State Actions to Address Health Insurance Exchanges

2/25/2020

For individuals who purchase their own health insurance, many will shop for health care plans through a state or federal marketplace, or “exchange,” established by the Affordable Care Act (ACA). Individuals can enroll in a new health care plan, modify their current coverage or change to a new health plan during an annual period known as open enrollment. Open enrollment for the upcoming year runs from November 1 through December 15—though some states have extended their open enrollment period.

The enrollment process varies state-to-state depending on the type of exchange a state maintains. Most Americans shopping for a health plan will do so on the health insurance marketplace through the federal website, www.HealthCare.gov. Some states, however, maintain state-run exchanges where individuals enroll through a state-based website. The following are the different structures of marketplaces available to states:

  1. Federally-facilitated Marketplace (FFM): The federal government performs all marketplace functions and consumers enroll in a health plan through HealthCare.gov.
  2. State-based Marketplace-Federal Platform (SBM-FP): States are responsible for several marketplace functions, including consumer outreach, enrollment assistance and oversight of participating health plans. Consumers, however, enroll through HealthCare.gov. Additionally, states rely on the federal government for eligibility and enrollment functions.
  3. State-Federal Partnership (SFP): States may choose to be responsible for a combination of marketplace functions, including outreach, enrollment assistance and oversight of participating plans. Consumers, however, enroll through HealthCare.gov. States also rely on the federal government for eligibility and enrollment functions.  
  4. State-based Marketplace (SBM): States are responsible for all marketplace functions. Consumers enroll for a health plan through a state-based website rather than enrolling through HealthCare.gov.

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State-based Marketplace State-based Marketplace-Federal Platform Federally Facilitated Marketplace

Map of Health Insurance Exchange Structures – 2020

DC PR MP GU AS VI AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

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Note: While State-Federal Partnership states conduct some plan management activities for certifying qualified health plans, they are considered FFM in the above map. 

Health Insurance Plan "Metal" Categories

Health plans sold on the state and federal marketplaces often cover four “metal” categories: Bronze, Silver, Gold and Platinum. Some marketplaces, like Idaho’s SBM, do not offer platinum plans.

The category is determined by how a health insurer and consumer split health care costs. For example, a bronze plan will have the lowest monthly premium but higher out-of-pocket costs when a person seeks care. A platinum plan, however, will have the highest monthly premium but the lowest out-of-pocket costs when a person seeks care. Some consumers may also purchase catastrophic health plans which offer low premiums but very high deductibles.

Archived Information

NCSL Session  in DC - Dec. 6, 2018

"Changes Affecting the Private Health Insurance Market" Health exchanges and subsidies, new short-term and association health plans, changes to state insurance oversight,1332 or other innovation waivers…what does this all mean for states? As states wrap up open enrollment for health coverage, come hear national experts share their views on the roles state legislatures can play in 2019.
 ►Downloads: 
 Private Health Insurance Session Speakers | PDF | 
 Sabrina Corlette - speaker slides | PDF |
• Brian Webb - NAIC speaker slides| PDF |
• Resource Reports by The Commonwealth Fund | PDF |
• Health Insurance and Exchange Facts from NCSL | 6 pp, PDF |

2019 Plans Now Closed for Consumer Sign-ups

This report has a 2019 Exchange Plans section. It also provides a snapshot and details for 2018 health enrollment  and costs across the 50 states.

Health exchanges, also called marketplaces, were open for business in all 50 states for the sixth year of health insurance sales, beginning Nov. 1, 2018 with open enrollment  for  45 days in the states operated by the federally-designed HealthCare.gov web site. Seven states used their state-run exchanges to extend enrollment later or into January 2019.

Policies are sold across a choice of monthly premium tiers, from the lowest cost "bronze", through a popular standard termed "silver," and the most comprehensive and costly known as "platinum."  This report provides brief explanations and links to more details on the features and state-by-state variations and legislative history.  The map below leads to individual state provisions and operational facts for 2017, 2018 and 2019.

50-State Table of State and Federal Actions to Implement Exchanges or Marketplaces

View, print or download your states in PDF Format. Updated for 2017-2019 plan activity | (58 pages) Includes a full page for each state plus all information in the map.

2019 Health Coverage Year

  • CMS Issues the 2019 Exchange Open Enrollment Period Final Report: The Centers for Medicare & Medicaid Services (CMS) released the final Health Insurance Exchanges 2019 Open Enrollment Report. Specifically, the report shows approximately 11.4 million consumers selected or were automatically re-enrolled in an Exchange plan during the 2019 open enrollment period in the 50 states, plus DC.  This represents a decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year.
  • "Consumers who buy insurance through the Affordable Care Act markets may be pleasantly surprised this fall as average premiums are forecast to rise much less than in recent years. The price of a 2019 policy sold on the ACA exchanges will increase less than 4 percent, according to an analysis of preliminary filings from insurers in all 50 states by ACASignups.net." (NPR News excerpt9/3/2018)

State Run-Exchanges Extend Deadlines Beyond HHS:  Deadlines for 2019 Plan Year Open Enrollment Period in State-Run Marketplaces. ALso two federally-faciltated marketplaces run until February due to hurricane service disruptions

  • Marketplace

    Extended open enrollment

    Date of extension

    # extra days

    California

    Y

    Jan. 15, 2019

    31

    Colorado

    Y

    Jan. 15, 2019

    31

    Connecticut

    N

     

    0

    District of Columbia

    Y

    Jan. 21, 2019

    37

    Florida Y Feb. 2019 60
    Georgia (parts) Y Feb. 2019 60

    Idaho

    N

     

    0

    Maryland

    N

     

    0

    Massachusetts

    Y

    Jan. 23, 2019

    39

    Minnesota

    Y

    Jan.13, 2019

    29

    New York

    Y

    Jan. 31, 2019

    45

    Rhode Island

    Y

    Dec. 31, 2018

    16

    Vermont

    N

     

    0

    Washington

    N

     

    0

    * Data: NCSL analysis of state exchange website, Nov. 9, 2018

  • Enrollment Lags and Gains by Early December (updated 12/13/2018)

    On December 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released its sixth weekly open enrollment snapshot, the last before Saturday’s deadline. Through December 8, more than 4.1 million consumers had selected a plan in the 39 states that use HealthCare.gov. Of these consumers, about 1.1 million were new consumers and more than 3 million were renewing their coverage from last year. The data show that more people are enrolling in coverage as the deadline nears: plan selections are up by nearly 1 million since last week’s snapshot. Despite this uptick, enrollment through HealthCare.gov continues to lag relative to last year. At nearly the same time last year (note that last year’s report includes one extra day), more than 4.6 million consumers had selected a plan through HealthCare.gov. Of these consumers, nearly 1.4 million were new and about 3.3 million were returning customers.
         As with similar weekly reports, lagging metrics are not limited to plan selection: every metric is down compared to last year (except window shopping by CuidadoDeSalud.gov users). Charles Gaba’s detailed analysis shows that enrollment is down in every state that uses HealthCare.gov but trending up for most states with their own marketplaces.  A weak enrollment season will likely erode historic gains made in reducing the uninsured rate since the Affordable Care Act (ACA) was enacted in 2010. Source: HHS and Health Affairs, 12/13/2018.

    How ACA Marketplace Premiums Are Changing by County in 2019 
    Many low-income consumers who are eligible for federal financial help under the ACA can get a bronze-level plan and pay nothing out-of-pocket in premiums in more than 2,000 counties next year, depending on their annual income, according to a new analysis. But such plans can come with higher deductibles and out-of-pocket maximums. (View Issue Brief with interactive state maps) Kaiser Family Foundation, 7/20/2018.
  • Tracking 2019 PremiumsChanges for ACA Exchanges - Update October 2018.

    2019: Health Insurance Premiums by NCSL: Descriptions and 50-state details and comparisons for 2019, 2018, 2017 - View the full report- updated October 2018 
  • Experiences Under the ACA Suggest Association Health Plans Could Harm the Small-Group Insurance Market.  *RECENT*
    The federal rule making it easier for groups to form association health plans may result in higher costs for those who need the ACA’s more comprehensive coverage or don’t qualify for less-regulated plans. Full report by The Commonwealth Fund, 12/4/2018

  • 2019: CMS Publishes 50-State Rate Review: Updated Aug. 1. (Details by insurer and by state for state policymakers and consumers)
    "The Affordable Care Act (ACA) requires that insurers planning to significantly increase plan premiums submit their rates to either the state or federal government for review.The rate review process is designed to improve insurer accountability and transparency. It ensures that experts evaluate whether the proposed rate increases are based on reasonable cost assumptions and solid evidence and gives consumers the chance to comment on proposed increases. The ACA also requires that a summary of rate review justifications and results be accessible to the public in an easily understandable format. This HHS/CMS site is designed to meet that mandate." (transcribed from CMS website)

  • An online tracker monitors preliminary 2019 premiums in the ACA's marketplaces as insurers file rate information with state regulators. Beginning with data from eight states and the District of Columbia, the tracker shows preliminary premium information in nine major cities for the lowest-cost bronze plan and “benchmark” silver plan, which is used to determine the size of the premium tax credits available to low-and moderate-income enrollees. (News ReleaseIssue Brief)
  • Updated Navigator Resource Guide. (November 2018)
    The Guide provides information on recent policy changes, a list of enrollment tools for consumers and assisters, and answers to hundreds of FAQs, ranging from questions about eligibility for marketplace subsidies to post-enrollment issues and small employer coverage. The Guide is a useful resource throughout the open enrollment season. You can access it online via the Georgetown Univ. site.
  • Health Insurance Marketplace Calculator Updated for 2019 (Updated 11/2/2018)
    Health Insurance Marketplace Calculator, posted by Kaiser Family Foundation (KFF), now includes local data on the 2019 health plans being sold through the Affordable Care Act (ACA) marketplaces during the 2019 open enrollment period. With the tool, consumers around the nation can generate estimates of their health insurance premiums and what financial help may be available -- based on household income, family size, ages of family members, and zip code -- for ACA marketplace plans sold in their local area. The calculator also helps consumers determine whether they could be eligible for Medicaid. A Spanish-language version of the calculator is also available. 
         • KFF also offers a searchable collection of more than 300 Frequently Asked Questions about open enrollment, the marketplaces and the ACA. 

  • 2019 Rate Review Information About Your Insurer
    Use for policy analysis - enrollment is closed for federally run exchanges as of 12/15/2018. Select a category of health coverage from the CMS federal website to start: (https://ratereview.healthcare.gov/)

Search ACA-Compliant Products |

Search Transitional and Student Plans

  • Trump Administration Reverses Policy; Will Resume Risk Payments to Health Insurers
    "CMS Adopts the Methodology for the Permanent Risk Adjustment Program under the PPACA for the 2017 Benefit Year"

    The Trump administration, in an abrupt reversal, said on July 24 that it would restart for 2018 & 2019 the ACA provision and program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act. The administration suspended the program less than three weeks ago, saying it was compelled to do so by a federal court decision in New Mexico. But the administration said Tuesday that it would restore the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers.
          “This rule will restore operation of the risk adjustment program, and mitigate some of the uncertainty caused by the New Mexico litigation,” said CMS Administrator Seema Verma.  “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today.  Alleviating concerns in the market helps to protect consumer choices.” (CMS full announcement | Article by NY Times, 7/24/2018) 

  • ACA statutory and regulatory exemptions from the requirement to obtain minimum essential coverage- updated Sepember 2018 (CMS and NCSL descriptions)

  • Key Obamacare plan premiums will jump 15 percent next year, Congressional Budget Office Estimates. The price of closely watched Health Exchange "benchmark silver-level" plans w ill rise as estimated 15 percent for 2019 the CBO projected in a report released May 23, 2018.
  • Exchange Operations Manual, 2019:
    he Centers for Medicare & Medicaid Services (CMS) released an updated version of the Federally-facilitated Exchange and Federally-facilitated Small Business Health Options Enrollment Operational Policy and Guidance manual to provide operational guidance for issuers to implement regulations. The information applies to the individual market Federally-facilitated Exchanges (FFEs), the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) and to State-based Marketplaces and SHOPs that use the federal eligibility and enrollment platforms (SBEs-FP). Topics covered include, but are not limited to, initial open enrollment periods and effective dates, premium payment, direct enrollment, special enrollment periods, and enrollment terminations. (Full manual - 195 pp, PDF) 6/26/2018.

