RESEARCH BRIEF

Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://aspe.hhs.gov

ASPE

RESEARCH BRIEF

HEALTH PLAN CHOICE AND PREMIUMS

IN THE 2017 HEALTH INSURANCE MARKETPLACE

October 24, 2016

The Affordable Care Act (ACA) strengthened protections for consumers who purchase coverage

in the individual health insurance market. Before the Affordable Care Act, individuals could be

denied health insurance coverage based on pre-existing conditions, it was difficult for consumers

to make apples-to-apples comparisons among plans and premiums, and people without

employer-sponsored health insurance or who were ineligible for public programs (such as

Medicare, Medicaid, and the Children’s Health Insurance Program) generally received no

financial help paying for coverage. Today, the Health Insurance Marketplace gives eligible

consumers options when purchasing a health plan, provides consumers with tools to compare

options, and offers financial assistance in the form of advance premium tax credits that reduce

the cost of health insurance to the majority of enrollees.

When the 2017 Open Enrollment Period begins on November 1, 2016, millions of Americans

will once again be able to shop for high-quality, affordable health care coverage through the

Marketplace.

The Marketplace is welcoming new consumers and encouraging those who have

previously enrolled to come back, update their information, and select the plan that best meets

their needs and budget. All plans in the Marketplace cover essential health benefits and

recommended preventive care. Consumers can see detailed information about each health

insurance plan offered in their area, in addition to estimated yearly out-of-pocket expenses,

before they apply. HealthCare.gov has tools to help consumers evaluate plans based on factors

important to them, such as premiums, deductibles, out-of-pocket costs, provider network,

prescription drug formulary, customer service, and more.

Consumers may be eligible for

The Health Insurance Marketplace includes the Marketplaces established in each of the states (and the District of

Columbia) and run by the state or the federal government. This report focuses primarily on individual market

Marketplaces using the HealthCare.gov eligibility and enrollment system, and select State-Based Marketplaces. This

analysis excludes stand-alone dental and SHOP plans.

This brief does not analyze consumers’ final expenses, after considering other health plan features, such as

deductibles and copayments. Consumers may examine all elements of health insurance plans in order to estimate

expected total out-of-pocket costs.

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ASPE Office of Health Policy October 2016

financial assistance to help pay for the cost of premiums. In fact, 84 percent of consumers

receive financial assistance (see Table 5 in Appendix A for state data).

This brief presents analysis of Qualified Health Plan (QHP) data in the individual market

Marketplace for states that use the HealthCare.gov Marketplace platform and State-Based

Marketplaces where data is available.

It examines plan affordability in 2017 after taking into

account premium tax credits and also examines the plan choices that new and returning

consumers will have for 2017. This brief shows that the Affordable Care Act is continuing to

promote affordability and choice in the Marketplace for plan year 2017.

This represents the percentage of individuals who have effectuated Marketplace coverage and qualified for an

advance premium tax credit (APTC), with or without a cost-sharing reduction. See: U.S. Department of Health and

Human Services, “First Half of 2016 Effectuated Enrollment Snapshot,” CMS, October 19, 2016, available at:

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-19.html.

These 39 states are: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana,

Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire,

New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South

Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. However,

some tables are limited to the 38 states that were included in the 2016 Marketplace landscape files (excluding

Kentucky). Kentucky is new to the HealthCare.gov platform for 2017. Meanwhile, tables include data for states not

using the HealthCare.gov platform where available. More information is in the methodology and limitations section

of the Appendix.

The 2017 plan landscape file used in this brief is a snapshot of issuer participation and plans as of October 14,

2016 and does not reflect changes in issuer and plan offerings after that date. Similar to last year’s analysis

(available at https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2016-health-insurance-marketplace),

we compare data from the 2017 landscape file to data from the most recent available version of the 2016 landscape

file (dated July 29, 2016 and available at https://www.healthcare.gov/health-and-dental-plan-datasets-for-

researchers-and-issuers/). The 2016 file incorporates some changes in plan offerings that have taken place since the

2016 Open Enrollment Period.

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ASPE Office of Health Policy October 2016

Key Findings

The Affordable Care Act continues to promote access to affordable health insurance plans

through the Marketplace, where consumers can choose the health insurance product that best

meets their needs and budget.

Affordability

 Marketplace consumers will have affordable options. More than 7 in 10 (72 percent)

current Marketplace enrollees can find a plan for $75 or less in premiums per month,

after applicable tax credits in 2017. Nearly 8 in 10 (77 percent) current Marketplace

enrollees can find a plan for $100 or less in premiums per month, after applicable tax

credits in 2017.

 Premium tax credits protect consumers from rate increases. Marketplace tax credits

adjust to match changes in each consumer’s benchmark silver plan premium. A 27-year-

old with an income of $25,000 a year will on average get a monthly tax credit of $160, a

62 percent increase compared to their tax credit in 2016. As a result, this consumer will

pay $142 per month to purchase the benchmark plan in 2017, almost exactly the same as

in 2016, when the consumer would have paid $143.

 Additional consumers are eligible for tax credits. As Marketplace tax credits adjust to

match increases in benchmark premiums, some consumers in areas that had low

benchmark premiums in 2016 may be newly eligible for tax credits in 2017. Of the

nearly 1.3 million HealthCare.gov consumers who did not receive tax credits in 2016, 22

percent have benchmark premiums and incomes in the range that may make them

eligible for tax credits in 2017. In addition, an estimated 2.5 million consumers currently

paying full price for individual market coverage off-Marketplace have incomes

indicating they could be eligible for tax credits.

Choice

 Switching plans can save consumers significant amounts on their premiums. If all

consumers switched from their current plan to the lowest premium plan in the same

metal level, the average 2017 Marketplace premium after tax credits would be $28 per

month less than the average 2016 Marketplace premium after tax credits – a 20 percent

reduction.

 Consumers will be able to choose among plans with different combinations of

premiums, out-of-pocket costs, networks, and other features. All consumers will

have a choice of plans and on average consumers will have 30 plans to choose from,

including 14 silver plans and 10 bronze plans (the most popular metal levels selected by

9 out of 10 Marketplace enrollees). In addition, nearly 8 out of 10 (79 percent)

consumers returning to the Marketplace will be able to choose from 2 or more issuers for

2017 coverage. Among people with health insurance coverage through an employer, plan

choice is often considerably narrower. According to a 2015 survey 30 percent of

employees who were offered health insurance were offered only one plan from one

issuer.

