Premiums paid by unsubsidized ACA consumers remain near record highs: study
Hard facts about the ACA’s overlooked or forgotten enrollees: middle-income Americans just beyond the reach of subsidy assistance.
Despite the enactment of the American Rescue Plan in March, some Americans continue to fall through the cracks and don’t receive federal subsidies in the form of advanced premium tax credits.
“We often referred to these as the ACA’s overlooked or forgotten enrollees: middle-income Americans just beyond the reach of subsidy assistance who were asked to pay monthly premiums that were often seriously financially burdensome or else risk going uninsured,” according to the ACA Index Report on Unsubsidized Consumers from eHealth.
The report has researched cost and plan selection trends among this group each year since 2014. Among this year’s highlights:
Average monthly premiums hovered near record highs. Average individual premiums decreased 1 percent year over year, from $456 to $450 per month. Average family premiums remained essentially unchanged, at $1,157 per month.
Five-year trend lines marked a steep increase in premiums. Since 2016, average premiums increased 40 percent, while family premiums increased 39 percent.
Average deductibles continued to rise. Average annual deductibles for individual plans increased 4 percent since 2019, while deductibles for family coverage increased 7 percent in the same period. Older ACA consumers paid nearly three times as much as those aged 18 to 24, but average premiums decreased since last year.
- Average monthly premiums for those ages 18 to 24 decreased 4 percent, from $278 to $267.
- Average monthly premiums for those ages 35 to 44 decreased 5 percent, from $411 to $391.
- Average monthly premiums for those ages 55 to 64 decreased 2 percent, from $784 to $771.
Annual potential costs for four-person families topped $25,000. For 2021, the average family of four paid $16,776 in annual premiums and faced an annual deductible of $8,440.
- Premiums for four-person families have averaged in the $1,350 to $1,450 range for four years.
- Average premiums for four-person families decreased 3 percent between 2020 and 2021 (from $1,437 to $1,398).
- However, 2021’s average premium for four-person families was still 62 percent higher than in 2014.
- Over the course of a year, unsubsidized four-person families paid an average of $16,776 in premiums alone (not counting an average deductible of $8,440 for four-person families).
Silver plans topped bronze plans for the first time. More unsubsidized consumers chose silver plans than bronze plans for the first time since eHealth began tracking trends in 2014.
- Thirty-nine percent of individuals and families chose silver plans for 2021, compared to 34 percent the year before.
- Thirty-six percent chose bronze plans, compared to 42 percent the year before.
- Seventeen percent chose gold plans, compared to 14 percent the year before.
EPO plans continued to increase in popularity. As of 2021, EPO plans accounted for more than a third (35 percent) of all plan selections, while HMO plans accounted for about half and PPO plans for 17 percent.
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