations” section at the end of this brief for more details on benchmark plans and premium tax credits.

Health Insurance Plan Affordability after Tax Credits in the Marketplace in 2015

With over 25 percent more issuers in the Marketplace this coming year, the increased choice and competition means there are affordable premiums for new consumers and for those who selected a plan last year and are returning to shop.

In order to make health insurance affordable, the Affordable Care Act established premium tax credits to help consumers with the cost of coverage based on their incomes.During the initial open enrollment period, 85 percent of consumers who selected a Marketplace plan received financial assistance.10 And nearly 7 out of 10 who selected a plan with tax credits found coverage for less than $100 after tax credits.11

The tax credits are based on the premium of the so-called benchmark plan in their area (the second-lowest-cost silver plan). The health plan category or “metal level” determines how consumers and plans share the costs of care. For example, with a silver level plan the health plan pays about 70 percent of the total costs of care for essential health benefits, on average, and the consumer pays 30 percent of these costs. This takes into account the plan’s deductibles, copayments, coinsurance, and out-of-pocket maximums. The second-lowest cost silver plan premiums are significant because premium tax credits that are available to help make Marketplace coverage more affordable are calculated based on the premium for those plans. The actual payment made by consumers for their insurance depends on the plan they choose and the level of tax credit they qualify for.

Competition and tax credits are related. Increased numbers of plans in a market means more competition. More competition tends to put downward pressure on premiums. As competition intensifies, the benchmark plan (second-lowest cost silver plan) may change. This means that the benchmark premium (and thus the tax credit) may grow more slowly than a consumer’s current plan’s premium. For this reason, consumers that want to make their tax credit’s purchasing power go as far as possible should shop. Another implication is that premium competition serves to benefit taxpayers by holding down tax credit costs.

The percentages in Tables 3, 4, and 5 include current Marketplace enrollees who selected a plan, with or without tax credits. Table 3 shows the percent of current Marketplace enrollees in the 35 states who could get coverage for as little as $100 or less per month, taking into account any applicable tax credits in 2015, regardless of the metal level they selected in 2014. For example, 79 percent of all customers returning to the Marketplace can get coverage for $100 or less after tax credits, regardless of their 2014 plan metal level choice. Sixty-six percent can get coverage for $50 or less, and an additional 12 percent could get coverage for as little as $50 to $100. (Percentages of those who could obtain coverage for $100 or less by state are shown in Table 13 in the Appendix at the end of this brief.)

TABLE 3

It Pays to Shop: Percent of Current Marketplace Enrollees Who Could Obtain Coverage for $100 or Less after Any Applicable Tax Credits in 2015, 35 States

Regardless of Metal Level in 2014

Monthly Premium After Tax CreditsAny Plan TypeBronzeSilverGoldPlatinum
$100 or less79%79%64%36%9%
$50 or Less66%66%42%8%1%
$50 to $10012%12%22%27%8%

Source: Plan information is from the plan landscape files as of November 2014 for 35 states. Enrollment information is based on active plan selections by in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2015 premiums and tax credits based on the same age, family composition, and household income as percentage of the FPL as in 2014. This analysis includes only enrollees who could be linked to complete plan and premium data for both 2014 and 2015, and excludes tobacco users. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the “Methods and Limitations” section at the end of this brief for more details.


Table 4 shows the percentage of current Marketplace enrollees who could get covered for $100 or less, taking into account any applicable tax credits, if they keep their current plan and do not switch to a lower-premium plan for 2015. For example, 58 percent of Marketplace enrollees who selected a silver-level plan in 2014 will have 2015 coverage for $100 or less if they do not change plans.

