Most people have access to to medium- or high-quality ACA marketplace plans

However, there may be tradeoffs between higher-rated plans and premium costs for marketplace enrollees.

Policymakers should make efforts to ensure that consumers have access to an adequate supply of insurance offerings to be able to choose plans based on quality. (Photo: Shutterstock)

Most consumers who enrolled for coverage on the ACA marketplace in the plan year 2020 had access to medium- or high-quality plans. However, there may be tradeoffs between higher-rated plans and premium costs for marketplace enrollees.

With the development of the ACA Marketplace Quality Rating System, quality ratings ranging from one to five stars now appear alongside listings of plans on HealthCare.gov. The goal is to empower consumers to make better-informed health insurance decisions while also incentivizing improvement of health plan quality through public reporting. These data also allow consumers to assess trade-offs among the breadth of coverage, cost of premiums and quality of marketplace plans.

Related: ACA marketplaces see decreasing premiums, healthier competition

With increasing enrollment in the marketplace, it was unknown whether there is equitable access to plans from high-rated insurers. If counties with a higher concentration of impoverished or racial and ethnic minority customers have access only to plans from lower-rated insurers, it could exacerbate underlying disparities in health care access.

A study reported in Health Affairs used recently released ACA Marketplace Quality Rating System data to examine three main questions. First, what is the variation in quality star ratings across U.S. counties, and what are the characteristics of counties with access to plans from low-, medium- and high-rated insurers? Second, is there a relationship between premiums and quality star ratings? Third, what factors predict county-level access to high-rated plans?

The results suggest three important implications for policymakers:

“Overall, counties with three or more insurers and those with the highest percentage of county residents obtaining individual coverage through the ACA marketplace were most likely to have access to plans from high-rated insurers,” researchers concluded. “Importantly, there does not appear to be any evidence of reduced access to high-rated plans among Black and Hispanic consumers. Policymakers should explore additional options to encourage insurers to enter the ACA marketplace, which remains an important source of nongroup insurance coverage.”

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