2016 HealthCare.gov Premiums Average $113 per Month With APTC

A new report released by the Department of Health and Human Services found that 83% of the 8.5 million HealthCare.gov enrollees whose coverage went into effect on January 1, 2016 qualify for advanced premium tax credits (APTC), and have an average monthly premium of $113 after tax credits are applied. Without the APTC, the average monthly premium for those same enrollees would be $408. The report also found that nearly 70% of Marketplace consumers could purchase a plan with a monthly premium of $100 or less after applying APTC, and approximately 60% could do so for less than $50 after applying APTC. Of the 3.6 million individuals who had 2015 coverage and returned to HealthCare.gov to shop for 2016, 60% switched plans, saving them an average of $43 per month after applying APTC.

Insurer Participation in State-Based Marketplaces Stable in 2016

In 2016, nine of the 17 State-based Marketplaces (SBMs) experienced no decline in the number of participating insurers, while three experienced a net gain of insurers, according to a new report by The Commonwealth Fund. Of the five SBMs that experienced a net loss, three are the result of CO-OPs closing, while two SBMs lost insurers that were unable to gain market share or secure requested premium rates. The report attributes state-designed Marketplace participation rules, such as Maryland's prohibition on insurers offering products outside of the Marketplace unless they participate in the Marketplace, as key to maintaining strong levels of participation.

California: Marketplace Board Proposes New Revenue Mechanism, May Consider New Insurers

California's State-based Marketplace, Covered California, has proposed a process for certifying qualified health plans for the 2017 plan year that requires all Marketplace insurers to pay a fee equal to 3.5% of gross premiums instead of the current per member per month participation fee. Under the proposed process, Covered California will accept applications for a multi-year contract term (2017-2019), which will be reviewed and approved by the board in July 2016. The board also noted that it may consider new entrants to the Marketplace in 2018 and 2019 if the applicant is a newly-licensed carrier or a Medi-Cal managed care plan. The board is expected to vote on the proposals on February 18.