TABLE 4

It Pays to Shop: Percent of Current Marketplace Enrollees Who Would Be Covered for $100 or Less after Any Applicable Tax Credits in 2015, 35 States

If They Did Not Switch Plans

Monthly Premium After Tax CreditsAll Plan TypesBronzeSilverGoldPlatinum
$100 or less50%47%58%8%4%
$50 or Less26%26%31%1%0%
$50 to $10023%20%27%7%3%

Source: Plan information is from the plan landscape files as of November 2014 for 35 states. Enrollment information is based on active plan selections in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2015 premiums and tax credits based on the same age, family composition, and household income as percentage of the FPL as in 2014. This analysis includes only enrollees linked to complete plan and premium data for both 2014 and 2015, and excludes tobacco users. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the “Methods and Limitations” section at the end of this brief for more details.


However, there may be more affordable plans in 2015 available to current enrollees. Table 5, below, shows the percentage of current Marketplace enrollees in the 35 states that could get coverage for $100 or less, taking into account any applicable tax credits, while staying in their current metal level. For example, 65 percent of all people who selected a plan in 2014 could get coverage for $100 or less if they selected a lower-premium plan in their same metal level. Of those who selected a silver plan in 2014, 77 percent could get silver plan coverage for $100 or less in 2015 if they choose a lower-cost plan.

TABLE 5

It Pays to Shop: Percent of Current Marketplace Enrollees Who Could Obtain Coverage for $100 or Less after Tax Credits in 2015, 35 States

within Their Current Metal Level

Monthly Premium After Tax CreditsAll Plan TypesBronzeSilverGoldPlatinum
$100 or less65%58%77%14%7%
$50 or Less45%39%54%2%1%
$50 to $10020%19%23%12%7%

Source: Plan information is from the plan landscape files as of November 2014 for 35 states. Enrollment information is based on active plan selections by in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2015 premiums and tax credits based on the same age, family composition, and household income as percentage of the FPL as in 2014. This analysis includes only enrollees linked to complete plan and premium data for both 2014 and 2015, and excludes tobacco users. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the “Methods and Limitations” section at the end of this brief for more details.


10 Represents the percentage of individuals who selected a 2014 Marketplace plan and qualified for an advance premium tax credit (APTC), with or without a cost-sharing reduction, from: HHS, ASPE, May 1, 2014, “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period.”

11 Amy Burke, Arpit Misra, and Steven Sheingold, “Premium Affordability, Competition and Choice in the Health Insurance Marketplace, 2014,” ASPE Research Brief, June 2014.

Conclusion

New and returning customers to the Health Insurance Marketplace will see improved choice and affordable premiums in 2015, a clear sign that the Marketplace is succeeding in creating a competitive and dynamic environment. Consumers should take advantage of this by shopping around to find the plan that best meets their needs and their budget. They can do so by going to HealthCare.gov, which provides information for consumers looking to compare plans on premiums and other plan features.

Methodology and Limitations

Data

The plan and premium data reported here are from the Marketplace QHP landscape individual market medical files, which are publicly available at HealthCare.gov.12 Data were not available for all states. This analysis considers the 35 states which were included in both the 2014 and 2015 Marketplace landscape files: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

 For most State-based Marketplaces (SBMs), comprehensive plan and premium data were not available for both 2014 and 2015. The State-based Marketplaces not included in the analysis in this brief are California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Oregon, Nevada, New York, Rhode Island, Vermont, and Washington. Some State-based Marketplaces submit plan data to the Center for Consumer Information and Insurance Oversight (CCIIO) for display using Federal web architecture. New Mexico’s SBM utilized the FFM platform to support its eligibility and enrollment functions in 2014, will continue to do so in 2015, and is included in this analysis in this brief. Oregon and Nevada did not rely on the FFM platform in 2014 but will in 2015; Idaho relied on the FFM platform in 2014, but will not in 2015.

The analysis in this brief does not include stand-alone dental plans, child-only plans, or small-group Marketplace plans. In our estimates of Marketplace premiums, we also did not consider catastrophic plans, Virginia morbid obesity plans, and their enrollees. Catastrophic coverage is not available to all consumers.

Most of the increase in number of plans available to consumers for 2015 is due to newly available plans on the Marketplaces. However, a small proportion of the increase in plan offerings is due to returning issuers breaking 2014 plans into two or more plans for 2015 because of changes in the Marketplace rules governing premium rates.