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ASPE Office of Health Policy October 2016

Overview

Section I of this brief provides an overview of advance premium tax credits (APTC) and

premiums in HealthCare.gov states and State Based Marketplaces where data are available for

2017 and illustrates how consumers may benefit from returning to the Marketplace to shop for a

plan that meets their needs and budget.

Section II of this brief describes the choices of issuers and plans that consumers will have in the

2017 coverage year in states using the HealthCare.gov platform and in State Based Marketplaces

where data are available.

SECTION I: MARKETPLACE HEALTH PLAN PREMIUMS IN 2016 AND 2017

In this section, we examine the affordability of 2017 Marketplace coverage, taking into account

benchmark premium changes, tax credits, and shopping.

We find that, notwithstanding higher benchmark premium increases than in previous years, the

majority of consumers will continue to have access to affordable coverage because they are

protected by the combination of financial assistance and the ability to shop. Specifically, as

shown in Table 1, 77 percent of returning Marketplace consumers will be able to find a plan for

$100 per month or less and 72 percent will be able to find a plan for $75 or less per month,

similar to these metrics for previous years. (Percentages of those who could obtain coverage for a

premium of $100 or less, $75 or less, and $50 or less by state are shown in Table 8 in Appendix

A.)

TABLE 1. Percent of Current Marketplace Enrollees Who Could Obtain Coverage for $100 or

Less after Applicable Advance Premium Tax Credits in 2017, Regardless of Metal Level

Chosen, in HealthCare.gov States

Monthly Premium After

Advance Premium Tax Credits

Any Plan

Types

Bronze

Silver

Gold

Platinum

$100 or less

77%

76%

63%

13%

$75 or Less

72%

71%

55%

$50 or Less

65%

64%

44%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data

Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the

HealthCare.gov platform in 2017 and is not included in this analysis.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2017

premiums and tax credits based on the same age, family composition, and household income as in 2016. This analysis includes

only enrollees who could be linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users. This

analysis includes both enrollees who will be automatically crosswalked into a 2017 plan with the same issuer and other returning

consumers. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the

“Methods and Limitations” section at the end of this brief for more details.

Benchmark Premium Increases

In the second year of the Marketplace, average premiums for the second-lowest cost silver plan

increased only 2 percent, and in the third year they increased 7 percent. This year, Marketplace

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ASPE Office of Health Policy October 2016

premiums are increasing more than they have the past two years. Through 2016, Marketplace

rates remained below initial projections from the independent Congressional Budget Office, and

below the cost of comparable coverage in the employer market. This year, with two years of

cost data available, issuers are adjusting their premiums to bring them in line with costs. In

addition, some of the ACA’s programs designed to support the new market in its early years are

ending this year, putting transitory upward pressure on premium growth.

Under the ACA, people can no longer be denied coverage because they have a pre-existing

condition, a crucial reform for up to 129 million Americans with conditions like asthma,

diabetes, or heart disease. But because excluding people with pre-existing conditions was

previously allowed in the individual market, there were no data available on how much it would

cost to extend coverage to everyone, and many issuers’ initial premiums were below actual costs.

Notably, Marketplace rates through 2016 remained 12 to 20 percent below initial projections

from the independent Congressional Budget Office.

In addition, Urban Institute researchers

recently found that 2016 Marketplace premiums were well below premiums for comparable

employer coverage.

Even with this year’s increases, Marketplace premiums in 2017 will still be

roughly in line with the projections by the Congressional Budget Office. (See Appendix C for a

detailed discussion.)

Table 6, in Appendix A, shows the estimated increase in the average second-lowest cost silver

plan by state. (The second-lowest cost silver plan is significant because it provides the

benchmark by which tax credits are calculated.) Across states using the HealthCare.gov

platform, the median increase in the second-lowest cost silver plan premium is 16 percent, while

the average increase is 25 percent.

See Table 2 (See Table 13 in Appendix A for information

by select cities and counties).

Levitt, L., Cox, C., & Claxton, G, “How ACA Marketplace Premiums Measure Up to Expectations,” Kaiser

Family Foundation, August 1, 2016, available at: http://kff.org/health-reform/perspective/how-aca-marketplace-

premiums-measure-up-to-expectations/.

Adler, L. & Ginsburg, P. B., “Obamacare Premiums Are Lower Than You Think,” The Brookings Institution, July

21, 2016, available at: http://healthaffairs.org/blog/2016/07/21/obamacare-premiums-are-lower-than-you-think/.

Blumberg, L., Holahan, F., & Wengle, E, “Are Nongroup Marketplace Premiums Really High? Not in Comparison

with Employer Insurance,” Urban Institute, September 2016, available at

http://www.urban.org/sites/default/files/2000931-are-nongroup-marketplace-premiums-really-high-not-in-

comparison-with-employer-insurance.pdf.

There are 39 states using the HealthCare.gov platform for the 2017 plan year. Kentucky is new to the

HealthCare.gov platform for 2017 and is not included in the HealthCare.gov states average or median.

This brief closely follows the actual methodology used to determine the benchmark for advanced premium tax

credits (APTC) and enrollees’ APTC amount. For the purposes of calculating the APTC, a second-lowest cost silver

plan for a specific taxpayer is identified based on what is available to the taxpayer at the time of enrollment, in the

taxpayer’s geographical area. In this brief for analytic purposes, at times we use the term “benchmark plan” to refer

to the second-lowest cost silver plan in a county, which may not be the benchmark plan for all individual consumers.

This brief identifies the second-lowest cost silver benchmark plan based on the portion of the premium that covers

essential health benefits (EHB), which may be less than the full premium price charged by issuers. For more details

on how benchmark premiums are calculated, see the “Methodology and Limitations” section at the end of this brief.

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ASPE Office of Health Policy October 2016

The gap between the average and the median rate increase in HealthCare.gov states reflects that

most consumers are experiencing below average increases. Moderate rate increases or rate

decreases in states like Arkansas, Indiana, Nevada, New Hampshire, New Jersey, North Dakota,

Michigan, and Ohio suggest that Marketplaces in states around the country are maturing and

approaching stable price points. Meanwhile, several of the states experiencing larger increases

had 2016 premiums that were well below the national average and especially far below the cost

of comparable employer plans in that state (for example, Arizona, Hawaii, Illinois, Kansas, and

Pennsylvania).

