Since long before the Affordable Care Act (ACA) marketplaces opened to the public in October 2013, insurers have been working to find the best ways to meet the health care needs of Americans seeking coverage. With the third enrollment season now upon us, the ACA marketplaces are evolving as insurers gain a better understanding of how to design coverage options that meet the needs of consumers while managing risk for health insurers.
Blue Cross and Blue Shield companies (BCBS) participate extensively in the ACA marketplaces, with more members than any other insurance carrier and more extensive geographic coverage. But to get the most complete understanding of the marketplaces as a whole, the Blue Cross Blue Shield Association compiled and analyzed an extensive database of every health insurer and product sold acrossthe country. The findings are revealed in “The Evolving Affordable Care Act Marketplaces: The 2015 to 2016 Transition,” the fifth report in the ongoing Blue Cross Blue Shield, The Health of America Report®, series.
The BCBS analysis uncovered three key points of interest with implications for both consumers and the evolving industry.
1. Continued range of insurance carriers and coverage choices: Choices for consumers are relatively unchanged. On average, consumers in urban markets have 44 product choices in 2016, down slightly from 50 choices in 2015. Rural markets saw a somewhat smaller decline; consumers in those markets have 32 products to choose from, on average– four fewer than they saw in 2015.
- What does this mean for me? If you’re shopping for health insurance on the marketplace, you’ll have an average of 44 options in urban areas and 32 options in rural areas. That’s about the same as last year.
2. Coverage options are evolving: Insurers are offering more coverage options with networks and benefits designed to offer consumers lower out-of-pocket costs. The share of HMO and EPO products offered in the marketplaces increased from 41 percent in 2015 to 52 percent in 2016. In addition, in 2015 the lowest-cost silver plan in 47 percent of all counties was an HMO. In 2016, that figure increased to 58 percent. Insurers are also offering varying benefit designs, such as plans that couple a high deductible with two to five primary care physician office visits before the deductible is met.
- What does this mean for me? In 2016, more than half of the lowest-cost plans are HMOs. If you’re trying to stick to a budget, selecting an HMO may be a good option – just be sure to double check that your doctor is part of the network.
3. Markets are showing less variation in price: With more data and greater experience in this new market, insurers are able to price their products more accurately. In 2014, 53 percent of counties had lowest-cost silver plans priced more than 10 percent lower than the next lowest-cost competitor’s option. In 2016, that number dropped to 38 percent of counties.
- What does this mean for me? There are more similar prices across different insurance companies for similar types of coverage in 2016.
To learn more and see the complete findings of the BCBS analysis, download the full report.
 The ACA defines four types of health insurance products for individuals and families. The four types of products, ranked from highest out-of-pocket costs for consumers to lowest, are: Bronze, Silver, Gold, and Platinum. All of these products will offer the same minimum of benefits determined by the federal and state government. Silver Products have lower out-of-pocket costs than Bronze Products but higher out- of-pocket costs than both Gold and Platinum Products.