Katherine Hempstead, PhD, MA, senior adviser to the executive vice president, leads RWJF's work on health insurance coverage.
Understanding the premium increases for individual market plans presents more complications than usual this year because of the ways that states and carriers approached the last-minute suspension of the cost-sharing reduction (CSR) subsidies. In many states, carriers attempted to recapture that lost revenue by increasing the premium of the silver plan relative to other metals. ‘Silver-loading’ gives subsidized non-CSR consumers the opportunity to purchase a relatively more affordable bronze or gold plan. Much has been made of this quirk in market pricing, which is truly beneficial to the subsidized population in a number of states.
Silver-loading affects consumers differently
However, enthusiasm about this feature should be tempered by the fact that the population to which it applies is relatively small. Many conversations about open enrollment limit themselves to the marketplace, but it is probably more useful to focus on the ACA-compliant individual market as a whole. A good estimate of the size of this market is about 17.5 million. The 40 percent of customers that are eligible for CSR plans are held harmless in 2018, as higher premiums result in higher subsidies. The roughly three million who are subsidized but not CSR eligible should at least break even, and may have an arbitrage opportunity in some states. But what about the roughly seven million who are unsubsidized?