While complete data on Marketplace premiums in the 12 states not using the HealthCare.gov

platform are not available, data on benchmark premiums are available for four states (California,

Connecticut, Massachusetts, and Minnesota) and the District of Columbia, constituting about 60

percent of State-Based Marketplace enrollment. If these states are included, we estimate that the

increase in the average second-lowest cost silver plan would be 22 percent. In particular,

benchmark premiums in California, which accounts for about half of State-Based Marketplace

enrollment, are increasing by an average of 7 percent.

TABLE 2. Change in Benchmark Premiums from 2016 to 2017, HealthCare.gov States and

Select State-Based Marketplaces for Which Data are Available Before Shopping and Tax Credits

Percent

Average Increase in 2017 Benchmark Premium for HealthCare.gov States

25%

Median Increase in 2017 Benchmark Premium for HealthCare.gov States

16%

Average Increase in 2017 Benchmark Premium for HealthCare.gov States and

State-Based Marketplaces for Which Data are Available

22%

Average Premium Change for Returning Consumers IF All Consumers

Shopped and Selected Lowest-Cost Plan in Metal Level

-20%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data

Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the

HealthCare.gov platform in 2017 and is not included in this analysis.

Note: State-Based Marketplaces for which data are available include California, Connecticut, District of Columbia,

Massachusetts, and Minnesota. We calculated a weighted average increase in the second-lowest cost silver plan including these

State-Based Marketplaces using plan selections in each state from February 1, 2016 (as reported in “Health Insurance

Marketplaces 2016 Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:

https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.). Plan and premium information were provided by

each state, with the exception of Minnesota; data for Minnesota were provided by the state and calculations were done by ASPE.

Financial Assistance

Most Marketplace enrollees will receive financial assistance to help with the cost of their

monthly premiums. Not only do 84 percent of Marketplace enrollees who selected a plan during

Blumberg, L., Holahan, F., & Wengle, E, “Are Nongroup Marketplace Premiums Really High? Not in

Comparison with Employer Insurance,” Urban Institute, September 2016, available at:

http://www.urban.org/sites/default/files/2000931-are-nongroup-marketplace-premiums-really-high-not-in-

comparison-with-employer-insurance.pdf.

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ASPE Office of Health Policy October 2016

the third Open Enrollment period receive tax credits to help pay for coverage

, but we also

estimate that 84 percent of the uninsured who are eligible for coverage through the Marketplaces

have incomes between 100 percent and 400 percent of the Federal Poverty Level (FPL) and may

be eligible to receive tax credits for plan year 2017.

In addition, ASPE recently estimated that

as many as 2.5 million people currently purchasing off-Marketplace individual market coverage

could be eligible for financial assistance if they purchase 2017 coverage through the

Marketplaces.

In total, about 78 percent of all consumers who are uninsured, who purchase

Marketplace coverage, or who purchase individual market coverage outside the Marketplace

have incomes making them potentially eligible for advance premium tax credits.

Consumers who receive premium tax credits are protected by the ACA’s cap on the amount they

pay for the benchmark plan, the second-lowest cost silver plan in their area. For those eligible for

premium tax credits, the law sets a maximum amount of family income (“applicable

percentage”) that can be paid toward Marketplace coverage. This means that no matter the cost

of the benchmark plan in an individual’s area, a tax credit eligible consumer’s premium is

capped. Because the dollar amount of the premium tax credit depends on the benchmark plan’s

premium, the tax credit amount a consumer is eligible for adjusts with the premium of the

benchmark plan. If premiums for all plans in an area rise similarly, the difference between the

maximum required monthly premium and the benchmark premium would increase, resulting in a

higher tax credit that would offset the dollar increase in premiums.

The applicable percentage varies only by household income as a percentage of the Federal

Poverty Level (FPL) and does not depend on household members’ ages, the number of people

within the household covered through the Marketplace, or Marketplace premiums. (For examples

of 2017 incomes and maximum applicable percentages for a single adult who is eligible for tax

credits, see Table 16 in Appendix B.) The applicable percentage is converted into a maximum

dollar amount the household is required to pay annually, and the tax credit is applied to make up

the difference, if any, between the maximum dollar amount and the benchmark premiums for the

family members who are seeking Marketplace coverage.

This represents the percentage of individuals who have effectuated Marketplace coverage and qualified for an

advance premium tax credit (APTC), with or without a cost-sharing reduction and includes SEP enrollment. See:

U.S. Department of Health and Human Services, “First Half of 2016 Effectuated Enrollment Snapshot,” CMS,

October 19, 2016, available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-

sheets-items/2016-10-19.html.

U.S. Department of Health and Human Services, “Marketplace Enrollment Projections for 2017,” ASPE Issue

Brief, ASPE, October 19, 2016, available at: https://aspe.hhs.gov/pdf-report/marketplace-enrollment-projections-

2017.

U.S. Department of Health and Human Services, “About 2.5 Million People Who Currently Buy Coverage Off-

Marketplace May Be Eligible for ACA Subsidies,” ASPE Issue Brief, ASPE, October 4, 2016, available at:

https://aspe.hhs.gov/sites/default/files/pdf/208306/OffMarketplaceSubsidyeligible.pdf.

Ibid.

If the premium of the second-lowest cost silver plan falls below the maximum amount the household pays for

benchmark coverage, then the household does not receive a tax credit and pays the full premium for the benchmark

plan.

The maximum percent of income paid toward the second-lowest cost silver plan is adjusted annually by a measure

of the difference between premium growth and income growth.

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ASPE Office of Health Policy October 2016

The textbox on page 9 provides an illustrative example for a single 27-year-old woman in Dallas,

TX earning $25,000 per year. Based on her income, her maximum monthly payment for the

benchmark plan is $143 in 2016. In the first example, the monthly premium for the benchmark

plan is $216; thus, the woman is eligible for a tax credit of $73 per month, which she may apply

to her choice of a qualified health plan. In the second example, premiums are adjusted to reflect

2017 plan options, making the monthly premium for the benchmark plan $232. Because the

applicable percentage of income that the consumer is required to contribute to the cost of the

benchmark premium remains approximately the same, her contribution to the benchmark plan

remains roughly the same as well at $142, and her tax credit increases to $90 per month to cover

the remaining premium cost. Thus, the consumer has a higher dollar amount of tax credit to

apply to a plan of her choice and, therefore, could pay less out-of-pocket for all plans with

premiums below the benchmark premium cost. This example illustrates that the tax credit

ensures that enrollees can obtain coverage at an affordable price.

