Four ways the ACA marketplace has changed coverage options

After just three years of growing pains, Affordable Care Act marketplaces are beginning to take shape, leading payers to refine plan options and premium pricing to better cater to consumers, according to a report from by PwC's Health Research Institute.

Marketplace shifts have changed coverage options in four ways, according to the report:

  • Benchmark premiums are increasing, but at a modest rate: Although the Centers for Medicare & Medicaid Services (CMS) announced premium rates for "benchmark" ACA plans would rise an average of 7.5 percent in 2016, rate changes are dependent on a wide range of factors including location, companies, network types and enrollee demographics. Although populous counties have seen larger spikes in benchmark premiums, average increases have been more in line with employer premiums. The federal government has emphasized that even though premiums are increasing, ACA plans remain affordable.
  • Price leaders are changing year-over-year: Fluctuating premiums and a better understanding of consumers has led insurers to refine plans better suited for buyer needs. As a result, price leaders in each state have changed year-over-year. In 2015 and 2016, the benchmark plan carrier has changed in 60 percent of states, and only nine states have had the same benchmark plan in all three years.  For example, Blue Cross Blue Shield held the benchmark plan in the most populous county in 24 states in 2014, but dropped down to nine states in 2016.
  • Provider-owned plans are increasing: Although some researchers have argued provider-owned ACA plans are doomed to fail, the PwC report indicates marketplace variations have created more space for provider-owned plans. From 2014 to 2016, the percentage of provider-owned benchmark plans jumped from 20 percent to 27 percent. Medicaid managed care plans have also gained more traction, offering 27 percent of benchmark plans, up from 10 percent in 2014.
  • Platinum plans are shrinking: Changes in the ACA marketplace have forced carriers to refine their options. In many cases, that means doing away with platinum plans, primarily because the majority of enrollees received subsidies for silver plans. In 2016, the most populous county in 19 states offered zero platinum plans, up from 12 in 2014. Of the 35 states that used for all three years, 10 states no longer offer platinum plans. Previous reports have indicated that platinum and gold-level plans have experienced severe adverse selection, leading many insurers to stop offering the plans altogether.

 To learn more:
- here's the PwC report

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