Enrollment information is based on active QHP selections in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014. In this brief, we use the term “enrollees” to refer to individuals with active Marketplace individual market health plan selections; it does not refer to “effectuated enrollees”—individuals who selected and paid the premium. Additionally, we exclude tobacco users and morbid obesity plan enrollees from our calculations of average premiums because their premium rates may be higher than standard, non-tobacco rates. Our calculations of the savings from switching plans (Table 2) and premium tax credits (Table 3, 4, and 5) are based on only enrollees whom we were able to link to complete premium and plan data for both 2014 and 2015.


12 The Marketplace plan landscape files can be downloaded at: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researche...

Premiums

In this issue brief, we examine the plans and premiums available at the county level. Because some plans may not serve all counties within a rating area, county-level analysis provides a better approximation of plan availability. Note that analysis in previous ASPE briefs on Marketplace premiums was typically at the rating area level; therefore, numbers in this brief should not be compared against those in previous briefs using rating-area analysis.

Our analysis of premiums in Tables 2-5 considers only current enrollees whose 2014 Marketplace plan is available in 2015, based on each plan’s unique ID code. Consumers can be auto-enrolled into similar coverage even if their exact plan is not available for the next year.

Premium Tax Credits

The Affordable Care Act specifies that an individual or family who is eligible for premium tax credits will be required to pay no more than a fixed percentage of their income for the second-lowest cost silver plan available in the Marketplace in their local area. This applicable percentage varies only by household income as a percentage of the Federal Poverty Level (FPL) and does not depend on household members’ ages, the number of people within the household covered through the Marketplace, or Marketplace premiums. (For examples of 2015 incomes and benchmark premiums for those who are eligible for tax credits, see Table 6.) The applicable percentage is converted into a maximum dollar amount the household is required to pay annually for the benchmark plan, and the tax credit is applied to make up the difference between the maximum dollar amount and the actual premium, if any.13 The exact dollar amount of the tax credit depends on the premium of the second-lowest cost silver plan available to the household and the cost of covering the family members who are seeking Marketplace coverage.

For example, a 27-year-old woman with an income of $25,000 in 2014 would be at 218 percent of the FPL.14 For tax credits in coverage year 2014, the amount she pays for the second-lowest cost silver plan is capped at $145 per month. If her premium for the second-lowest cost silver plan available is $336 per month before tax credits, then the amount of the premium tax credit will be $191 per month—the difference between specified contribution to the benchmark plan and the actual cost of the benchmark plan. Her use of the tax credit is not restricted to the second-lowest cost silver plan. She can apply the $191 per month tax credit toward any plan of her choosing in any metal level. By applying her tax credit to the lowest-cost bronze plan, which may be priced at $199 per month, she could obtain Marketplace coverage for just $8 per month after tax credits. If she picks the lowest-cost silver plan, at $226 per month, she pays just $35 per month after tax credits.

Suppose that for 2015, this woman’s income is again equivalent to 218 percent of the FPL. The maximum she will pay for the second-lowest cost silver plan in her area in 2015 is capped at $148 for 2015 (see Table 6 for 2015 applicable percentages). She can choose to buy the second-lowest silver plan if she wishes, and it will cost her up to $148 after tax credits—regardless of how much the second-lowest silver plan’s actual premium may have increased. Her tax credit for 2015 will be the difference between $148 and what the second-lowest cost silver plan premium would be for her in 2015. Again, she can take her tax credit and apply it to whatever plan in any metal tier that best fits her needs.