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ASPE Office of Health Policy October 2016

Shopping

The Marketplace enables consumers to comparison shop for a plan that meets their needs and

budget. In 2015, 47 percent of individuals who selected a plan in the Marketplace selected the

lowest cost (31 percent) or second-lowest cost plan (17 percent) in their metal tier, and in 2016,

Premium Tax Credits: Examples

Example 1: Single 27-year-old in Dallas, TX with an income of $25,000 for 2016

Calculate her tax credit for 2016 coverage:

 Income as percentage of FPL: 212%

 Maximum monthly payment for second-lowest silver benchmark plan: $143

 Monthly total premium of second-lowest silver benchmark plan: $216

 Advance premium tax credit per month: $216 – $143= $73

Suppose she’s trying to decide among two silver plans and a bronze. She can apply her tax

credit to any of them.

 Before tax credit, the monthly premiums are

o Bronze: $180

o Lowest silver: $214

o Second-lowest silver: $216

 After applying her tax credit, the monthly premiums are

o Bronze: $180 – $73 = $107

o Lowest silver after tax credit: $214 – $73 = $141

o Second-lowest silver after tax credit: $216 – $73 = $143

Example 2: Premiums for a 27-year-old making $25,000 in Dallas, TX for 2017

Calculate her tax credit for 2017 coverage:

 Income as percentage of FPL: 210%

 Maximum monthly payment for second-lowest silver benchmark plan: $142

 Monthly total premium of second-lowest silver benchmark plan: $232

 Advance premium tax credit per month: $232 – $142 = $90

Even if premiums rose from 2016 to 2017, the tax credit protects consumers from higher

prices.

 Before tax credit, the monthly premiums are

o Bronze: $195

o Lowest silver: $227

o Second-lowest silver: $232

 After applying her tax credit, the monthly premiums are

o Bronze: $195 – $90 = $105

o Lowest silver after tax credit: $227 – $90 = $137

o Second-lowest silver after tax credit: $232 – $90 = $142

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45 percent of individuals who selected a plan in the Marketplace selected the lowest cost (30

percent) or second-lowest cost plan (15 percent) in their metal tier.

Previous ASPE analysis

illustrates that Marketplace consumers are active shoppers with a demonstrated willingness to

switch plans to get a better deal. In 2016, nearly 70 percent of HealthCare.gov consumers that

came back to the Marketplace actively selected a plan, and nearly 43 percent of consumers who

reenrolled in a Marketplace plan in 2016 switched to a new plan.

The Marketplace continues to be dynamic, and plans that were the second-lowest cost silver plan

or lowest-cost silver plan in 2016 may not be the second-lowest cost or lowest-cost plan in 2017,

so it will be important for returning consumers to review other options in 2017. The actual

payment made by consumers for their insurance depends on the plan they choose when enrolling

in coverage through the Marketplace and the level of tax credit they qualify for.

In 2017, more than 7 in 10 (76 percent) current Marketplace enrollees can find a lower premium

plan in the same metal level by returning to the Marketplace to shop for coverage rather than

reenrolling in their current plan, as illustrated in Table 3 (next page). For example, the average

lowest-cost premium for a silver plan available to current silver-level enrollees is $433 per

month for 2017 before applicable tax credits. Consumers who bought a silver plan in 2016 would

save an average of $58 a month by switching to the lowest premium plan in 2017. This results in

total premium savings of $691 a year for these consumers.

If all silver plan holders with

potential savings switch to the lowest-cost silver plan available to them for 2017, the total

savings for the year would be $3.2 billion. Across all metal levels, the total premium savings

would be $4.3 billion if all consumers with potential savings switch to the lowest-cost plan

within their 2016 metal level (state-level analyses are in Table 7 in Appendix A).

May not sum due to rounding. Percentages do not include tobacco users.

U.S. Department of Health and Human Services, “Health Insurance Marketplaces 2016 Open Enrollment Period:

Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:

https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.

Average premium savings by switching to the lowest-cost plan within metal level are calculated only for

consumers who would not be automatically crosswalked into the lowest-cost plan within their metal level and thus

have the ability to save by switching. Savings for individual enrollees may differ from this amount based on their

choice of plan, eligibility for premium tax credits, and other characteristics.

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TABLE 3. Potential Savings from Shopping Based on Premium if Current Marketplace

Enrollees Switch to 2017 Lowest-Cost Premium Plan within Metal Level, HealthCare.gov States

Current Marketplace Enrollees

All Plan

Types

Bronze

Silver

Gold

Platinum

Average Lowest-Cost 2017 Monthly

Premium within Metal Level before

Applicable Tax Credit

N/A

$366

$433

$538

$674

% of Enrollees Who Could Save on

Premium Costs by Switching to the

Lowest-Cost Plan in Metal Level

76%

74%

77%

67%

73%

Average 2017 Monthly Premium Savings

from Switching to Lowest-Cost Plan

within Metal Level, Across All Enrollees

$57

$50

$58

$71

$81

ANNUAL Average Savings in Premium

Costs per Enrollee Across All Enrollees

$682

$603

$691

$852

$967

MONTHLY Aggregate Amount of

Savings in Premium Costs Across All

Enrollees

$360 M

$67 M

$270 M

$21 M

$3 M

ANNUAL Aggregate Amount of Savings

in Premiums Costs Across All Enrollees

$4.3 B

$800 M

$3.2 B

$254 M

$32 M

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data

Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the

HealthCare.gov platform in 2017 and is not included in this analysis.

Note: Amounts presented here do not take into account potential premium tax credits. The lowest-cost premium refers to the plan

with the lowest premium within the county within each metal tier. In some cases, plans were tied for lowest premium. This

analysis includes only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users,

who may face additional surcharges. This analysis only includes enrollees who will be automatically crosswalked into a 2017

plan with the same issuer. Catastrophic plans, which are not available to all consumers, were not considered in these calculations.

We assume that all enrollee characteristics are unchanged and calculate premiums based on the same age, family composition,

and household income as in 2016. Metal-level analysis is based on the metal consumers would be automatically crosswalked into

for 2017, based on their metal choice in 2016. The lowest cost plan does not take into account other cost-sharing features, but

refers only to the cost of the premium charged for that plan. See the “Methods and Limitations” section at the end of this brief for

more details.

