What did ACA health insurance cost in your state this year?

In the second HealthSherpa Research “ACA 2018 Open Enrollment Year in Review,” we take a look at how individual states fared with plan premium costs, subsidies, and the types of plans selected. We’ll also look at the gender and age distribution to understand who is electing which plans and what may be driving their choices.

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As we noted in our previous review of 2018 OEP, the majority of consumers who shopped and enrolled via HealthSherpa paid a monthly premium of less than $100. (For a recap infographic, click here.) But as you might expect, the distribution of those premiums were not as low in every state. Here are the average premiums in the Federally Facilitated Marketplace (FFM) states (i.e. states that use healthcare.gov for enrollment fulfillment).

As shown in the map at the top of this article, many states had average net premiums that exceeded $200, with some approaching $500. You can also see that individuals in the most states were more likely to select silver health plans—though the economics of the available options in other states made higher-level gold or lower-level bronze plans more popular.

Premiums and Subsidies

Here were the highest and lowest premiums and subsidies:

A number of factors account for these disparities, First, income levels have a major impact on how much consumers end up paying versus how much subsidy will apply to their monthly premium costs. Second, the average age of consumers is higher in states with higher premiums, which correlates with both higher gross premium costs and higher income for those pre-65 consumers. Finally, the availability of plans can impact total costs to consumers. In states with fewer plans, premium costs may run higher than in states where multiple carriers competed for enrollments. Altogether, these and other factors contributed to the highs and lows noted above.

Demographics

Why is it important to note the gender of the primary applicant for policies? While not a direct correlation, the primary applicant, combined with the total number of applicants and total income can lead to valuable insights about who is shopping for health insurance and what may factor into their choices.

In most states, the primary applicants were women—the highest being Mississippi, at two out of three. Conversely, three in five head-of-household applicants in Alaska were men.

With regard to age distribution, nearly every state saw the majority of its applicants fall in the 50+ (50-65) age range. One notable exception was Utah, the state with the youngest median age (30.2 years old) in the nation. But while Maine has the oldest median age of any state, it was Ohio that saw the highest number of enrollees over age 40 — nearly 82 percent of all enrollments.

Plan Selection

The ACA established the metal level tiers to give consumers a simpler understanding of the actuarial value — the percentage that your insurance pays for your utilization versus what you pay — of their coverage. It was designed to get people into Silver plans by benchmarking subsidies against the lowest-cost silver plan on each state’s individual marketplace. It’s very technical to understand but the important part for consumers is that it impacts what plans will cost and what you get for what you pay. After 2018’s silver plan loading strategy, the vast majority of consumers at the state level chose silver plans. But in some states with less competition among carriers (and therefore different considerations for consumers) other metal levels were more appealing.

So far in 2019, plan costs are staying relatively steady, or even declining in some states, due to more competition among health plans and better data driving health plans to more accurately price their offerings. With this in mind, it will be interesting to see if consumers choose to upgrade their plans or keep them where they were in 2018.

State-by-State Premium Costs

If you live in an FFM state and would like to see how your residents fared for premium costs and subsidy allocations, here’s a detailed look: