Fact sheet
Data on 2019 Individual Health Insurance Market Conditions

Oct 11, 2018
CMS

Data on 2019 Individual Health Insurance Market Conditions

The Centers for Medicare and Medicaid services released data showing average premiums rates will drop in 2019 for individual health insurance plans sold on the HealthCare.gov platform.

Specifically, the average premium for the Second Lowest Cost Silver Plan (SLCSP) is expected to drop by 1.5 percent. In addition, more health insurers are entering the market in 2019, providing more plan choices for consumers. These developments suggest health insurance markets across much of the country are stabilizing after a number of difficult years.

Individual health insurance markets across the country have experienced substantial disruption in the years following the implementation of the Patient Protection and Affordable Care Act (PPACA). Average premiums more than doubled between 2013 and 2017 and increased another 27 percent in 2018. In addition, many issuers dropped out of the market in recent years, leaving more than half of U.S. counties with only one issuer in plan year 2018. Rising premiums and fewer choices resulted in a large portion of unsubsidized people dropping out of the market.

Between 2016 and 2017, unsubsidized enrollment declined by 20 percent nationally, with six states losing over 40 percent of their unsubsidized enrollment.

CMS took immediate administrative actions in 2017 to address market stability issues and to improve the performance of the Exchange in order to mitigate the deterioration of the individual health insurance market. These actions focused on improving the individual market risk pool by encouraging people to maintain continuous coverage and attracting younger and healthier people to join the market.

After implementing these administrative actions, market conditions moving into plan year 2019 substantially improved. Data shows 2019 premiums are stabilizing for plans sold on the HealthCare.gov platform.

• Average 2019 premium rates for a benchmark plan represent the first decline in rates since the Federally-facilitated Exchange began in 2014.
  • The average second lowest cost silver plan (SLCSP) premium decreased by 1.5% in 2019. By comparison, the average SLCSP increased by 37% from 2017 to 2018.
• Actual premium increases on average may be even lower, as consumers “buy-down” coverage. When faced with high premiums, consumers have the opportunity to buy-down to coverage with higher cost sharing and lower premiums.
• Stabilizing premiums will help retain healthier people in the risk pool.

Alongside stabilizing premiums, issuer participation is also growing and expanding across the country, making health insurance markets more competitive and driven to deliver better value to consumers.

• In 2019, both market participation and county coverage are recovering from the drop seen in 2018.
  • There are 23 more issuers for 2019 than were participating during open enrollment in 2018.
• 29 current issuers are expanding their service area into more counties.
• Anthem, Wellmark, Molina, and Cigna have returned to markets they left in 2016 and 2017.
• The number of single-issuer counties has decreased.
  • 39% of counties in the FFE have a single issuer compared to 56% in 2018.
  • This means that 19.8% of enrollees have access to only one issuer down from 29.5% in 2018, and the majority of enrollees (58.0%) now have access to three of more issuers.
  • Only 5 states (AK, DE, NE, MS, WY)* will have only one issuer in 2019, compared to 10 states in 2018.