The Kaiser Family Foundation is keeping track of 2019 rate filings for the ACA. Their Table 1 has the least expensive Bronze and Gold plans as well as the benchmark Silver plan in a single major city in each state that they’ve updated. This is very valuable albeit incomplete data as the story in central cities can and often is different than the story in rural areas.
What I find interesting is the changes in the spreads from 2018 to 2019. For people who are eligible for premium tax credit subsidies, those subsidies are calculated based on the benchmark Silver plan. The benchmark is the second least expensive Silver plan in a county if there are multiple Silver plans or the premium of the only Silver plan. If a person buys a plan that is less expensive than the benchmark, they get all of the savings. If they buy a plan that is more expensive than the benchmark, they pay all of the incremental costs.
In 2018, we saw significant spreads as the termination of Cost Sharing Reduction (CSR) subsidies led to most states putting CSR costs into only the Silver plans which made Gold and Bronze plans comparatively cheaper. Now that insurers have more policy certainty, I am curious as to how the relative prices are projected to change in 2019 compared to 2018.
It varies a lot. Some cities like Burlington Vermont will see Gold and Bronze plans get at least $100 cheaper relative to the benchmark in 2019 than 2018. We should expect significant increases in subsidized enrollment as Vermont will be Silver Switching this year instead of doing nothing like they did in 2018.
Richmond, Virginia will see the relative prices of Bronze plans increase slightly while the least expensive Gold plans will get far cheaper. This makes the unlikely assumption that Medicaid expansion will not alter final pricing.
At the same time, subsidized folks who are not buying the benchmark plan will be slightly worse off as the least expensive Bronze and Gold plans have wider premium spreads this year than they did last year.
The important take-away is that the ACA is a county by county story with very idiosyncratic premium shocks built into the subsidy structure.