  • CMS Announces Reduced New Funding Opportunity for Federally-run Exchange Navigator Program
    Your state still can benefit. CMS expects to award up to $10 million for a 1-year period of performance. A minimum of $100,000 will be awarded in each of the 34 FFE states to provide assistance to Exchange consumers, starting in the fall of 2018. Awards will go to eligible grantees, such as chambers of commerce, small businesses, trade associations, and faith-based organizations. Th amoung is a significant from for last year’’s $36 million to $10 million for the upcoming 45-day enrollment period. In August 2017 the Trump administration decreased navigators’ funding by 40 percent from $62.5 million — and cut advertising  and other outreach activities by 90 percent to $10 million. To view the Funding Announcement (FOA), visit: www.grants.gov , and search for CFDA # 93.332.  READ MORE: CMS release, 7/10/2018
    • States that run their own marketplaces are not included in the federal navigation program. "But some of them are continuing to put resources into enrollment. California’s 2017-18 marketing budget stands in stark contrast to the federal government’s. The state is poised to spend $111.5 million advertising Obamacare, more than 10 times what CMS plans to spend in 38 states." according to Kaiser Health News, 7/10/2018
  • Overview of Final 2019 Payment Notice - Health Insurance Marketplace - CMS notice to states in a slide summary format, May 2018 (download, 36 pp , PDF)

  • The Effects of Federal Policy: What Early Premium Rate Filings Can Tell Us About the Future of the Affordable Care Act. "Insurers have started to propose some pretty eye-popping premium increases for Affordable Care Act coverage in 2019. CHIR expert Sabrina Corlette dug deep into the companies’ actuarial memos to find out what’s causing the price hikes & found that recent changes in federal policy are making a big difference." 
    Filed Rate Examples: States with deadlines in May, include VirginiaMarylandVermont and Oregon. In these states, proposed rate changes vary from a 9.58 percent decrease (PacificSource in Oregon) to a 91.4 percent increase (CareFirst of Maryland’s Blue Preferred product). Published by Georgetown Univ CHIRin collabotration with The Commonwealth Fund, May 21, 2018.​
  • Health News on Costs and Insurance - NCSL web feature with links to recent articles and reports. Updated regularly for 2018. 
  • State Laws and Actions Challenging Certain Health Reforms (Dec. 14, 2018 update)

    Learn about state laws and actions in 22 states opposing or opting-out of elements of health reforms, updated for 2014-2018. The report includes descriptions of court cases ruled on or advanced throughout 2017-18, including the Texas district court ruling judging the entire ACA unconstitutional.

2018 Health Exchange Coverage Year Plans and Activities

The information below generally applies to health insurance policies available for sale as of Nov. 1, 2017, that took effect for coverage Jan. 1, 2018 through Dec. 31, 2018.  Special situation enrollment is still open, through Oct. 2018.

2018 UPDATE: The Centers for Medicare & Medicaid Services (CMS) released the Final Enrollment Report for the 2018 Health Insurance Exchanges showing approximately 11.8 million consumers selected or were automatically re-enrolled in an Exchange plan in the 50 states, plus DC. This includes 8.7 million consumers in the 39 states using Healthcare.gov and 3 million consumers in State-based Exchanges. Compared to prior years, this year’s open enrollment was the agency’s most cost effective and successful experience for HealthCare.gov consumers to date. While the 2018 open enrollment period ran smoothly, Americans continue to experience skyrocketing premiums and limited choice. See the full report here.

  • HHS-CMS Exchange Enrollment Snapshots-July 2, 2018 SEE the latest Trump Administration analysis of their Marketplace implementation.
  • REPORT 1Early 2018 Effectuated Enrollment Snapshot . (12 pp, PDF) July 2, 2018
    REPORT 2Trends in Subsidized and Unsubsidized Individual Health Insurance Market Enrollment. "Average monthly enrollment in individual market plans decreased by 10 percent between 2016 and 2017 at the same time premiums increased by 21 percent." (12 pp, PDF) July 2, 2018
    REPORT 3  The Exchanges Trends Report "This report presents an an HH/CMS analysis of the current condition of the operational and programmatic aspects of the Exchanges. The analysis shows that while CMS achieved the highest stakeholder satisfaction to date, lack of affordability continues to be a driving factor that determines whether currently uninsured consumers choose to buy health coverage through the Exchanges using the Federal platform. (9 pp, PDF) July 2, 2018
     
