Marketplace Competition and Premiums: 2019–2022

Health insurance premiums in the Affordable Care Act Marketplaces declined in most states in 2022 for the third straight year, while employer-sponsored insurance premiums rose.

The Issue

Several new factors affected insurers as they set premiums for 2022, including generous subsidies from the 2021 American Rescue Plan Act, increased outreach and enrollment spending by the Biden administration, and an increasing number of insurers in the Marketplaces. Lower health premiums can help lower healthcare costs for consumers across the country.

Key Findings

• Premiums for benchmark plans in the marketplace fell 1.8 percent nationally in 2022, following declines of 3.2 percent in 2020 and 1.7 percent in 2021. These trends contrast with premium increases in employer-sponsored plans of 3.6 percent in 2021 and 3.9 percent in 2020.
• Most states saw reductions in marketplace premiums, but premium prices varied considerably across states. Eleven states had average benchmark premiums of more than $500 a month for a 40-year-old nonsmoker, while six states had premiums less than $365 per month for similar individuals.
• Regions with higher unemployment rates saw higher premium increases.
• The number of insurers participating in the marketplace increased from 198 to 288 between 2020 and 2022 in the regions analyzed. Additionally, increases in the number of insurers in a marketplace correlated with lower premium increases. Health premiums in markets with only one insurer were $189.50 higher, on average, relative to markets with five or more insurers.

Conclusion                 

Researchers find that overall Marketplace premiums decreased in 2022. It is unclear how the persistence of the pandemic and anticipated changes in the policy space, such as the end of the Medicaid continuous coverage requirement, will impact premiums going forward.