This report summarizes the results of an analysis of Marketplace premiums and insurer participation in each state in 2023 and changes between 2022 and 2023. We use regression analysis to explain the variation in premiums across geographic areas and changes between 2022 and 2023. We also examine changes in insurer participation in 43 rating regions in 28 states.
Why It Matters
Marketplace premiums have significant implications for federal spending and the premiums faced by people not eligible for premium subsidies. There is also interest in how competition in Marketplaces is working: for example, is competition controlling spending growth? Are Marketplaces attracting new insurers? Is competition resulting in narrow provider networks that could be concerning?
We find that premiums increased by 3.4 percent nationally between 2022 and 2023, following several years of small declines. The increase largely stems from the strong economic growth and inflationary pressures; increases were dampened by the anticipated extension of Inflation Reduction Act premium subsidies and their effect on risk pools.
The wide variation in premiums across states remains and is largely explained by the amount of competition and the presence of Medicaid insurers. For example, areas with many insurers tended to have lower premiums, and areas with more limited competition, such as rural areas and small states, had higher premiums.
We also found an increase in insurer participation among large commercial insurers who have reentered Marketplaces in large numbers. There has also been an increase in participation by provider-sponsored insurers.