Marketplace Coverage Enrollment by Metal Tier, 2016–18

Brief

Marketplace Coverage Enrollment by Metal Tier, 2016–18

Trends in States Using the Healthcare.gov Enrollment Platform
September 29, 2020

Abstract

This report uses new enrollment data to examine trends by insurer actuarial value (metal tier) from 2016-2018. We use these data to analyze shifts in consumer choices over time as administrative changes artificially increased silver premium prices beginning in 2018. The Trump administration decision to cease directly reimbursing insurers for the cost-sharing subsidies the ACA requires them to provide to low-income enrollees led many states to instruct their marketplace insurers to incorporate the expected costs of the cost-sharing reductions into their silver plan premiums.  We find that the changes in premium prices are correlated with a shift in enrollment among metal tiers, with a nearly 11 percentage point drop in silver level enrollment in 2018. Silver plans were still the most popular enrollment tier, with 64 percent of enrollment in 2018, but bronze plans grew in popularity garnering 28 percent of all marketplace enrollment.  This shift is significant since bronze level coverage leaves consumers exposed to higher out of pocket costs should substantial medical needs arise.

Research Area: 

Centers

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