Health Insurance Plan Affordability for 2017 Taking Into Account Advance Premium Tax

Credits and Shopping

Table 1, on page 4, shows the percentage of current Marketplace enrollees in 38 states who could

get coverage for as little as $75 or less across all available plans. Table 4 (next page) shows the

share who could get coverage for $75 or less taking into account any applicable tax credits while

staying in their current metal level, thereby maintaining comparable responsibility for out of

pocket costs.

For example, nearly 6 in 10 (58 percent) of all customers returning to the

Marketplace can get coverage for a premium of $75 or less if they selected a lower-premium

The health plan category or “metal level” determines how consumers and plans can expect to share the costs of

care. For example, with a silver level plan the health plan pays about 70 percent of the total costs of care for

essential health benefits, on average, and the consumer pays 30 percent of these costs. This takes into account the

plan’s deductibles, copayments, coinsurance, and out-of-pocket maximums.

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ASPE Office of Health Policy October 2016

plan in their same metal level in 2017. Of those who selected a silver plan in 2016, 64 percent

could get silver plan coverage for a premium of $75 or less in 2017 if they choose a lower-cost

plan. (Percentages of those who could obtain coverage for a premium of $100 or less, $75 or

less, and $50 or less by state regardless of metal level are shown in Table 8 in Appendix A.)

TABLE 4. Percent of Current Marketplace Enrollees Who Could Obtain Coverage within Their

Current Metal Level for $100 or Less after Advance Premium Tax Credits in 2017, 38 States

Monthly Premium After

Advance Premium Tax Credits

All Plan

Types

Bronze

Silver

Gold

Platinum

$100 or less

66%

61%

73%

$75 or Less

58%

54%

64%

$50 or Less

48%

45%

52%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data

Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the

HealthCare.gov platform in 2017 and is not included in this analysis.

Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2017

premiums and tax credits based on the same age, family composition, and household income as in 2016. This analysis includes

only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users. This analysis

includes both enrollees who will be automatically cross walked into a 2017 plan with the same issuer and other returning

consumers. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. Metal-level

analysis is based on the metal level consumers would be automatically cross walked into for 2017, based on their metal choice in

2016. See the “Methods and Limitations” section at the end of this brief for more details.

In addition, if every returning consumer nationwide selected the lowest-cost plan available

within their current metal level, average premiums would decrease by $28 per month, or 20

percent, compared to average premiums in 2016 (taking tax credits into account). (Estimates by

state are shown in Table 9 in Appendix A.) In fact, many consumers do not choose the lowest

cost plan available, because they are willing to pay more for a wider network or other plan

features, but this calculation confirms that affordable options for 2017 coverage are available to

consumers who shop around to find a better deal.

SECTION II: CONSUMER CHOICE FROM 2016 TO 2017

With an average of 30 Marketplace plans to choose from in 2017, both new and returning

consumers have options when shopping for coverage.

Issuers

There are 167 issuers participating in the Marketplace in HealthCare.gov states in 2017 (see

Tables 10, 14 in Appendix A). Based on analysis at the county level, the average Marketplace

consumer can choose from 3 issuers in their county for 2017 coverage.

Seventy-nine percent

(or about four in five) of consumers will have a choice of two or more issuers, and 56 percent

will have a choice of three or more (see Table 15 in Appendix B).

Note that some previous ASPE issue briefs on plan choice and availability presented analyses at the rating area

level. Because plans available in some parts of a rating area are not always available in all parts of a rating area,

conducting the analysis at the county level better captures the set of options consumers will see when they shop and

more closely matches consumers’ shopping experience.

ASPE Research Brief Page 13

ASPE Office of Health Policy October 2016

The number of issuers offering health plans in the Marketplace has decreased from 2016 to 2017,

as shown in Table 10 in Appendix A. Across the HealthCare.gov states, 15 new issuers will

begin offering Marketplace plans for the 2017 coverage year, while 83 issuers that offered plans

in 2016 will no longer offer plans through the Marketplace in 2017.

Reduced participation in

large part reflects multi-state withdrawals by a few large insurers; in particular, withdrawals by

United Health and Aetna account for 26 and 17 issuer exits, respectively. A number of other

firms are entering the Marketplace or expanding their participation into new states (or new

service areas within states), but they are doing so more gradually.

Table 10 in Appendix A provides the number of issuers by state for the years 2016 and 2017.

(Not all issuers operate in all counties within a state, however, and thus the number of issuers

available to a particular consumer may be less than the number of issuers that operate anywhere

in the state.)

Plans

Issuers can sell multiple plans across the various metal levels. In 2017, consumers can choose

from 30 plans in their county on average, as shown in Tables 11, 12 in Appendix A, and all

consumers will have a choice of plans. That means all consumers will be able to choose among

different combinations of premiums, out-of-pocket costs, and networks of hospitals and

physicians. Among people with health insurance coverage through an employer, plan choice can

be considerably narrower. According to a 2015 survey 30 percent of employees who were

offered health insurance were offered only one plan by one issuer.

Limited plan choice through

employers is not new. One leading survey estimated in 2005 that 37 percent of workers enrolled

in employer-provided health insurance coverage had only one issuer offering one plan and

another 20 percent of workers had only two plan options.

As shown in Table 15 in Appendix B, there continues to be particularly robust choice among

silver and bronze plans, which were the choice of 68 percent and 23 percent of consumers who

selected a plan during the third Open Enrollment period respectively, with the least choice

among platinum plans and catastrophic plans, which were the choice of only 2 percent and 1

percent of consumers respectively.

Table 15 shows additional details on the number of plans an

average consumer can choose from.

The total number of issuers is calculated based on identifying an issuer by its unique five-digit Health Insurance

Oversight System (HIOS) ID. In some cases, issuers with different HIOS IDs belong to the same parent company.

An issuing entity’s HIOS issuer ID is specific to the state in which it operates, such that a company offering QHPs

through the Marketplace in two states would be counted twice—once for each state. Issuer totals for 2017 and 2016

include 38 states and do not include Kentucky, which is beginning to use the HealthCare.gov platform for the 2017

coverage year.

Agency for Healthcare Research and Quality, “MEPS Insurance Component Chartbook 2015,” August 2016,

available at https://meps.ahrq.gov/mepsweb/data_files/publications/cb20/cb20.pdf.

Kaiser Family Foundation, “Employer Health Benefits, 2005 Annual Survey,” 2005, available at:

https://kaiserfamilyfoundation.files.wordpress.com/2012/09/2005ehbs.pdf.

