Evolving National Picture of ACA Marketplaces

As more data have become available about the Affordable Care Act (ACA), now in its third open enrollment period, The Blue Cross Blue Shield (BCBS) Association has issued a new report about the transition the nation is going though with respect to health insurance.

The report, “The Evolving Affordable Care Act Marketplaces: The 2015 to 2016 Transition,” published in January 2016, compiles and analyzes a county-level database of every individual market health insurance carrier and product sold across the United States. Nationally, BCBS has more members than any other insurance carrier and more extensive geographic coverage.

3 Main Trends

Overall, the analysis found 3 main trends regarding health insurance in the United States.

A continued wide range of insurance carriers and product choices.

Although some smaller carriers are no longer offering health insurance coverage, choices for consumers are relatively unchanged. On average, consumers in urban markets have 44 product choices in 2016 (down slightly from 50 choices in 2015). Rural markets saw a smaller decline; on average, consumers in rural markets have 32 products to choose from (4 fewer than in 2015).

Carrier offerings are evolving.

Insurers are offering more product choices with networks and benefits designed to offer options to consumers who are seeking lower out-of-pocket costs. The share of health maintenance organization (HMO) and exclusive provider organizations (EPO) products offered increased from 41% in 2015 to 52% in 2016.

In 2015 the lowest-cost silver product in 47% of all counties was an HMO; in 2016 that figure increased to 58%. Some plans offering varying benefit designs are also becoming available. Examples of this are plans that couple a high deductible with 2 to 5 primary care physician office visits before the deductible is met.

Markets are showing less variation in price.

Insurers are able to price their products more accurately as they gained more experience and had more data to use. In 2014, 53% of counties had lowest-cost silver plans priced more than 10% lower than the next-lowest-cost competitor’s option. In 2016, 38% of counties had lowest-cost silver plans priced more than 10% lower than the next-lowest-cost competitor’s option.

The Overall Picture

This picture of the ACA marketplaces for 2015 and 2016 “shows that the choices in healthcare insurance products have changed somewhat over time, as health insurance carriers have responded to the demands of the market with a better understanding of the needs of this new group of consumers,” the report concludes.

While the number of coverage options available for a typical consumer is about the same in 2016 as it was in 2015, carriers are offering more cost-effective choices for consumers seeking lower out-of-pocket costs, the company states.

“With growing experience, insurance carriers are able to more accurately price their offerings, resulting in less variation in premiums for products within the same metal level.”