60% of ACA exchange insurers plan to broaden participation in 2020: survey

Affordable Care Act
Many insurers plan to up their Affordable Care Act offerings in 2020. (Getty/zimmytws)

Insurance companies plan to up their number of Affordable Care Act (ACA) plans available in 2020, according to eHealth’s latest survey (PDF) of health insurance companies on enrollment trends.

As of May, 45% of insurers said they intend to add to the number of ACA plans they will offer in 2020, compared to 21% who added plans for 2019. Overall, 60% said they plan to "broaden" their participation in the markets next year.

So why expand? A majority, 78%, said expansion aligns with the overall company mission; 44% said because the market has stabilized; and 33% intend to expand because the ACA market has become profitable for their company.

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"Insurers that have stayed in the ACA market have generally found a way to be profitable. I think our survey suggests they expect a certain amount of stability in the market for the foreseeable future, giving them confidence to consider modest expansions in their product offerings," an eHealth spokesperson told FierceHealthcare.

Also, 42% of insurers expect to raise premiums between 5% and 10% over 2019, 23% don’t expect to make changes to premiums and 23% expect to reduce monthly premiums by 5% or more.

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Most insurers surveyed said that the ACA’s last open enrollment period had predictable sales, while 15% said sales outpaced expectations by 10% to 15% and another 15% said sales were 10% or more below expectations.

More than half, 58%, of insurers do not intend to make changes to out-of-pocket expenses in their 2020 ACA plans; 17% will increase deductibles by 10% or less; and 17% will increase deductibles by more than 10%.

Also, about 67% of respondents said that elimination of the ACA tax penalty has had no major impact on member retention, but another 33% said they did lose members as a result.

In addition, Most insurers predict instability and higher premiums for older, sicker consumers if Texas vs. Azar is upheld  (82%). A quarter said they would expand their presence in the market as a result of the higher premiums, and 6% said they would leave the individual and family market entirely.

RELATED: Millions spent 10% of income on premiums in 2016—2017: study

So unless there is an appeal, 82% of respondents said Texas vs. Azar will not affect their plans already in place for 2020.

Most insurers also don’t expect to see the fruition of "Medicare for All" anytime soon. About 24% said this is a political issue that they are not taking seriously, up from 7% in 2018. Only 6% believed big changes to Medicare are possible in the future, compared to 27% in 2018.

"Barring any political or policy upheavals, it seems that the ACA market has found a point of relative equilibrium, and that we’re unlikely to see major insurer withdrawals from the market in the near term," the eHealth spokesperson added. "There may also be more plans for consumers to choose from during the next open enrollment period. That said, it’s still a tough market for middle-income folks who earn just a bit too much to qualify for government subsidies. As we reported some time ago, the average monthly premium for unsubsidized individuals buying ACA coverage on their own for 2019 is $448 per month, while the average for family coverage is $1,154 per month—that’s nearly $14,000 a year in premiums alone (not counting deductibles and copays) for the average family. Unfortunately, many people who do not qualify for subsidies are finding themselves priced out of this market."

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