U.S. Department of Health and Human Services, “Health Insurance Marketplaces 2016 Open Enrollment Period:

Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:

https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.

ASPE Research Brief Page 14

ASPE Office of Health Policy October 2016

Conclusion

As the Health Insurance Marketplace matures, new and returning customers to the Marketplace

will continue to be able to choose affordable, quality health insurance in 2017. Premium tax

credits will also continue to play an important role in ensuring that consumers have access to

affordable options. Many consumers who purchased plans in 2015 through the Marketplace

realized substantial savings by switching plans for the 2016 plan year, and consumers can realize

substantial savings again this year if they shop around to find the plan that best meets their needs

and their budget. They can do so by going to HealthCare.gov, which provides information for

consumers looking to compare plans on premiums and other important plan features.

ASPE Research Brief Page 15

ASPE Office of Health Policy October 2016

Methodology and Limitations

Data

The plan and premium data reported here are from the Marketplace QHP landscape individual

market health plan files, which are publicly available at HealthCare.gov.

Data were not

available for all states. This analysis focuses on the 39 states which were included in the 2017

Marketplace landscape file, including: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida,

Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan,

Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico,

North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South

Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. However,

some metrics are limited to the 38 states (39 states minus Kentucky) in the 2016 landscape file.

For most State-Based Marketplaces (SBMs) operating their own enrollment platforms,

comprehensive plan and premium data were not available. SBMs included in the analysis in this

brief are California, Connecticut, District of Columbia, Massachusetts, Minnesota, and New

York. Plan and premium information was provided by each state, with the exception of

Minnesota; data for Minnesota were provided by the state and calculations were done by ASPE.

SBMs not included in the analysis in this brief are Colorado, Idaho, Maryland, Rhode Island,

Vermont, and Washington. Some SBMs submit plan data to the Centers for Medicare &

Medicaid Services (CMS) for display using the HealthCare.gov eligibility and enrollment

platform. Idaho relied on the HealthCare.gov platform only in 2014 and is not included in this

brief. New Mexico, Oregon, Nevada, and Hawaii have utilized the HealthCare.gov platform to

support their eligibility and enrollment functions in past years and will continue to do so in 2017.

Kentucky is new to the HealthCare.gov platform for 2017.

Plan information is based on the plan landscape files for the states using the HealthCare.gov

platform as of July 2016 for the 2016 coverage year, and as of October 14, 2016, for the 2017

coverage year. The ASPE Issue Brief published last year, titled “Health Plan Choice and

Premiums in the 2016 Health Insurance Marketplace,” used an older version of the landscape file

for the 2016 coverage year.

Numbers relating to the 2016 coverage year have been updated for

this brief using the July 2016 landscape file and plan selections as of February 1, 2016; as a

result, some 2016 coverage year estimates in this brief may differ from previously published

estimates. The 2017 plan landscape file used in this brief is a snapshot of issuer participation and

plans as of October 14, 2016 and does not reflect changes in issuer and plan offerings after that

date.

Enrollment information is based on active QHP selections in the CMS Multidimensional

Insurance Data Analytics System (MIDAS) as of February 1, 2016 for the 2016 and 2017

coverage years. In this brief, we use the term “enrollees” to refer to individuals with active

The Marketplace plan landscape files can be downloaded at: https://www.healthcare.gov/health-and-dental-plan-

datasets-for-researchers-and-issuers/.

Brief available at https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2016-health-insurance-

marketplace.

ASPE Research Brief Page 16

ASPE Office of Health Policy October 2016

Marketplace individual market health plan selections; it does not refer to “effectuated

enrollees”—individuals who selected plans and paid the premium.

Weighted averages have been calculated at the county level for all counties in the

HealthCare.gov states and weighted by 2016 plan selections in 38 states as of February 1, 2016,

unless otherwise specified. The median for HealthCare.gov states reported in Table 6 is also

weighted by 2016 plan selections. Weighted averages that include SBM states were calculated at

the county level for all counties in HealthCare.gov states and weighted at the state level, using

plan selections as of February 1, 2016 (as reported in “Health Insurance Marketplaces 2016

Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016,

available at: https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.), for

SBM states, with the exception of Minnesota (data for Minnesota were provided by the state and

calculations were done by ASPE).

Additionally, we exclude tobacco users from our calculations of premiums because their

premium rates may be higher than standard, non-tobacco rates. We also exclude enrollees in

Virginia plans covering treatment of morbid obesity. Our calculations of the savings from

switching plans (Tables 3, 7, 9) and premium tax credits (Tables 1, 4 and 8) are based only on

enrollees whom we were able to link to complete premium and plan data for both 2016 and 2017.

Our calculations for Tables 3, 7 and 9 only include enrollees who will be automatically

crosswalked into a 2017 plan with the same issuer. Our calculations for Tables 1, 4 and 8 include

nearly all returning enrollees. Excluding tobacco users, non-tobacco users who were missing

required data, non-tobacco users who could not be linked to 2017 plans, and non-tobacco users

who selected catastrophic plans reduced the number of plan selections in the 38 HealthCare.gov

states as of February 2016 from 9.6 million to 9.0 million used for this analysis.

Issuers and Plans

We calculate the total number of issuers by unique five-digit Health Insurance Oversight System

(HIOS) issuer IDs. In some cases, issuers with different HIOS IDs belong to the same parent

company. An issuing entity’s HIOS ID is specific to the state in which it operates, such that a

company offering QHPs through the Marketplace in two states would be counted twice—once

for each state.

Some previous ASPE issue briefs on plan choice and availability presented analyses at the rating

area level. Because plans available in some part of a rating area are not always available in all

parts of a rating area, in this brief we have conducted the analysis at the county level. Conducting

the analysis at the county level better captures the set of options consumers will see when they

shop and thus more closely matches consumers’ shopping experience.

The analysis in this brief does not include stand-alone dental plans, child-only plans, or small-

group Marketplace (SHOP) plans.

Premiums

In this issue brief, we examine the plans and premiums available at the county level. Because

some plans may not serve all counties within a rating area, county-level analysis provides a

better approximation of plan availability. Analyses in some previous ASPE briefs on

ASPE Research Brief Page 17

ASPE Office of Health Policy October 2016

Marketplace premiums was typically at the rating area level; therefore, numbers in this brief

should not be compared against those in previous briefs using rating area analysis.

