Thoughts for Consumers
In the early days of the individual market, there was a proliferation of plans. At the height of the market in 2016, there were 3,764 plans. In those early days, the question of how much choice was “too much” was a lively topic of debate, and some state-based marketplaces took steps to standardize plan design, most notably California. In 2017, CMS debuted the “Simple Choice” concept, a standard design for each metal. But by then, many carriers were fleeing the market—shedding plans, reducing territory, and sometimes exiting completely. The question of plan standardization became somewhat esoteric in the context of greatly reduced insurer participation and worries about bare counties.
While participation increased in 2019, the number of plans per issuer did not, so this year’s development marks the reversal of a multi-year trend. One of the first kinds of plans to be thrown overboard when the market started to contract were PPO or POS plans that included out-of-network benefits. That trend has not reversed, and new plan offerings in 2020 are mostly health maintenance organization or exclusive provider organization designs. Interestingly, there has been no major increase in plans with health savings account options. Consumers will mostly find a wider range of deductible levels, particularly in the silver level. One type of plan that increased slightly is a zero-deductible bronze or silver plan. In 2020, 13 percent of counties gained a zero-deductible low metal plan, 2.5 percent already had one, and another 2.5 percent lost one. With a growing number of states thinking about creating their own marketplace, there may be an increased interest in standardized plans if this trend continues. In part, this will depend on whether consumers view this proliferation of new options with relief or with confusion.
 Because carriers can file the same plan more than once in different areas of the same state, the number of plans being sold by a carrier in a state is measured here as the maximum number of plans available from an issuer in any one county. We included only on-market, individual plans and removed all cost sharing reduction plan variants and child-only plans.