TABLE 6

Examples of Maximum Monthly Health Insurance Premiums for the Second-Lowest Cost Silver Plan for Marketplace Coverage for a Single Adult in 201515

Single
Adult
Income 16
Percent of the Federal Poverty LevelMaximum Percent of Income Paid toward Second-Lowest Cost Silver PlanMaximum Monthly Premium Payment for Second-Lowest Cost Silver Plan
$11,670100%172.01%$20
$17,505150%4.02%$59
$23,340200%6.34%$123
$29,175250%8.10%$197
$35,010300%9.56%$279
$40,845350%9.56%$325
$46,797401%Not ApplicableNo Limit

Source: Applicable percentages for 2015 coverage are available at: www.irs.gov/pub/irs-drop/rp-14-37.pdf. The 2014 Federal Poverty Guidelines, used for premium tax credits for 2015 coverage, are at: http://aspe.hhs.gov/poverty/14poverty.cfm.


Many families may also be eligible for premium tax credits. For example, suppose a family with an income of $60,000 was shopping for Marketplace coverage for 2015 for all four family members. The family’s income is equivalent to 252 percent of the FPL; therefore, the family’s premium is capped at 8.15% of income or no more than $407 per month for the benchmark second-lowest cost silver plan in its local area. If the premium for the second-lowest cost silver plan for the family is $805 per month, the family will receive a tax credit of $398, making the premium after tax credits $407 ($805 – $407 = $398). The family can apply its $398 tax credit toward the purchase of coverage in any metal level. Note that the maximum percent of income paid toward the second-lowest silver plan is adjusted annually by a measure of the difference between premium growth and income growth.


13 If the premium of the second-lowest cost silver plan falls below the maximum amount the household pays for benchmark coverage, then the household does not receive a tax credit and pays the full premium for the benchmark plan.

14 For coverage in 2014, the 2013 Federal Poverty Guidelines are used to calculate FPL. For coverage in 2015, the 2014 Federal Poverty Guidelines are used to calculate FPL.

15 For more information on premium tax credits, see the Internal Revenue Service final rule on “Health Insurance Premium Tax Credit,” (Federal Register, May 23, 2012, vol., 77, no. 100, p. 30392; available at: http://www.gpo.gov/fdsys/pkg/FR-2012-05-23/pdf/2012-12421.pdf).

16 Income examples are based on the 2014 federal poverty guidelines for the continental United States. Alaska and Hawaii have higher federal poverty guidelines, which are not shown in this table.

17 In states expanding Medicaid, individuals and families at 100 percent of the FPL who are eligible for Medicaid coverage are not eligible for premium tax credits.

Appendix: Tables by State and City

TABLE 7

Average Monthly Premiums for Second-Lowest Cost Silver Plans for a 27-Year-Old
(Before Tax Credits), 2014 and 2015 in Selected States

StateAverage Second-Lowest Cost Silver Premium
for a 27-Year-Old
20142015% Change
AK$349$44928%
AL$210$2163%
AR$241$234-3%
AZ$164$158-4%
DE$237$2474%
FL$217$2316%
GA$235$220-6%
IA$206$2154%
IL$185$1913%
IN$270$265-2%
KS$196$187-5%
LA$252$2572%
ME$266$262-2%
MI$206$2070%
MO$234$232-1%
MS$311$249-20%
MT$208$196-5%
NC$244$2628%
ND$233$2487%
NE$205$2165%
NH$237$205-14%
NJ$264$259-2%
NM$184$165-10%
OH$216$2202%
OK$175$1845%
PA$200$196-2%
SC$222$2220%
SD$234$216-8%
TN$161$1706%
TX$203$2103%
UT$206$2112%
VA$222$2303%
WI$246$2512%
WV$231$2487%
WY$343$3595%

Source: Plan information is from the plan landscape files as of November 2014 for 35 states.

Note: The numbers in this table represent premiums before the application of tax credits. Premiums are weighted averages across each county in each state, weighted by the number of Marketplace health plan selections in each county, as of May 12, 2014.

TABLE 8

Number of Marketplace Issuers by State, 2014 and 2015 in Selected States

StateNumber of Issuers in StateNet Change in Number of Issuers in StateNumber of New Issuers to the StateNumber of Issuers Exiting the State
20142015
AK22000
AL23110
AR34110
AZ1013330
DE33022
FL1114341
GA59440
IA44000
IL810231
IN49561
KS45110
LA56110
ME23110
MI1216440
MO47330
MS23110
MT34110
NC23110
ND33000
NE44011
NH15440
NJ46220
NM45110
OH1216451
OK64-213
PA1415143
SC45110
SD33000
TN45110
TX1215330
UT66000
VA89110
WI1315220
WV11000
WY22000

Source: Plan information is from the plan landscape files as of November 2014 for 35 states.

