Recent news about individual-market health insurance continues to be largely focused on the American Rescue Plan and just how it's made coverage in 2022 much more affordable than it was once. Now, as we approach ACA's annual open enrollment period, it is a good time for you to look ahead to what we can expect to occur with 2022 coverage.
Fortunately, the ARP's enhanced subsidies will still be in effect in 2022 – and perhaps longer, if Congress can agree on extra time. Which means subsidies will still be bigger than they used to be, and more widely available, including to households earning a lot more than 400% from the poverty level.
For 2022 individual/family coverage, we're seeing some wide variation in proposed and finalized rate changes across the country. Average rates will decrease in some areas and increase in others, with modest single-digit rate alterations in most places.
(Because the ARP has eliminated the income cap for subsidy eligibility for 2022 and 2022, few enrollees might find these rate changes reflected in their actual premiums, since most enrollees get premium subsidies. But rate changes do affect the size the subsidy amount, and that can lead to changes for after-subsidy premiums, as explained below.)
Increased insurer participation in marketplaces continues
But we're also seeing widespread continuation of the increasing insurer participation trend which has been ongoing since 2022. In 2022 and 2022, insurers fled the ACA's exchanges – or perhaps the entire individual/family market. But that started to change in 2022, and insurer participation increased again in 2022 and 2022.
For 2022, that trend is continuing. Some big-name insurers that previously scaled back their marketplace participation are rejoining various marketplaces, and some smaller regional insurers are joining marketplaces or expanding their existing footprints.
Where are new carriers entering ACA's marketplace for 2022?
Here's a listing of a few of the major individual/family insurers which are entering new markets for 2022:
- Aetna CVS Health is joining industry in Arizona, Florida, Georgia, Missouri, Nevada, New york, Virginia, and Texas.
- AmeriHealth Caritas is joining the marketplace in New york.
- Bright Healthcare is joining the marketplace in California, Texas, Utah, Virginia, and Georgia.
- Capital Health Plan is joining the marketplace in Florida.
- Centene/Ambetter/WellCare/Celtic/Sunshine State Health Plan is joining industry in Kentucky, Nj, Florida, Oklahoma, Nj, Nebraska, and New york.
- Cigna is joining the marketplace in Georgia, Mississippi, and Pennsylvania.
- ConnectiCare Insurance Company is joining the marketplace in Connecticut.
- Friday Health Plans is joining industry in Oklahoma, Georgia, and North Carolina.
- Hometown Health Plan is joining industry in Nevada.
- Innovation Health Plan is joining industry in Virginia.
- Medica is joining industry in Arizona
- Moda is joining industry in Texas.
- Molina is joining the marketplace in Idaho, Kentucky, and Illinois
- Oscar Health is joining industry in Arkansas, Illinois, and Nebraska.
- Presbyterian Health Plan is rejoining industry in Boise state broncos.
- UnitedHealthcare is joining/rejoining the marketplace in Alabama, Texas, Georgia, Florida, Illinois, Louisiana, and Michigan.
- US Health and Life is joining industry in Indiana, Kansas, and Michigan.
- Vantage Health Plan of Mississippi is joining the marketplace in Mississippi.
More carriers = more plan options –
That's along with numerous coverage area expansions by existing marketplace insurers in lots of states. Based on the rate filings that we've analyzed so far, we anticipate that many – if not most – marketplace enrollees will have more plan options available for 2022 than they had this season.
One from the goals of the ACA was to increase competition within the individual health insurance market. The exchanges are positioned up to facilitate that, with enrollees in a position to compare options from all of the participating insurers and select the plan that best fits their demands.
From that perspective, increasing insurer participation and competition within the exchange is good. Also it does give people more plans to choose from, which could be also a good thing. But too many choices can overwhelm applicants and lead to poor making decisions.
– along with a new carrier may also affect premium subsidies
In accessory for delivering more plan options, carriers expanding into a place may also affect premium subsidies in that area. Just how much effect is determined by the way the new plans are priced when compared with the present plans – bearing in mind that rates change every year on January 1 whether or not any new insurers are entering the marketplace.
Premium subsidy amounts are based on the cost of the benchmark plan in each area. Consider that just refers to the second-lowest-cost Silver plan, it's not necessarily the same plan in one year to another. If a new insurer enters the marketplace with low-priced plans, the insurer may undercut the current benchmark and dominate the second-lowest-cost spot. When the premium is less than the benchmark plan's price would otherwise have been, it makes sense smaller premium subsidies for everyone on the bottom.