  • Nearly 11.8M Enroll for Obama Health Law in 2018.  At the conclusion of the 2018 plan year open enrollment numbers were substantial but mixed locally.  [Read article by AP] Feb. 7, 2018.
  • Despite Changes That Undermined ACA Enrollment, 2018 Marketplaces ‘Remarkably Stable.’
    After much drama leading to this year’s open enrollment for Affordable Care Act coverage — a shorter time frame, a sharply reduced federal budget for marketing and assistance, and confusion resulting from months of repeal-and-replace debate — the final tally paints a mixed picture. With all states now reporting, ACA plan enrollment ticked downward this year, a report out Wednesday shows, but states running their own marketplaces saw slight gains and did better than those relying on the federal exchange. [Full article posted by Kaiser Health News], by Julie Appleby, Feb. 7, 2018.
  • Survey of the Non-Group Market Finds Most Say the Individual Mandate Was Not a Major Reason They Got Coverage in 2018, And Most Plan to Continue Buying Insurance Despite Recent Repeal of the Mandate Penalty.  Nine in 10 enrollees in the non-group market say they intend to continue buying their own insurance even after being told that Congress has repealed the individual mandate penalty for not having coverage as of 2019, according to a new survey by the Kaiser Family Foundation. The survey finds the mandate, part of the Affordable Care Act, ranks low among the reasons people give for buying their own insurance in 2018. [Read the full report by Kaiser Family Foundation] April 4, 2018.

STATE Run by
(codes below)
2018 Exchange
Enrollment
(Feb. 7, 2017 update)
2017 Exchange
Enrollment
% Change in
Enrollment
2017 to 2018

Alaska

Federal

18,313

19,145

-4.35%

Alabama

Federal

170,211

178,414

-4.60%

Arizona

Federal

165,758

196,291

-15.55%

Arkansas

State-FP

68,100

70,404

-3.27%

California 

State

1,521,524

1,556,676

-2.26%

Colorado

State

165,777

161,568

2.61%

Connecticut 

State

114,134

111,542

2.32%

Delaware

Fed-state

24,500

27,584

-11.18%

District of Columbia

State

22,469

21,248

5.75%

Florida

Federal

1,715,227

1,760,025

-2.55%

Georgia

Federal

480,912

493,880

-2.63%

Hawaii

State-FP

19,799

18,938

4.55%

Idaho 

State

94,507

100,082

-5.57%

Iowa

Fed-state

53,217

51,573

3.19%

Illinois

Fed-state

334,979

356,403

-6.01%

Indiana

Federal

166,711

174,611

-4.52%

Kansas

Federal

98,238

98,780

-0.55%

Kentucky 1

State-FP

81,155

89,569

10.37%

Idaho 

State

94,507

100,082

-5.57%

Louisiana

Federal

109,855

143,577

-23.49%

Maine

Federal

75,809

79,407

-4.53%

Maryland 

State

153,584

157,832

-2.69%

Massachusetts

State

270,688

266,664

1.51%

Michigan

Fed-state

293,940

321,451

-8.56%

Minnesota 

State

116,358

109,974

5.81%

Mississippi

Federal

83,649

88,483

-5.46%

Missouri

Federal

243,382

244,382

-0.41%

Montana

Federal

47,699

52,473

-9.10%

Nebraska

Federal

88,213

84,371

4.55%

Nevada

State-FP

91,003

89,061

2.18%

New Hampshire

Fed-state

49,573

53,024

-6.51%

New Jersey

Federal

274,782

295,067

-6.87%

New Mexico

State-FP

49,792

54,653

-8.89%

New York 

State

253,102

242,880

4.21%

North Carolina

Federal

519,803

549,158

-5.35%

North Dakota

Federal

22,486

21,982

2.29%

Ohio

Federal

230,127

238,843

-3.65%

Oklahoma

Federal

140184

146,286

-4.17%

Oregon

State-FP

156,105

155,430

0.43%

Pennsylvania

Federal

389,081

426,059

-8.68%

Rhode Island 

State

33,021

29,456

12.10%

South Carolina

Federal

215,983

230211

-6.18%

South Dakota

Federal

29,652

29,622

0.10%

Tennessee

Federal

228,646

234,125

-2.34%

Texas

Federal

1,126,838

1,227,290

-8.18%

Utah 2

 

