ACA premiums are declining in 2020, but costs vary widely between counties: KFF

Affordable Care Act
The Kaiser Family Foundation took a county-by-county look at Affordable Care Act premiums for 2020. (Getty/zimmytws)

Though the average benchmark premium for Affordable Care Act (ACA) exchange plans in 2020 declined, there’s plenty of regional variability in premium costs, according to a new analysis. 

Researchers at the Kaiser Family Foundation (KFF) compared data from insurer filings to state regulators, state exchange websites and the federal exchange HealthCare.gov. They found that overall, the average unsubsidized premiums for the lowest-cost bronze, silver and gold plans decreased by about 3% for the 2020 plan year. 

However, what individual consumers see hit their wallets varies based on their income, the plan level they choose and where they live, according to the report. Average premiums are set to increase in certain counties—Carroll, Tennessee, for example, will see benchmark premiums rise 487% from $33 to $195. 

“For consumers to know how much they will pay, they must return to Healthcare.gov or their state’s exchange each year and carefully consider their options,” the researchers wrote. 

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The analysts found that insurers are continuing to embrace so-called “silver loading” in the absence of cost-sharing reduction (CSR) payments, which were halted by the Trump administration in 2017

The practice was insurers’ response to the end of CSRs, in which they put most premium increases on silver plans that are used to determine federal subsidies, creating an alternative path to reduced cost sharing. 

The Centers for Medicare & Medicaid Services have eyed policy changes that would prevent payers from engaging in silver loading but didn’t pull the trigger for the 2020 plan year. Agency officials also indicated they’re open to a legislative solution that reinstates CSR payments. 

As a result of silver loading, a number of potential exchange enrollees would qualify for zero premium bronze plans instead, according to the KFF report. Many people who qualify for exchange subsidies would also have the option of a “free” bronze or gold plan but would exchange the lack of premium for other cost sharing, the report said. 

Silver plans with lowered cost sharing are typically the highest-value option for subsidized enrollees, the analysis said. 

“Low-income consumers will need to consider whether it makes sense to purchase a metal level other than silver, as a lower premium plan may come with significantly higher deductibles, copays or coinsurance,” the researchers wrote.