
Katherine Hempstead, PhD, MA, director and senior program officer, leads RWJF's work on health insurance coverage.
Data Insight 1: Carriers made adjustments in 2016 to reduce their exposure to high costs.
In 2016, carriers attempted to minimize their exposure to high costs by reducing the number of plan offerings that included out-of-network benefits, among other strategies. This change occurred at all metal levels and in all regions. The percentage of silver plans that were HMOs or EPOs (Exclusive Provider Organizations) increased from 61 percent in 2015 to 69 percent in 2016. Similarly, the number of gold plans declined relative to other metal levels. While the number of silver plans increased by 2.9 percent, the gold plans declined by 8.7 percent. The number of gold plans declined in most regions.
Data Insight 2: Regional variation in prices narrowed.
There was a geographic convergence in premium prices in 2016, as premiums rose far more in regions that had lower prices the prior year. Nationally, the distribution of average premium prices in all rating areas tightened and the interquartile range shrank. This pattern was less straightforward for deductibles, as many combinations of cost-sharing options are on the market.
Data Insight 3: Price variation within markets increased.
Despite this reduced variation across markets, differences in premium prices within markets increased. The average premium price range in a rating area increased between 2015 and 2016. This was true for all metal levels and all regions. The distribution also became more skewed, as maximum prices increased more than minimum prices. In 2016, about 75 percent of the time, the highest priced plan in a rating area was offered by either a Blue or a national carrier.
Data Insight 4: Large regional differences in plan design persist.
Despite convergence across regions in prices, large regional differences in plan design remain. Plans in the Northeast and West have a much broader range in premium prices, and less variation in deductibles. Plans in the Midwest and South show the opposite pattern, with a smaller range in premium prices and a far greater range in deductibles. There are some changes in these patterns between 2015 and 2016, but there are still important regional differences in plan design.
Data Insight 5: More regulated markets have higher premiums and lower deductibles.
In 2015, state-based marketplaces (SBM) had higher premium prices than did federally facilitated marketplace (FFM) states, but by 2016, the average premium prices were very similar, as prices in FFM states rose an average of 12 percent as compared with 7 percent for SBM states. Deductibles were lower in SBM states and remained lower in 2016. The subset of FFMs with the greatest amount of plan regulation—CA, CT, DC, MA, NY, RI, VT—had the highest premiums and lowest deductibles of all categories.