194,118

197,187

-1.56%

Vermont

State

28,762

30,682

-6.26%

Virginia

Federal

400,015

410,726

-2.61%

Washington

State

242,850

225,594

7.65%

Wisconsin

Federal

225,435

242,863

-7.18%

West Virginia

Federal

27,409

34,045

-19.49%

Wyoming

Federal

24,529

24,826

-1.20%

 

 

2018 Exchange
Enrollment

2017 Exchange
Enrollment

% Change in
Enrollment
2017 to 2018

National Total

 

11,760,418

12,216,003

-3.73%

Federal Only Totals   8,289,073 8,751,102 -5.28%
State and State-FP Only   3,471,345 3,464,901 0.19%

Calculated by AP and CMS/CCIIO; added data and posted by NASHP February 7th, 2018

Individual Marketplace Enrollment Remains Stable in the Face of National Uncertainty - Press release by NASHP 2/7/2018

Majority of people who signed up in ACA exchanges came from Trump statesA year-end 2017 analysis found that more than 4 in 5 people, or 7.3 million of the 8.8 million Americans who signed up for Affordable Care Act plans through the federal exchange this year, came from states that voted for President Donald Trump in 2016. Figures also showed that Florida, Texas, North Carolina and Georgia, which had the highest sign-up rates and accounted for almost 3.9 million enrollees, were all Trump states. CBS News/The Associated Press, 12/26/2017.

State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market. "
The Trump administration’s proposed rules encouraging enrollment in health plans that aren’t ACA-compliant may expose more consumers to fraud and financial risk. ... No state’s regulatory framework fully protects the individual market from adverse selection by the alternative coverage arrangements studied. However, states have the authority to ensure a level playing field among coverage options to promote market stability." Full report, published by The Commonwealth Fund, April, 2018

G.O.P. Attacks on Obamacare Expand Role of Government. Efforts by Republicans to chip away at the Affordable Care Act have left behind a health program ever more reliant on subsidies.While President Trump has insisted that the health law was “essentially” being repealed, what remains of it appears relatively stable. Read article from the NY Times, 12/27/2017          

State-Based Marketplaces Push Ahead, Despite Federal Resistance” 
While the Trump administration has scaled back efforts to provide health coverage, a November report documents how state-based marketplaces have reinforced efforts to stabilize their insurance markets and maintain or grow enrollment for 2018. The brief describes how three-fourths of the state-run marketplaces have extended their open enrollment periods beyond the December 15 federal deadline and worked closely with insurers to ensure consumer choice. Overwhelmingly, states reported that having the flexibility to extend the deadline was critical to fulfilling outreach strategies and giving consumers sufficient time to enroll. In addition, most marketplaces are expanding or modifying their advertising to counter misinformation and remind consumers they are open for business. Read the report posted by Georgetown University’s Center on Health Insurance Reforms for The Commonwealth Fund, 11/2/2017.

Maps: How Premiums Are Changing In 2018.
User-controlled maps illustrate how premiums in Affordable Care Act (ACA) marketplaces changed for 2018 by looking at the change in the lowest-cost bronze, silver, and gold plans by county in states participating in healthcare.gov; counties where an individual’s tax credit covers the full premium of the lowest-cost bronze plan; and counties where the unsubsidized premium for the lowest-cost gold plan has a lower or comparable premium to the lowest-cost silver plan in 2018.
> View map report posted by Kaiser Family Foundation analysis of premium data from Healthcare.gov. 10/30/2017.

States Where Health Exchange Premiums Are Increasing. In the week before the 2018 open enrollment period began, an independent health policy report about the state of premiums on the health exchanges created by the ACA/Obamacare. The new analysis from Avalere of filings from the 40 Healthcare.gov states," shows exchange premiums for the most widespread type of exchange plan (silver level) will be 34 percent higher, on average, compared to last year's 25 percent." These averages omit the 10 states that run their own exchanges and sometimes outpace the federally run versions.

  • Largest Increases: in Iowa (69 percent), Wyoming (65 percent) and Utah (64 percent). Iowa requested to waive certain aspects insurance to avoid large increases, but was forced to withdrew their request on Oct. 23 when it became clear that it would be rejected by the Trump administration.
  • Premium decreases: In Alaska, by 22 percent; in Arizona, by 6 percent; and in North Dakota, by 4 percent.

