ASPE
RESEARCH BRIEF
HEALTH PLAN CHOICE AND PREMIUMS
IN THE 2017 HEALTH INSURANCE MARKETPLACE
October 24, 2016
The Affordable Care Act (ACA) strengthened protections for consumers who purchase coverage
in the individual health insurance market. Before the Affordable Care Act, individuals could be
denied health insurance coverage based on pre-existing conditions, it was difficult for consumers
to make apples-to-apples comparisons among plans and premiums, and people without
employer-sponsored health insurance or who were ineligible for public programs (such as
Medicare, Medicaid, and the Children’s Health Insurance Program) generally received no
financial help paying for coverage. Today, the Health Insurance Marketplace gives eligible
consumers options when purchasing a health plan, provides consumers with tools to compare
options, and offers financial assistance in the form of advance premium tax credits that reduce
the cost of health insurance to the majority of enrollees.
When the 2017 Open Enrollment Period begins on November 1, 2016, millions of Americans
will once again be able to shop for high-quality, affordable health care coverage through the
Marketplace.1 The Marketplace is welcoming new consumers and encouraging those who have
previously enrolled to come back, update their information, and select the plan that best meets
their needs and budget. All plans in the Marketplace cover essential health benefits and
recommended preventive care. Consumers can see detailed information about each health
insurance plan offered in their area, in addition to estimated yearly out-of-pocket expenses,
before they apply. HealthCare.gov has tools to help consumers evaluate plans based on factors
important to them, such as premiums, deductibles, out-of-pocket costs, provider network,
prescription drug formulary, customer service, and more.2 Consumers may be eligible for
1

The Health Insurance Marketplace includes the Marketplaces established in each of the states (and the District of
Columbia) and run by the state or the federal government. This report focuses primarily on individual market
Marketplaces using the HealthCare.gov eligibility and enrollment system, and select State-Based Marketplaces. This
analysis excludes stand-alone dental and SHOP plans.
2
This brief does not analyze consumers’ final expenses, after considering other health plan features, such as
deductibles and copayments. Consumers may examine all elements of health insurance plans in order to estimate
expected total out-of-pocket costs.

Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
http://aspe.hhs.gov

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financial assistance to help pay for the cost of premiums. In fact, 84 percent of consumers
receive financial assistance (see Table 5 in Appendix A for state data).3
This brief presents analysis of Qualified Health Plan (QHP) data in the individual market
Marketplace for states that use the HealthCare.gov Marketplace platform and State-Based
Marketplaces where data is available.4 It examines plan affordability in 2017 after taking into
account premium tax credits and also examines the plan choices that new and returning
consumers will have for 2017. This brief shows that the Affordable Care Act is continuing to
promote affordability and choice in the Marketplace for plan year 2017.5

3

This represents the percentage of individuals who have effectuated Marketplace coverage and qualified for an
advance premium tax credit (APTC), with or without a cost-sharing reduction. See: U.S. Department of Health and
Human Services, “First Half of 2016 Effectuated Enrollment Snapshot,” CMS, October 19, 2016, available at:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-19.html.
4
These 39 states are: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana,
Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire,
New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South
Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. However,
some tables are limited to the 38 states that were included in the 2016 Marketplace landscape files (excluding
Kentucky). Kentucky is new to the HealthCare.gov platform for 2017. Meanwhile, tables include data for states not
using the HealthCare.gov platform where available. More information is in the methodology and limitations section
of the Appendix.
5
The 2017 plan landscape file used in this brief is a snapshot of issuer participation and plans as of October 14,
2016 and does not reflect changes in issuer and plan offerings after that date. Similar to last year’s analysis
(available at https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2016-health-insurance-marketplace),
we compare data from the 2017 landscape file to data from the most recent available version of the 2016 landscape
file (dated July 29, 2016 and available at https://www.healthcare.gov/health-and-dental-plan-datasets-forresearchers-and-issuers/). The 2016 file incorporates some changes in plan offerings that have taken place since the
2016 Open Enrollment Period.

