The Center for Medicare and Medicaid Services (CMS) released the 2018 Healthcare.gov Open Enrollment report. I am looking at the county level public use files to estimate the market share by county of the different metal bands. My data is here. I made the following assumption that cells which CMS censored due to having less than 10 policies sold have a value of zero. That assumption may skew percentages in a few very small counties but I’m accepting that imprecision. Zero marketshare due to lack of sales or a metal band not being offered in a county is suppressed for each metal band.
The Tableau below is the marketshare by Metal Band by each Healthcare.gov county. I am starting off on Gold Plans as I was expecting to see significant variation on sales because of Silver Loading and Gold Gap.
And we have massive variation in Gold Plans. Most of Pennsylvania excluding the Philadelphia Main Line had Gold purchase rates that were at between five and ten times the national rate. 58% of all on-Exchange plans in Montour County were Gold plans. This is to be expected. The least expensive Gold plan in most of Pennsylvania was priced underneath the Silver Benchmark plan. From there, Gold purchases were likely a better deal for anyone making over 200% Federal Poverty Level and plausibly a valued trade-off for folks making between 100% and 200% FPL.
Balloon Juice World Headquarters in Brooke County, West Virginia borders Washington County, Pennsylvania. Washington saw 34% of on-Exchange buyers go Gold. Brooke County saw no more than 6.5% of its on Exchange buyers buy a Gold plan (Gold and catastrophic plans were censored as one of those two cells had less than 10 people). Brooke County’s least expensive Gold plan for a 40 year old was $139 more expensive than the benchmark Silver. Washington County’s benchmark Silver was $15 more than the least expensive Gold plan. Pricing matters.
All of Wyoming and New Mexico as well as most of Pennsylvania and Kansas plus chunks of northern Georgia, southern Wisconsin and pieces of Texas and North Dakota had counties where at least 20% of the plans sold were Gold.
The ACA has always been a county by county story. It is even more so this year as aggressive state regulators and the decisions of various insurers could lead to incredible deals being offered on Healthcare.gov or business as usual.