Note: An issuer is counted as “new” in 2015 if it did not offer an individual market health plan in a given state’s Marketplace in 2014 based on its HIOS ID number, and “exiting” if it was active in a given state in 2014 but not in 2015.

TABLE 9

Average Number of Marketplace Plans per County, 2014 and 2015 in Selected States

StateAverage Number of Qualified Health PlansNet Change in Average Number of Marketplace Plans, 2014-2015
20142015
AK3428-6
AL61711
AR223412
AZ8171-10
DE19245
FL6642-24
GA224119
IA2723-4
IL38468
IN234320
KS3227-5
LA334411
ME17258
MI296435
MO17203
MS132714
MT264014
NC18268
ND23263
NE23252
NH103828
NJ264519
NM36437
OH305424
OK29290
PA41509
SC255934
SD32386
TN487123
TX25316
UT556914
VA3023-7
WI496718
WV12142
WY164024

Source: Plan information is from the plan landscape files as of November 2014 for 35 states.

Note: Number of plans in 2014 and 2015 represent the average number of Marketplace QHPs per county within each state. Averages are unweighted and exclude catastrophic plans. Rows may not sum due to rounding.

TABLE 10

Average Monthly Marketplace Premiums, Issuers, and QHPs Available by County, 2014 and 2015 in Selected States

State20152014
Total Number of Issuers in StateAverage Number of QHPs per County27-Year-Old with an Income of $25,000Family of Four with an Income of $60,00027-Year-Old with an Income of $25,000Family of Four with an Income of $60,000
AverageAverageAverageAverage
Second Lowest Silver Before Tax CreditSecond Lowest Silver After Tax CreditSecond Lowest Silver Before Tax CreditSecond Lowest Silver After Tax CreditSecond Lowest Silver Before Tax CreditSecond Lowest Silver After Tax Credit***Second Lowest Silver Before Tax CreditSecond Lowest Silver After Tax Credit
AK*228$449$105$1,624$319$349$107$1,265$323
AL317$216$143$783$407$210$145$761$410
AR434$234$143$847$407$241$145$874$410
AZ***1371$158$143$573$407$164$144$595$410
DE324$247$143$893$407$237$145$859$410
FL1442$231$143$835$407$217$145$787$410
GA941$220$143$797$407$235$145$850$410
IA**423$215$143$777$407$206$145$747$410
IL1046$191$143$692$407$185$145$669$410
IN943$265$143$959$407$270$145$978$410
KS527$187$143$677$407$196$145$710$410
LA644$257$143$932$407$252$145$913$410
ME325$262$143$950$407$266$145$962$410
MI1664$207$143$751$407$206$145$745$410
MO**720$232$143$839$407$234$145$847$410
MS327$249$143$901$407$311$145$1,127$410
MT**440$196$143$710$407$208$145$752$410
NC326$262$143$950$407$244$145$883$410
ND326$248$143$898$407$233$145$842$410
NE425$216$143$782$407$205$145$742$410
NH538$205$143$741$407$237$145$859$410
NJ**645$259$143$937$407$264$145$957$410
NM543$165$143$597$407$184$145$665$410
OH1654$220$143$796$407$216$145$783$410
OK429$184$143$668$407$175$145$632$410
PA***1550$196$143$709$407$200$144$725$410
SC559$222$143$805$407$222$145$804$410
SD338$216$143$783$407$234$145$848$410
TN571$170$143$614$407$161$145$582$410
TX1531$210$143$760$407$203$145$736$410
UT669$211$143$681$407$206$145$619$410
VA923$230$143$833$407$222$145$805$410
WI**1567$251$143$909$407$246$145$891$410
WV**114$248$143$900$407$231$145$835$410
WY240$359$143$1,299$407$343$145$1,243$410
35 State Average737$222$143$803$407$218$145$789$410

Source: Plan information is from the plan landscape files as of November 2014 for 35 states.