(From NCSL TODAY):

Obamacare curveball: free insurance in 1,500-plus counties. In an odd twist, low-income people in about half of U.S. counties will now be able to get a taxpayer-subsidized "Obamacare" policy for free, according to a new study that suggests some actions by President Donald Trump against the health law could backfire. AP news, 11/1/2017.

2018 health exchange premium for "Silver: level plans -40+ states

  • 2018 Premium Table for Average Bronze, Gold and Platinum Health Exchange Plans (Healthcare.gov states only) - Open in new window
  • HHS announced a 90% cut to funds for health enrollment programs in all 50 states - from $100 million for fall 2016, down to $10 million for fall 2017. Additionally, grants to about 100 nonprofit groups, known as navigators, that help people enroll in health plans offered by the insurance marketplaces will be cut to a total of $36 million, from about $63 million. [Read CMS Bulletin, Aug. 31, 2017]; additional news and analysis online: Kaiser Health News | N.Y. Times |
  • Where exchanges potentially have changed or reduced insurers in 2018
    • Centers for Medicare and Medicaid Services posted an update to the HHS Health Insurance Exchanges Issuer Map by County. It shows every county with at least one insurer on the marketplace (exchange) in 2018. Updated Oct. 20, 2017. 

50-state map of number of insurers by county-Sept. 2017

  • On July 10 2017 The Centers for Medicare and Medicaid Services released a press statement stating that 141 insurers had applied for participation in the federal exchange for 2018 in the 39 states it serves. This is down from the 227 initial applicants for 2017 and the 167 insurers that actually offered coverage in 2017. This destabilization is happening despite the fact that insurers in the individual market are doing much better financially so far in 2017 than they have in recent years. Insurers and insurance regulators have repeatedly identified ongoing uncertainty about whether the government will continue the CSR payments as a major cause of insurer reluctance to participate in the exchanges for 2018. Read more from Prof. Tim Jost in Health Affairs, 7/11/2017.
  • NCSL Session: "Fixing Health Care: What's Next?"- held Aug 8, 2017 in Boston. See Agenda and Speakers.
  • The  "2018 Federal Poverty Guidelines" were released by HHS in January 2018.  The guidelines increase the basic poverty number for an individual to $12,140, from $12,060 for 2017. The effect on eligibility for subsidies was determined at later dates. 
  • Health News on Costs and Insurance - NCSL web feature with links to recent articles and reports. Updated periodically.

Section 1332 of ACA: Federal Waivers Provide Options for States and Insurance

  • Section 1332 Waivers - State Roles and Legislation as of 2018 - NCSL 1332 report shows 19 states with signed laws and just four approved by HHS. - as of October, 2018
    • NCSL Webinar (Part 2): Health Care Waivers in Action: Section 1332 - featuring Cindy Mann, Aug. 4, 2016 - [See description and archive]

NCSL is not responsible for opinions expressed in third party publications.

2017 Coverage Year Benefit and Payment Activities - [For 2011-2017 details offline -members may request this archive]

Individual Mandate Requirements and Penalties
Penalty Eleminated:
In early 2018, the U.S. Congress and the president by a change in federal law, eliminated any financial penalty for not have health coverage. Legally this change takes effect as of 2019 federal tax deadlines. The IRS has indicated it will not be administering tax enforcement during 2018.

For those who are uninsured and do not meet one of the exemptions, the penalty for 2017-2018 is calculated as the greater of two amounts:

  1. A flat dollar amount equal to $695 per adult plus $347.50 per child, up to a maximum of $2,085 for the family.
  2. 2.5% of family income in excess of the 2015 income tax filing thresholds ($10,300 for a single person and $20,600 for a family).

The penalty can be no more than the national average premium for a bronze plan (the minimum coverage available in the individual insurance market under the ACA), which was $2,484 in 2015 for single coverage and $12,420 for a family of three or more children. The penalty is pro-rated for people who are uninsured for a portion of the year and waived for people who have a period without insurance of less than three months.

Table of Penalties Under the Individual Mandate

Year

Percent of Income (%)

Per Adult Penalty ($)

Household Penalty ($)

Prior Tax Year Filing Threshold Individual under 65 

Prior Tax Year Filing Threshold – Married filing jointly under 65

Affordability
Standard (%)

2019**   $0.    Financial penalties will be eliminated
effective Jan. 1, 2019
     

2016-2018*

2.5

$695

2,085

$10,300

$20,600

8.13%

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