Our analysis of premiums in Tables 1, 3, 4, 7, 8 and 9 considers only current enrollees, based on

the batch auto-reenrollment crosswalk developed by CMS or the state. Our calculations for

Tables 3, 7 and 9 only include enrollees who will be automatically crosswalked into a 2017 plan

with the same issuer. Our calculations for Tables 1, 4 and 8 include nearly all returning enrollees.

Consumers can be automatically crosswalked into other coverage within the same issuer or to

another issuer if their plan is not available for the next year.

In our dataset, we observe some households that are not receiving tax credits in 2016 but do

appear eligible on the basis of household income.

New to this analysis for 2017, we impute the

maximum amount that these households would need to pay toward benchmark coverage by

applying the 2016 IRS applicable percentages and calculating the amount, if any, of tax credit

the household would be eligible for in 2017. We impute tax credits for these consumers because

some consumers who do not receive tax credits in 2016 due to benchmark premiums that were

below the maximum required monthly premium payment may see their 2017 premium increase

enough to qualify for tax credits.

Identifying Benchmark Plans

Plans in the Health Insurance Marketplace are required to offer a comprehensive package of

items and services, known as essential health benefits (EHB). Marketplace plans can also offer

benefits beyond these minimum benefits.

Each Marketplace plan reports what percentage of its premium is related to EHB. Most plans

have an EHB percentage of 100 percent. However, plans that cover benefits beyond EHB have

EHB percentages smaller than 100 percent, reflecting the fact that a portion of the premium pays

for these additional benefits. The amount of premium that covers EHB is used to rank silver

plans available to a consumer and determine which plan is the second-lowest cost silver plan—

also called the benchmark plan—for the purposes of calculating advance premium tax credits.

In this issue brief, the EHB amount enters into our analysis in two ways. We ranked silver plans

by the EHB amount of premium in order to determine what we define for analytic purposes as

each county’s “benchmark” plan.

We then compared the full premium amount of each year’s

respective benchmark to calculate the increase in the second-lowest cost silver plan. Secondly,

EHB amounts affect the calculation of premiums after applicable advance premium tax credits.

Premium tax credits can be applied only to the portion of the plan’s premium that covers EHB.

There are various reasons a consumer may not appear to be receiving APTC but have a household income that

would suggest they may be eligible (i.e., from 100/138 percent to 400 percent of the Federal Poverty Level). For

example, the benchmark plan available to the consumer may be priced below the maximum monthly premium

payment, the household may receive an offer of affordable employer-sponsored coverage, or the plan selection or

income data in our analytic file are not up-to-date.

For the purposes of calculating the advance premium tax credit, a second-lowest cost silver level plan for a

specific taxpayer is identified based on what is available to the taxpayer at the time of enrollment, in the taxpayer’s

geographical area. In this brief for analytic purposes, at times we use the term “benchmark plan” to refer to the

second-lowest cost silver plan in a county, which may not be the benchmark plan for all individual consumers.

ASPE Research Brief Page 18

ASPE Office of Health Policy October 2016

For example, suppose a consumer has a $200 premium tax credit. If he selects a plan that costs

$200 before tax credit and has an EHB percent of 95%, the tax credit will cover $190 of the plan

premium and he will be responsible for covering the remaining $10.

The 2016 and 2017 QHP landscape files include a variable called “EHB percent of total

premium,” which represents the proportion the plan’s premium cost that covers EHB. For plan

years 2014 and 2015, the EHB percentage of premium variable is not available on the landscape

file but is available on the Health Insurance Marketplace public use files.

In this analysis, we rank silver plans according to the percentage of premium that is related to

EHB; however, premiums reported in this brief are for the full premium amount, not just the

premium amount that covers EHB.

The Health Insurance Marketplace public use files are available at: https://www.cms.gov/cciio/resources/data-

resources/marketplace-puf.html.

ASPE Research Brief Page 19

ASPE Office of Health Policy October 2016

APPENDIX A: TABLES BY STATE AND COUNTY

TABLE 5. Percent of 2016 HealthCare.gov Enrollees Receiving Financial Assistance, by State

State

Percent of

Plan

Selections

with APTC

Percent of

Plan

Selections

with CSRs

Median

Income as

Percent of

FPL

Percent of

Plan

Selections

with

Household

Income

<100%

FPL

Percent of

Plan

Selections

with

Household

Income

100-250%

FPL

Percent of

Plan

Selections

with

Household

Income

250-400%

FPL

Percent of

Plan

Selections

with

Household

Income

>400%

FPL

HealthCare.gov States

85%

59%

165%

78%

17%

86%

42%

202%

68%

27%

89%

73%

144%

83%

12%

87%

55%

189%

75%

21%

74%

51%

189%

75%

19%

82%

43%

212%

63%

30%

91%

71%

137%

86%

10%

86%

65%

141%

82%

13%

81%

61%

164%

29%

53%

16%

85%

51%

196%

71%

24%

75%

45%

194%

69%

23%

81%

45%

196%

68%

27%

82%

57%

168%

75%

18%

89%

61%

148%

80%

15%

87%

56%

188%

71%

24%

83%

51%

195%

72%

24%

87%

57%

157%

79%

16%

90%

74%

129%

89%

83%

45%

196%

67%

27%

89%

64%

157%

79%

16%

85%

45%

209%

66%

29%

88%

51%

185%

73%

22%

66%

35%

211%

62%

30%

80%

50%

199%

66%

26%

68%

44%

200%

68%

25%

87%

58%

188%

75%

20%

80%

44%

203%

70%

25%

84%

60%

164%

77%

17%

71%

39%

216%

62%

31%

76%

51%

190%

71%

23%

89%

71%

153%

82%

15%

88%

60%

187%

73%

23%

85%

58%

159%

77%

17%

84%

57%

153%

81%

13%

86%

63%

177%

80%

16%

82%

56%

169%

75%

18%

84%

54%

187%

70%

25%

85%

51%

199%

69%

27%

90%

54%

198%

68%

27%

Source: U.S. Department of Health and Human Services, “Addendum to the Health Insurance Marketplaces 2016 Open

Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:

https://aspe.hhs.gov/sites/default/files/pdf/188026/MarketPlaceAddendumFinal2016.pdf.

Note: Columns may not sum due to rounding.