Note: The average number of QHPs per county is unweighted across counties within a state and excludes catastrophic plans. Premiums are weighted averages across all counties in each state, weighted by the county’s number of Marketplace health plan selections as of May 12, 2014. In this example, the family of four is one 40-year-old adult, one 38-year-old adult, and two children under the age of 21. For households eligible for premium tax credits, after-tax-credit benchmark premiums are capped at a given percentage of household income. As shown in the table, after-tax benchmark premiums will differ slightly between 2014 and 2015 for identical family compositions and income amounts because of changes in the applicable percentages and the Federal Poverty Guidelines. The 2014 guidelines are used to calculate benchmark premiums for coverage in 2015, and 2013 guidelines are used for coverage in 2014. Because poverty guideline thresholds generally increase each year, a given dollar amount of income may equate to a smaller percentage of the Federal Poverty Level (FPL) this year than it did in the year previous. For example, a four-person family with an income of $60,000 is at 252 percent of the FPL by 2014 guidelines and at 255 percent of the FPL by 2013 guidelines. As a result, the percentage of income the family would pay for the benchmark plan is smaller for 2015 than for 2014.

* Alaska’s federal poverty guidelines are higher than those for the continental United States; consequently, the after tax credit premium is lower for a given amount of income.

** In all 35 states, our calculations of premiums after tax credits assume that all members of the family of four making $60,000 would be eligible for premium tax credits. However, in states with higher Medicaid/CHIP thresholds the children would be eligible for Medicaid/CHIP and not eligible for premium tax credits.

*** If the benchmark plan premium is below the applicable percentage of income after tax credit, the tax credit-eligible enrollee pays the actual premium. In Pennsylvania and Arizona in 2014, average premiums for second-lowest silver after tax credit for a 27-year-old making $25,000 were below the amount corresponding to the applicable percentage.

TABLE 11

Second-Lowest Cost Silver Plan Monthly Premiums for a 27-Year-Old
(Before Tax Credits), 2014 and 2015 in Selected Cities

StateCityCountySecond-Lowest Cost Silver Monthly Premium
for a 27-year-old
20142015% Change
AKAnchorageAnchorage$355$44926%
AKJuneauJuneau$334$44934%
ALBirminghamJeff rson$211$2173%
ARLittle RockPulaski$251$245-2%
AZPhoenixMaricopa$161$145-10%
AZTucsonPima$138$1477%
DEWilmingtonNew Castle$237$2474%
FLFt. LauderdaleBroward$199$198-1%
FLJacksonvilleDuval$210$2236%
FLMiamiMiami-Dade$221$2252%
FLOrlandoOrange$225$2448%
FLTampaHillsborough$199$24021%
FLWest Palm BeachPalm Beach$220$2367%
GAAtlantaFulton$205$2092%
IACedar RapidsLinn$209$202-3%
ILChicagoCook$174$1772%
INIndianapolisMarion$290$270-7%
KSKansas CityWyandotte$213$188-12%
KSWichitaSedgwick$184$179-3%
LANew OrleansOrleans Parish$255$243-5%
MEPortlandCumberland$242$231-5%
MIDetroitWayne$184$1882%
MOSt. LouisSaint Louis$216$2265%
MSJacksonJackson$332$253-24%
MTBozemanGallatin$206$195-5%
NCCharlotteMecklenburg$251$2697%
NCGreensboroGuilford$228$25914%
NCRaleigh-DurhamWake$222$25113%
NDFargoCass$222$2230%
NEOmahaDouglas$222$216-3%
NHManchesterHillsborough$237$202-15%
NJNewarkEssex$264$259-2%
NMAlbuquerqueBernalillo$159$142-11%
OHCincinnatiHamilton$196$194-1%
OHClevelandCuyahoga$204$202-1%
OHColumbusFranklin$207$2196%
OHDaytonMontgomery$212$2193%
OKOklahoma CityOklahoma$165$1798%
OKTulsaTulsa$183$1830%
PAPhiladelphiaPhiladelphia$246$219-11%
PAPittsburghAllegheny$139$1411%
SCColumbiaRichland$220$2263%
SDSioux FallsLincoln$217$210-3%
SDSioux FallsMinnehaha$217$210-3%
TNMemphisShelby$159$158-1%
TNNashvilleDavidson$154$1668%
TXAustinTravis$205$197-4%
TXDallasDallas$223$2303%
TXHoustonHarris$201$2052%
TXMcAllenHidalgo$155$1656%
TXSan AntonioBexar$196$191-3%
TXSan AntonioComal$202$195-3%
TXSan AntonioMedina$202$2177%
UTSalt LakeSalt Lake$197$2023%
VARichmondHenrico$208$2132%
WIMilwaukeeMilwaukee$258$2736%
WVHuntingtonCabell$220$2378%
WVHuntingtonWayne$220$2378%
WYCheyenneLaramie$324$3343%

