How Premiums Are Changing in 2018 is now available.

Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in this market and the phasing out of the ACA’s reinsurance program. We analyzed 2017 premiums and insurer participation made available through Healthcare.gov on October 24, 2017, as well as data collected from states that run their own exchange websites.

Changes in the Second-Lowest Silver Premium

The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (We have been reporting premiums in these cities since the launch of the ACA’s exchanges in 2014; similar analyses for 2015 and 2016 are also available.)

Across these major cities in 2016, the second-lowest silver premium for a 40-year-old non-smoker ranged from $186 per month in Albuquerque, NM to $719 in Anchorage, AK, before accounting for the tax credit that most enrollees in this market receive. In 2017, the second-lowest silver premium for a 40-year-old non-smoker living in these cities will range from $229 in Louisville, KY and Cleveland, OH to $904 in Anchorage, AK, before accounting for the tax credit.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker), Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), Boston, MA (down -1% from $250 to $247), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).

Most enrollees in the marketplaces receive a tax credit to lower their premium. In most parts of the country in 2016, a 40-year-old adult making $30,000 per year would pay about $208 per month for the second-lowest-silver plan. If this person is willing to switch to whatever the new second lowest-cost silver plan is in 2017, they will pay a similar amount (the after-tax credit payment for a similar person in 2017 is $207 per month or a change of 0%). In some parts of the country (for example, in Albuquerque, NM), premiums for a 40-year-old are so low in 2016 that an enrollee making $30,000 may not have qualified for a subsidy. In these places, an increase in the benchmark silver premium may make them newly-eligible for financial assistance.

Table 1: Monthly Silver Premiums and Financial Assistance

for a 40 Year Old Non-Smoker Making $30,000 / Year State Major City 2nd Lowest Cost Silver

Before Tax Credit 2nd Lowest Cost Silver

After Tax Credit Amount of

Premium Tax Credit 2016 2017 % Change

from 2016 2016 2017 % Change

from 2016 2016 2017 % Change

from 2016 Alabama Birmingham $288 $492 71% $208 $207 0% $80 $285 256% Alaska Anchorage $719 $904 26% $164 $163 -1% $555 $741 33% Arizona Phoenix $207 $507 145% $207 $207 0% $0 $300 N/A Arkansas Little Rock $310 $314 1% $208 $207 0% $102 $107 4% California Los Angeles $245 $258 5% $208 $207 0% $37 $51 38% Colorado Denver $278 $313 12% $208 $207 0% $70 $106 51% Connecticut Hartford $318 $404 27% $208 $207 0% $110 $196 79% Delaware Wilmington $356 $423 19% $208 $207 0% $148 $216 46% DC Washington $244 $298 22% $208 $207 0% $36 $91 153% Florida Miami $262 $306 17% $208 $207 0% $54 $99 84% Georgia Atlanta $254 $286 13% $208 $207 0% $46 $79 72% Hawaii Honolulu $262 $347 32% $179 $178 -1% $83 $169 104% Idaho Boise $273 $348 27% $208 $207 0% $65 $141 117% Illinois Chicago $198 $291 48% $198 $207 5% $0 $84 N/A Indiana Indianapolis $298 $286 -4% $208 $207 0% $90 $79 -12% Iowa Cedar Rapids $284 $301 6% $208 $207 0% $76 $94 25% Kansas Wichita $248 $361 46% $208 $207 0% $40 $154 287% Kentucky Louisville $223 $229 3% $208 $207 0% $15 $22 47% Louisiana New Orleans $332 $373 13% $208 $207 0% $124 $166 34% Maine Portland $288 $341 19% $208 $207 0% $80 $134 68% Maryland Baltimore $249 $309 24% $208 $207 0% $41 $102 152% Massachusetts Boston $250 $247 -1% $208 $207 0% $42 $40 -5% Michigan Detroit $226 $237 5% $208 $207 0% $18 $29 65% Minnesota Minneapolis $235 $366 55% $208 $207 0% $27 $159 481% Mississippi Jackson $283 $352 25% $208 $207 0% $75 $145 95% Missouri St Louis $287 $310 8% $208 $207 0% $79 $103 31% Montana Billings $322 $425 32% $208 $207 0% $114 $218 92% Nebraska Omaha $313 $368 18% $208 $207 0% $105 $161 54% Nevada Las Vegas $261 $282 8% $208 $207 0% $53 $75 41% New Hampshire Manchester $261 $267 2% $208 $207 0% $53 $60 14% New Jersey Newark $330 $353 7% $208 $207 0% $122 $146 19% New Mexico Albuquerque $186 $258 39% $186 $207 11% $0 $51 N/A New York New York City $369 $456 24% $208 $207 0% $161 $249 55% North Carolina Charlotte $409 $572 40% $208 $207 0% $201 $364 82% North Dakota Fargo $304 $331 9% $208 $207 0% $96 $124 29% Ohio Cleveland $234 $229 -2% $208 $207 0% $26 $22 -17% Oklahoma Okla. City $295 $493 67% $208 $207 0% $87 $286 230% Oregon Portland $261 $312 20% $208 $207 0% $53 $105 98% Pennsylvania Philadelphia $276 $418 51% $208 $207 0% $68 $211 209% Rhode Island Providence $263 $261 -1% $208 $207 0% $55 $54 -2% South Carolina Columbia $314 $404 29% $208 $207 0% $106 $197 85% South Dakota Sioux Falls $309 $448 45% $208 $207 0% $101 $241 138% Tennessee Nashville $281 $419 49% $208 $207 0% $73 $212 192% Texas Houston $256 $288 13% $208 $207 0% $48 $81 69% Utah Salt Lake City $244 $292 20% $208 $207 0% $36 $85 139% Vermont Burlington $468 $492 5% $208 $207 0% $260 $285 9% Virginia Richmond $276 $296 7% $208 $207 0% $68 $89 31% Washington Seattle $227 $238 5% $208 $207 0% $19 $31 62% West Virginia Huntington $341 $419 23% $208 $207 0% $132 $212 60% Wisconsin Milwaukee $326 $379 16% $208 $207 0% $117 $172 46% Wyoming Cheyenne $426 $464 9% $208 $207 0% $218 $257 18% NOTES: In areas in which the two lowest-cost silver plans have the same premium, the next lowest-cost silver plan is used as the “second-lowest” silver plan. In some cases, a portion of the second lowest-cost silver plan is for non-essential health benefits so these values may differ from the benchmark used to determine subsidies.

SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. For more information see “Early Look at 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces” Jul 2016.

Changes in Insurer Participation

As a result of losses in this market, some insurers like UnitedHealth and Aetna have announced their withdrawal from the ACA marketplaces or the individual market in some states. In 2016, the number of insurers participating in each state (grouped by parent company) ranged from 1 in Wyoming to 16 in Texas. In states that use Healthcare.gov, the average number of insurers participating in the marketplace will be 3.9 in 2017 (down from 5.4 companies per state in 2016, 5.9 in 2015 and 4.5 in 2014). Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.