Insurer participation in ACA markets grew 20%
The average number of plans available per enrollee quadrupled between 2019 and 2022.
Americans signed up for Affordable Care Act Marketplace coverage at record numbers during the enrollment period that ended on January 15. At least 14.2 million plan selections were reported, according to Insurancenet.com. This reflects a combined total from the 33 states that use the healthcare.gov platform and the 18 state-based Marketplaces.
“The expanded premium tax credits implemented in the American Rescue Plan Act of 2021 remain in place, boosting affordability and capping premiums as a share of income,” said Katherine Hempstead, senior policy advisor for the Robert Wood Johnson Foundation. “While it is not yet clear how much new enrollment will result from the open enrollment period itself vs. the prior special enrollment period, the year-over-year increase in membership is nevertheless impressive, currently estimated at approximately 20%.”
The number of county-level exchange offerings has increased each year since 2019. Initially, issuer participation increased while enrollment was essentially flat. This year featured robust growth in enrollment but some moderation in issuer participation trends.
Although the total number of plan offerings increased about one-third in 2021 (from 10,289 to 13,596), this year’s increase to 15,638 constitutes a growth of about 15%. Additionally, there is a notable shift toward the Marketplace, with the number of exchange offerings growing 20% vs. only 6.8% for off-exchange-only plans. Data from states that use the healthcare.gov platform show that the average number of plans available per enrollee quadrupled between 2019 and 2022.
Key market highlights:
- Ascension, underwritten by US Health and LIfe Insurance Company, made its debut in three states.
- After years of retreating from the markets, CVS/Aetna rolled out health plans in eight states.
- Oscar rolled out new plans in Nebraska, Arkansas and Illinois, as well as co-branded plans with Cigna in three more states.
- Bright Health entered five new states: California, Illinois, Texas, Utah and Virginia.
- Centene expanded its presence in four states
- UnitedHealth offered plans in seven additional states
- Georgia and North Carolina saw the greatest increase in market competition, with the entrance of five and three new insurers, respectively.
Enrollment growth this year so far has been greatest in the 12 states that have not expanded Medicaid, where people with incomes between 100% and 138% of the federal poverty level can enroll in the Marketplace and take advantage of silver plans because of new subsidy provisions.
“In the longer run, if there is substantial growth in the individual market, it may well be more geographically dispersed,” Hempstead concluded. “While plans may be focusing now on areas where uninsurance rates are high, they may also be positioning themselves for the future, when more significant and widespread enrollment growth may come from the employer market or when growth must come through capturing market share.”