Note: The premiums in this table represent premiums before the application of tax credits. The number of QHPs in the county excludes catastrophic plans. Plan and premium information is from the Center for Consumer Information and Insurance Oversight as of November 2014 for 35 states.

TABLE 12

Number of Marketplace Plans in County, 2014 and 2015 in Selected Cities

StateCityCountyNumber of PlansNet Change in Number of Marketplace Plans 2014-2015
20142015
AKAnchorageAnchorage3428-6
AKJuneauJuneau3428-6
ALBirminghamJefferson102111
ARLittle RockPulaski3834-4
AZPhoenixMaricopa11112716
AZTucsonPima110103-7
DEWilmingtonNew Castle19245
FLFt. LauderdaleBroward13294-38
FLJacksonvilleDuval8644-42
FLMiamiMiami-Dade13790-47
FLOrlandoOrange9853-45
FLTampaHillsborough10253-49
FLWest Palm BeachPalm Beach13294-38
GAAtlantaFulton588931
IACedar RapidsLinn3029-1
ILChicagoCook6514378
INIndianapolisMarion186850
KSKansas CityWyandotte16248
KSWichitaSedgwick3632-4
LANew OrleansOrleans445511
MEPortlandCumberland17258
MIDetroitWayne5212674
MOSt. LouisSaint Louis224119
MSJacksonJackson18246
MTBozemanGallatin264014
NCCharlotteMecklenburg284416
NCGreensboroGuilford17269
NCRaleigh-DurhamWake283911
NDFargoCass24306
NEOmahaDouglas43441
NHManchesterHillsborough103929
NJNewarkEssex264721
NMAlbuquerqueBernalillo42519
OHCincinnatiHamilton6310239
OHClevelandCuyahoga4210260
OHColumbusFranklin265731
OHDaytonMontgomery369256
OKOklahoma CityOklahoma6150-11
OKTulsaTulsa5550-5
PAPhiladelphiaPhiladelphia244016
PAPittsburghAllegheny355823
SCColumbiaRichland286234
SDSioux FallsLincoln32397
SDSioux FallsMinnehaha32397
TNMemphisShelby7210634
TNNashvilleDavidson7210634
TXAustinTravis7611135
TXDallasDallas366428
TXHoustonHarris397132
TXMcAllenHidalgo247955
TXSan AntonioBexar589537
TXSan AntonioComal538027
TXSan AntonioMedina233310
UTSalt LakeSalt Lake859813
VARichmondHenrico4323-20
WIMilwaukeeMilwaukee8410925
WVHuntingtonCabell12142
WVHuntingtonWayne12142
WYCheyenneLaramie164024

Note: The number of QHPs in the county excludes catastrophic plans. Plan information is from the Center for Consumer Information and Insurance Oversight as of November 2014 for 35 states.

