Many people in the Affordable Care Act (ACA) exchanges marketplace and with individual insurance will see modest premium increases in 2019. Some will even see their premiums drop.
CMS released the average premiums for the 39 states that use the federal exchanges. Eleven states have their own exchanges, which aren’t part of the federal government’s analysis.
After years of double-digit premium hikes, 2019 rate increases are expected to be fairly stable with some rates actually falling. Experts worried that 2019 would see another round of substantial rate increases. Congress voted to end the individual mandate penalty in 2019. The mandate requires nearly all Americans to have health insurance.
Without that mandate, critics charge that healthy people may drop health coverage. That, in turn, will mean fewer healthy people pay into the system to help offset the sickest members.
Without fewer healthy people, health insurers would need to increase rates to make up the difference, critics charge.
That hasn’t happened for 2019.
“Despite predictions that our actions would increase rates and destabilize the markets, the opposite has happened. The drop in benchmark plan premiums for the plan year 2019 and the increased choices for Americans seeking insurance on the exchanges is proof positive that our actions are working,” said CMS Administrator Seema Verma in a statement.
One reason for this is that health insurers likely increased premiums too much in previous years. After years of losing money, insurers have found success in the ACA exchanges. Many insurance companies are now making a profit in the market.
In fact, insurers that left the exchanges in previous years are testing out the market again. New entrants are also entering the exchanges in 2019.
That’s a vast difference from previous years when major insurance companies like Anthem, Aetna and UnitedHealthcare pulled back or completely out of the marketplace.
The average individual market premiums more than doubled between 2014 and 2017 ($2,784 per year to $5,712 annually). The average premiums for the second-lowest-cost Silver plan increased by 25% between 2016 and 2017 and another 37% between 2016 and 2017.
Most expensive and least expensive states for individual insurance
Now that we’ve explained the state of the ACA marketplace and its recent past, let’s look at the most expensive and least expensive states on average.
The average premium for 2019 is $406. That’s a 1.5 percent decrease from 2018, but still well above the 2017 average premium ($301).
Average premium increases for 2019 vary from North Dakota, which expects a 20.2% increase and Delaware, which is planning for a 16.1% increase, and Tennessee, which projects a 26.2% rate decrease.
Here are the average monthly premiums for the second-lowest-cost Silver plan across the 39 states using the HealthCare.gov platform. The premiums are for a 27-year-old single non-smoker.
10 most expensive states
Wyoming -- $709
Nebraska -- $687
Iowa -- $625
Alaska -- $576
Oklahoma -- $571
Delaware -- $561
Utah -- $509
North Carolina -- $507
West Virginia -- $489
Montana -- $460
5 cheapest states
Indiana -- $278
New Jersey -- $289
New Mexico -- $299
Arkansas -- $310
Michigan -- $314
Here are the average monthly premiums for the second-lowest-cost Silver plan across the 39 states that use the HealthCare.gov platform.
What contributes to premiums?
Many factors go into a plan and the state’s average premiums. Competition and health of a state’s people are two factors.
More competition helps bring down rates as insurers battle for customers. Plus, spreading members across more insurance companies means they’re also balancing the sickest members. Not having to cover more high-cost members allows insurers to keep down rates.
Health insurers are on the rise in the individual market. CMS said health plans operating in the exchanges decreased from 237 in 2016 to 167 in 2017. In 2018, more than half of counties using the federal exchange's platform had only one insurer. Having no competition meant insurers in those counties set higher rates.
For 2019, there are 23 more insurance companies in the exchanges. Plus, 29 current insurers in the market are expanding to more counties and states. Only 39% of counties have one insurer in 2019 compared to 56% in 2018. Five states will have one insurance choice in the marketplace. That’s down from 10 in 2018.
Health insurance options beyond the health insurance exchanges
The individual mandate penalty ends in 2019. You won’t get whacked at tax time if you don’t have health insurance.
However, it’s still a good idea to have health coverage. The ACA created the exchanges to help people get covered if they don’t have other opportunities.
However, there are still other options to get health insurance and you’ll likely pay less for coverage:
Your employer or your spouse’s employer
Employer-sponsored health insurance remains the most common way Americans get coverage. It’s usually cheaper than getting individual insurance or family coverage from the exchanges.
If both you and your spouse have insurance options, compare each plan to see which one is best for you. Make sure to check that your doctors and physicians are part of the network.
Also, remember that children can stay on their parents’ health insurance until the age of 26, so you’ll want to take into account their health needs when making a decision.
A government health insurance plan
If you qualify, public plans like Medicare, Medicaid and the Children's Health Insurance Program (CHIP) are more inexpensive ways to get covered.
Medicare is usually for people 65 and older. It’s also for people with a disability or with end-stage renal disease.
Medicaid is another option for many Americans. The ACA allowed states to expand Medicaid up to 138% of the federal poverty level.
Thirty-three states have expanded Medicaid, which gave more than 15 million people health insurance. Check with your state’s Medicaid program to see if you’re eligible for Medicaid and if your children can get coverage through CHIP.
A direct individual or family plan from a health insurer
Rather than buy a plan through the ACA exchanges, you can also sign up for a health plan from the regular individual insurance market. Some insurers that don’t offer plans in the exchanges provide coverage through individual insurance, so you have that option too.
These plans are usually significantly more expensive than employer-sponsored coverage, but they’re an option to get full coverage if you’re not eligible for an employer-sponsored plan.
Starting in 2019, most Americans will have the opportunity to buy a short-term health plan. These plans are low-cost, but also don’t provide the same level of coverage as regular health insurance.
For instance, you might have trouble finding a short-term plan that covers mental health, prescription or maternity coverage. That’s basic coverage in a regular health insurance plan. So, you sacrifice a higher level of coverage and the potential for steep out-of-pocket costs for much lower rates in short-term plans.
You can sign up for a short-term plan for a year and you can renew them twice starting in 2019. Some states, including New York, New Jersey, and Massachusetts, don’t allow short-term plans. Other states put in other restrictions.
The ACA limited eligibility for short-term plans. Congress ended the penalty for 2019. Now, with most people eligible for these plans, except more states to establish limits and some will likely prohibit the option.