Marketplace Premiums and Insurer Participation: 2017-2020

A woman waits at the reception window of a family services SNAP office.

The cost of ACA marketplace premiums declines in 31 states.

The Issue

In 2018 and 2019, the Affordable Care Act’s (ACA) marketplaces experienced considerable turmoil that resulted in huge swings in premiums, leading to concerns about stability and long-term viability. Additionally, there was fear that not enforcing the individual mandate would threaten the risk pool and force insurers to increase premiums to cover the additional risk. In this paper, researchers look at changes in the average lowest silver premiums from 2017 to 2020 by state.

Key Findings

  • In most rating regions, premiums increased considerably between 2017 and 2018, yet stabilized in 2019 and 2020. Costs for the lowest-priced silver plans fell by an average of 3.5 percent.

  • In 2020, the average lowest silver plan premium is $426, with the lowest in Minnesota ($298) and highest in Wyoming ($871).

  • Analysis of insurer entrances and exits find increased insurer participation in 2019 and 2020, suggesting that many insurers feel the markets are stable, functional, and potentially profitable.


Researchers say that most low-cost silver premium states had more competition. This was often created by the participation of at least one Medicaid insurer, several other non-Medicaid insurers offering plans, or the state instituting a reinsurance program—a reimbursement system that protects insurers from very high claims. States with higher-priced silver premiums typically had little competition.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.