TABLE 13

Number of Marketplace Issuers in County, 2014 and 2015 in Selected Cities

StateCityCountyNumber of IssuersNet Change in Number of Marketplace Issuers, 2014-2015
20142015
AKAnchorageAnchorage220
AKJuneauJuneau220
ALBirminghamJefferson231
ARLittle RockPulaski341
AZPhoenixMaricopa10133
AZTucsonPima10122
DEWilmingtonNew Castle330
FLFt. LauderdaleBroward891
FLJacksonvilleDuval451
FLMiamiMiami-Dade990
FLOrlandoOrange561
FLTampaHillsborough660
FLWest Palm BeachPalm Beach891
GAAtlantaFulton484
IACedar RapidsLinn220
ILChicagoCook682
INIndianapolisMarion264
KSKansas CityWyandotte220
KSWichitaSedgwick341
LANew OrleansOrleans451
MEPortlandCumberland231
MIDetroitWayne11143
MOSt. LouisSaint Louis242
MSJacksonJackson110
MTBozemanGallatin341
NCCharlotteMecklenburg231
NCGreensboroGuilford231
NCRaleigh-DurhamWake231
NDFargoCass330
NEOmahaDouglas440
NHManchesterHillsborough154
NJNewarkEssex462
NMAlbuquerqueBernalillo451
OHCincinnatiHamilton7114
OHClevelandCuyahoga7114
OHColumbusFranklin484
OHDaytonMontgomery6104
OKOklahoma CityOklahoma54-1
OKTulsaTulsa54-1
PAPhiladelphiaPhiladelphia462
PAPittsburghAllegheny561
SCColumbiaRichland451
SDSioux FallsLincoln330
SDSioux FallsMinnehaha330
TNMemphisShelby451
TNNashvilleDavidson451
TXAustinTravis792
TXDallasDallas473
TXHoustonHarris682
TXMcAllenHidalgo374
TXSan AntonioBexar594
TXSan AntonioComal462
TXSan AntonioMedina231
UTSalt LakeSalt Lake660
VARichmondHenrico43-1
WIMilwaukeeMilwaukee462
WVHuntingtonCabell110
WVHuntingtonWayne110
WYCheyenneLaramie220

Note: Plan information is from the Center for Consumer Information and Insurance Oversight as of November 2014 for 35 states. Qualified health plan issuers are counted based on unique HIOS issuer ID number.

TABLE 14

It Pays to Shop: Percent of Current Marketplace Enrollees Who Could Obtain Coverage for $100 or Less after Any Applicable Tax Credits in 2015, Regardless of Metal Level Chosen in 2014

StateMonthly Premium After Tax Credits
$100 or less$50 or less$50 to $100
35 State Total79%66%12%
AK82%75%7%
AL78%68%11%
AR77%62%16%
AZ72%49%22%
DE69%52%16%
FL85%76%9%
GA81%71%10%
IA74%57%17%
IL67%49%18%
IN78%67%12%
KS73%56%17%
LA84%76%8%
ME77%63%14%
MI81%67%14%
MO80%69%11%
MS89%82%8%
MT65%48%17%
NC85%76%9%
ND70%51%19%
NE78%61%17%
NH67%51%16%
NJ61%43%18%
NM70%49%20%
OH75%58%17%
OK78%67%12%
PA69%56%13%
SC83%74%10%
SD74%56%18%
TN76%64%13%
TX80%68%12%
UT82%60%22%
VA80%69%11%
WI78%65%13%
WV69%54%15%
WY76%59%17%

Source: Plan information is from the plan landscape files as of November 2014 for 35 states. Enrollment information is based on active plan selections by in the CMS Multidimensional Insurance Data Analytics System (MIDAS) as of May 12, 2014.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2015 premiums and tax credits based on the same age, family composition, and household income as percentage of the FPL as in 2014. This analysis includes only enrollees who could be linked to complete plan and premium data for both 2014 and 2015, and excludes tobacco users. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the “Methods and Limitations” section for more details.

Program
Health Insurance Marketplace