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Key Findings
The Affordable Care Act continues to promote access to affordable health insurance plans
through the Marketplace, where consumers can choose the health insurance product that best
meets their needs and budget.
Affordability
 Marketplace consumers will have affordable options. More than 7 in 10 (72 percent)
current Marketplace enrollees can find a plan for $75 or less in premiums per month,
after applicable tax credits in 2017. Nearly 8 in 10 (77 percent) current Marketplace
enrollees can find a plan for $100 or less in premiums per month, after applicable tax
credits in 2017.


Premium tax credits protect consumers from rate increases. Marketplace tax credits
adjust to match changes in each consumer’s benchmark silver plan premium. A 27-yearold with an income of $25,000 a year will on average get a monthly tax credit of $160, a
62 percent increase compared to their tax credit in 2016. As a result, this consumer will
pay $142 per month to purchase the benchmark plan in 2017, almost exactly the same as
in 2016, when the consumer would have paid $143.



Additional consumers are eligible for tax credits. As Marketplace tax credits adjust to
match increases in benchmark premiums, some consumers in areas that had low
benchmark premiums in 2016 may be newly eligible for tax credits in 2017. Of the
nearly 1.3 million HealthCare.gov consumers who did not receive tax credits in 2016, 22
percent have benchmark premiums and incomes in the range that may make them
eligible for tax credits in 2017. In addition, an estimated 2.5 million consumers currently
paying full price for individual market coverage off-Marketplace have incomes
indicating they could be eligible for tax credits.

Choice
 Switching plans can save consumers significant amounts on their premiums. If all
consumers switched from their current plan to the lowest premium plan in the same
metal level, the average 2017 Marketplace premium after tax credits would be $28 per
month less than the average 2016 Marketplace premium after tax credits – a 20 percent
reduction.


Consumers will be able to choose among plans with different combinations of
premiums, out-of-pocket costs, networks, and other features. All consumers will
have a choice of plans and on average consumers will have 30 plans to choose from,
including 14 silver plans and 10 bronze plans (the most popular metal levels selected by
9 out of 10 Marketplace enrollees). In addition, nearly 8 out of 10 (79 percent)
consumers returning to the Marketplace will be able to choose from 2 or more issuers for
2017 coverage. Among people with health insurance coverage through an employer, plan
choice is often considerably narrower. According to a 2015 survey 30 percent of
employees who were offered health insurance were offered only one plan from one
issuer.

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Overview
Section I of this brief provides an overview of advance premium tax credits (APTC) and
premiums in HealthCare.gov states and State Based Marketplaces where data are available for
2017 and illustrates how consumers may benefit from returning to the Marketplace to shop for a
plan that meets their needs and budget.
Section II of this brief describes the choices of issuers and plans that consumers will have in the
2017 coverage year in states using the HealthCare.gov platform and in State Based Marketplaces
where data are available.
SECTION I: MARKETPLACE HEALTH PLAN PREMIUMS IN 2016 AND 2017
In this section, we examine the affordability of 2017 Marketplace coverage, taking into account
benchmark premium changes, tax credits, and shopping.
We find that, notwithstanding higher benchmark premium increases than in previous years, the
majority of consumers will continue to have access to affordable coverage because they are
protected by the combination of financial assistance and the ability to shop. Specifically, as
shown in Table 1, 77 percent of returning Marketplace consumers will be able to find a plan for
$100 per month or less and 72 percent will be able to find a plan for $75 or less per month,
similar to these metrics for previous years. (Percentages of those who could obtain coverage for a
premium of $100 or less, $75 or less, and $50 or less by state are shown in Table 8 in Appendix
A.)
TABLE 1. Percent of Current Marketplace Enrollees Who Could Obtain Coverage for $100 or
Less after Applicable Advance Premium Tax Credits in 2017, Regardless of Metal Level
Chosen, in HealthCare.gov States
Monthly Premium After
Advance Premium Tax Credits

Any Plan
Types

Bronze

Silver

Gold

Platinum

$100 or less

77%

76%

63%

13%

0%

$75 or Less

72%

71%

55%

5%

0%

$50 or Less

65%

64%

44%

1%

0%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2017
premiums and tax credits based on the same age, family composition, and household income as in 2016. This analysis includes
only enrollees who could be linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users. This
analysis includes both enrollees who will be automatically crosswalked into a 2017 plan with the same issuer and other returning
consumers. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the
“Methods and Limitations” section at the end of this brief for more details.