For individuals that area preferring to have their existing plan (instead of switching towards the new lower-cost options), this could lead to an increase in after-subsidy premiums, because the subsidies are small compared to they would otherwise happen to be. We can see a good example of this in the Phoenix area in 2022 and 2022, when new insurers entered the market with lower-priced plans that reduced the size of premium subsidies in the region.
To clarify, something that reduces the price of the benchmark premium will result in smaller subsidies. This can be a new lower-cost insurer entering the marketplace, or existing insurers reducing their rates. An example of this can be observed in how after-subsidy premiums increased for a lot of of Colorado's exchange enrollees in 2022, once the state's new reinsurance program reduced average pre-subsidy premiums by about 20%. The reduction helped unsubsidized enrollees (mostly those with incomes over the limit for subsidy eligibility, that has been removed a minimum of through 2022) but led to higher net premiums for many enrollees who qualified for subsidies.
Although the vast majority of exchange enrollees do be eligible for a premium subsidies (especially now that the American Rescue Plan has eliminated the “subsidy cliff” for 2022 and 2022) some enrollees don't. For these enrollees, the development of a new insurer simply broadens their plan options, and doesn't affect their premiums unless they decide to switch to the brand new plan.
And of course, if the new insurer has plans which are priced higher than the present benchmark plan, the carrier's entry won't affect net premiums paid by subsidized enrollees.
Plan to compare your coverage options during open enrollment
It will be several weeks prior to the facts are evident in terms of rate changes and plan availability for 2022 coverage. But it appears the trend of increasing competition in the exchanges continues.
And even though the American Rescue Plan's enhanced subsidy structure will still be in position in 2022 – making subsidies larger and much more widely available compared to what they would otherwise happen to be – it's still possible for a brand new insurer to disrupt the marketplace and end up adjusting the size of premium subsidies inside a given area.
Open enrollment for 2022 coverage will begin November 1. Actively comparing your options during open enrollment is definitely a great way, and that's especially true if your new insurer is going to be offering plans in your town. Letting your current plan auto-renew without comparison shopping isn't in your best interest.
If a brand new insurer is joining the marketplace, you might find that it is plans are a perfect fit for your needs. Or you might discover that your best option would be to change to a different plan since your after-subsidy premiums are increasing because of the new insurer undercutting the cost of the present benchmark plan. Switching plans may well be a non-starter because of your provider network or drug formulary needs, however, you won't know for sure until you consider the various options that are offered to you.
Ask a professional the way a new carrier could impact your coverage
We have an overview of factors to bear in mind when you're choosing a health plan, but it is also worthwhile to search out professional advice. Enrollment assistance is available from brokers, enrollment counselors, and Navigators.
Brokers are licensed and controlled by state insurance departments, and should also have certification in the exchange to be able to help people enroll in health plans offered with the exchange. Training and testing are necessary to be able to have the license and certification, and brokers should also complete ongoing continuing education to be able to maintain their credentials.
Broker training features a number of topics, including ethics, fraud prevention, evolving insurance regulations, and health plan details. Working out and regulatory oversight make brokers a dependable supply of information and help with initial plan selections and enrollments in addition to future problems that might arise as the health plan is utilized.
Navigators should be much more widely available this fall, because the Biden administration has allocated $80 million with this year's Navigator grants in the states that use HealthCare.gov. (The previous high was $63 million in 2022; the Trump administration subsequently reduced it to $36 million in 2022 and also to $10 million every year from 2022 through 2022.) The Biden administration has also proposed a return to expanded duties for Navigators, which may provide consumers with increased access to post-enrollment help with their coverage.
In short, enrollment assistance should be accessible this fall, and it's to your advantage to use it. A recent report from Young Invincibles highlights the myriad ways that enrollment assisters help consumers – it's more than just picking a plan.
Regardless of in which you seek assistance, it's not going to cost you anything – along with a broker, Navigator, or enrollment counselor will be able to assist you to determine the impact associated with a new insurers that'll be offering plans in your area for 2022, and help you produce sense of the choices open to you.
Louise Norris is an individual health insurance broker that has been covering health insurance and health reform since 2006. She's written a large number of opinions and academic pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform by other health insurance experts.
