Consumers are paying less for ACA plans, even as premiums continue to rise

Healthcare.gov site on computer
Final data from CMS on the 2018 enrollment period show higher consumer satisfaction and higher premiums alongside lower ad spending and a slight dip in enrollment numbers. (FierceHealthcare)

The Centers for Medicare & Medicaid Services (CMS) proclaimed its 2018 open enrollment period a success, citing relatively stable enrollment on reduced costs of outreach and a tightened enrollment period.

The agency’s final report on 2018 enrollment data provides insight on the 11.8 million individuals who enrolled or renewed coverage through the exchanges in 2018. That number includes approximately 8.7 million who signed up through HealthCare.gov, where the average premium rose 30% from $476 last year to $621 this year. A solid majority of consumers opted for the middle-tier silver plans, with 29% choosing bronze plans and only 7% purchasing gold plans.

CMS Administrator Seema Verma lauded the agency's efforts on Twitter, but pointed to the 30% jump in premiums as an indication that "more affordable options are needed," particularly for those that don't qualify for tax credits.   

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Despite higher premiums, consumers that qualified for the tax credit actually saw a 16% decline in their final cost, with average monthly costs dropping from $106 in 2017 to $89 in 2018. 

"The reduction in price that consumers paid was staggering," Josh Peck, co-founder of Get America Covered and former chief medical officer of Healthcare.gov under President Barack Obama, told FierceHealthcare.

"To be totally honest, enrollment would have been far higher had they tried," he added.

RELATED: ACA exchange enrollment totals 11.8M in 2018, down 3.7% from last year

While the total number of enrollees dipped slightly year over year, they remained relatively stable given the shortened time frame rolled out by the Trump administration. Verma also pointed to consumer satisfaction scores of 90%, up from 85% last year, as proof the agency had met its primary goal of ensuring “a seamless experience” for consumers.

Critics, however, lashed out at CMS for doing little to educate the public about open enrollment options.

The agency also touted the cost effectiveness of the enrollment period, after CMS slashed its advertising spending from approximately $11 per enrollee last year to just over $1 per enrollee in 2018. Those cuts spurred increased advertising dollars from private insurers in an attempt to make up the gap.

RELATED: Private insurers step in to fill void of open enrollment advertising

The majority of consumers using the exchanges continues to rely on premium subsidies. The age mix among consumers trended older, as enrollees aged 55 and over ticked up two percentage points to 29%, while the share of those aged 18-34 declined slightly.

In a statement, Verma said she was pleased with the rise in customer satisfaction, but expressed concerns about the future. “Even with the success of this year’s open enrollment, the individual market continues to see premiums rise and choices diminish,” she said.

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