ASPE Research Brief Page 20

ASPE Office of Health Policy October 2016

TABLE 6

Average Monthly Premiums for Second-Lowest Cost Silver Plans for a 27-Year-Old (Before Tax

Credits), 2016–2017 in HealthCare.gov States & State-Based Marketplaces

for Which Data are Available

State

Average Second-Lowest Cost Silver Premium for a 27-Year-Old

2016

2017

% Change, 2016–2017

HealthCare.gov States

Average

$242

$302

25%

Median Change

N/A

16%

HealthCare.gov States and State-Based Marketplaces for Which Data are Available

Average

$243

$296

22%

HealthCare.gov States

$590

$760

29%

$244

$384

58%

$244

$248

$196

$422

116%

$292

$347

19%

$238

$270

14%

$237

$273

15%

$213

$288

35%

$246

$308

25%

$208

$298

43%

$235

$229

-3%

$217

$308

42%

N/A

$259

N/A

$290

$340

17%

$275

$317

15%

$213

$228

$257

$305

18%

$230

$273

19%

$264

$381

44%

$319

$446

40%

$270

$288

$272

$411

51%

$215

$219

$272

$286

$174

$224

29%

$234

$249

$222

$226

$251

$424

69%

$225

$287

27%

$213

$327

53%

$247

$319

29%

$270

$374

39%

$236

$385

63%

$221

$261

18%

$245

$294

20%

$239

$264

10%

$262

$304

16%

$294

$386

32%

$380

$413

State-Based Marketplaces

ASPE Research Brief Page 21

ASPE Office of Health Policy October 2016

CA #

$255

$272

$291

$340

17%

$181

$222

22%

$227

$219

-3%

$214

$340

59%

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan

landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was

provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by

ASPE.

Note: The numbers in this table represent premiums before the application of advance premium tax credits. State and

HealthCare.gov average premiums are weighted by the number of Marketplace plan selections in each county, except for

Kentucky, in which all counties were weighted equally. Weighted averages that include SBM states were calculated at the county

level for all counties in HealthCare.gov states and weighted at the state level, using plan selections as of February 1, 2016 (as

reported in “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE,

March 11, 2016, available at: https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.), for SBM states, with

the exception of Minnesota (data for Minnesota were provided by the state and calculations were done by ASPE). The 2016 and

2017 averages use 2016 plan selections in 38 states. Kentucky, as well as State-Based Marketplaces using their own Marketplace

platforms, are not included in the HealthCare.gov states average. This analysis identifies the second-lowest cost silver plan in

each county based on the portion of the premium that covers essential health benefits (EHB); however, premiums reported in this

table are for the full premium amount, not just the premium amount that covers EHB. See the “Methodology and Limitations”

section for details.

# California averages are by rating region rather than county.

ASPE Research Brief Page 22

ASPE Office of Health Policy October 2016

TABLE 7

Potential Savings from Shopping Based on Premium if Current Marketplace Enrollees Switch to

2017 Lowest-Cost Premium Plan within Metal Level in HealthCare.gov States

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data

Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the

HealthCare.gov platform in 2017 and is not included in this analysis.

Note: Amounts presented here do not take into account potential premium tax credits. The lowest-cost premium refers to the plan

with the lowest premium within the county within each metal tier. In some cases, plans were tied for lowest premium. This

State

Average Lowest-

Cost 2017

Monthly Premium

Within Metal

Level

Average 2017 Monthly

Premium Savings if

Consumers Switch to

Lowest-Cost Plan

within Metal Level*

Annual Average

Potential Savings in

Premium Costs per

Enrollee*

% of Enrollees Who

Could Save on

Premium Costs by

Switching to the

Lowest-Cost Plan

within Metal Level*

HealthCare.gov States

N/A

$57

$682

76%

$1,004

$85

61%

$552

$20

$245

54%

$379

$60

$725

99%

$620

$15

$175

30%

$534

$63

$753

99%

$407

$54

$653

80%

$362

$76

$910

93%

$444

$44

$531

76%

$435

$18

$219

30%

$431

$111

$1,332

95%

$351

$119

$1,433

97%

$439

$15

$183

83%

$480

$83

$999

73%

$498

$24

$290

89%

$343

$88

$1,055

95%

$438

$43

$518

79%

$416

$53

$636

77%

$515

$81

$968

76%

$650

$24

$288

56%

$378

$25

$300

74%

$540

$14

$173

48%

$348

$68

$821

87%

$463

$46

$557

78%

$344

$26

$310

46%

$371

$25

$300

93%

$330

$91

$1,097

94%

$586

$34

$407

68%

$420

$52

$628

91%

$478

$29

$353

42%

$507

$10

$121

100%

$513

$30

$357

73%

$575

$25

$305

37%

$362

$74

$889

70%

$330

$25

$302

54%

$374

$42

$501

80%

$476

$51

$608

82%

$652

$61

$728

60%

$594

$12

$144

50%

ASPE Research Brief Page 23

ASPE Office of Health Policy October 2016

analysis includes only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users,

who may face additional surcharges. This analysis only includes enrollees who will be automatically crosswalked into a 2017

plan with the same issuer. Catastrophic plans, which are not available to all consumers, were not considered in these calculations.

We assume that all enrollee characteristics are unchanged and calculate premiums based on the same age, family composition,

and household income as in 2016. Metal-level analysis is based on the metal consumers would be automatically crosswalked into

for 2017, based on their metal choice in 2016. The lowest cost plan does not take into account other cost-sharing features, but

refers only to the cost of the premium charged for that plan. See the “Methods and Limitations” section at the end of this brief for

more details.

ASPE Research Brief Page 24

ASPE Office of Health Policy October 2016

TABLE 8

Percent of Current Marketplace Consumers Who Could Obtain Coverage for $100 or Less after

Applicable Tax Credits in 2017, Regardless of 2016 Metal Level, HealthCare.gov States

State

Monthly Premium After Advance Premium Tax Credits

$100 or less

$75 or less

$50 or less

HealthCare.gov States Total

77%

72%

65%

82%

79%

76%

90%

89%

87%

62%

52%

38%

78%

74%

70%

63%

55%

45%

84%

80%

74%

81%

76%

70%

76%

71%

67%

71%

65%

56%

60%

53%

43%

56%

48%

36%

74%

69%

62%

84%

81%

76%

68%

60%

50%

73%

65%

55%

78%

73%

67%

85%

81%

75%

80%

77%

72%

85%

82%

77%

71%

62%

82%

77%

70%

49%

42%

34%