Benchmark Premium Increases
In the second year of the Marketplace, average premiums for the second-lowest cost silver plan
increased only 2 percent, and in the third year they increased 7 percent. This year, Marketplace
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premiums are increasing more than they have the past two years. Through 2016, Marketplace
rates remained below initial projections from the independent Congressional Budget Office, and
below the cost of comparable coverage in the employer market. This year, with two years of
cost data available, issuers are adjusting their premiums to bring them in line with costs. In
addition, some of the ACA’s programs designed to support the new market in its early years are
ending this year, putting transitory upward pressure on premium growth.
Under the ACA, people can no longer be denied coverage because they have a pre-existing
condition, a crucial reform for up to 129 million Americans with conditions like asthma,
diabetes, or heart disease. But because excluding people with pre-existing conditions was
previously allowed in the individual market, there were no data available on how much it would
cost to extend coverage to everyone, and many issuers’ initial premiums were below actual costs.
Notably, Marketplace rates through 2016 remained 12 to 20 percent below initial projections
from the independent Congressional Budget Office.6,7 In addition, Urban Institute researchers
recently found that 2016 Marketplace premiums were well below premiums for comparable
employer coverage.8 Even with this year’s increases, Marketplace premiums in 2017 will still be
roughly in line with the projections by the Congressional Budget Office. (See Appendix C for a
detailed discussion.)
Table 6, in Appendix A, shows the estimated increase in the average second-lowest cost silver
plan by state. (The second-lowest cost silver plan is significant because it provides the
benchmark by which tax credits are calculated.) Across states using the HealthCare.gov
platform, the median increase in the second-lowest cost silver plan premium is 16 percent, while
the average increase is 25 percent.9,10 See Table 2 (See Table 13 in Appendix A for information
by select cities and counties).

6

Levitt, L., Cox, C., & Claxton, G, “How ACA Marketplace Premiums Measure Up to Expectations,” Kaiser
Family Foundation, August 1, 2016, available at: http://kff.org/health-reform/perspective/how-aca-marketplacepremiums-measure-up-to-expectations/.
7
Adler, L. & Ginsburg, P. B., “Obamacare Premiums Are Lower Than You Think,” The Brookings Institution, July
21, 2016, available at: http://healthaffairs.org/blog/2016/07/21/obamacare-premiums-are-lower-than-you-think/.
8
Blumberg, L., Holahan, F., & Wengle, E, “Are Nongroup Marketplace Premiums Really High? Not in Comparison
with Employer Insurance,” Urban Institute, September 2016, available at
http://www.urban.org/sites/default/files/2000931-are-nongroup-marketplace-premiums-really-high-not-incomparison-with-employer-insurance.pdf.
9
There are 39 states using the HealthCare.gov platform for the 2017 plan year. Kentucky is new to the
HealthCare.gov platform for 2017 and is not included in the HealthCare.gov states average or median.
10
This brief closely follows the actual methodology used to determine the benchmark for advanced premium tax
credits (APTC) and enrollees’ APTC amount. For the purposes of calculating the APTC, a second-lowest cost silver
plan for a specific taxpayer is identified based on what is available to the taxpayer at the time of enrollment, in the
taxpayer’s geographical area. In this brief for analytic purposes, at times we use the term “benchmark plan” to refer
to the second-lowest cost silver plan in a county, which may not be the benchmark plan for all individual consumers.
This brief identifies the second-lowest cost silver benchmark plan based on the portion of the premium that covers
essential health benefits (EHB), which may be less than the full premium price charged by issuers. For more details
on how benchmark premiums are calculated, see the “Methodology and Limitations” section at the end of this brief.

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The gap between the average and the median rate increase in HealthCare.gov states reflects that
most consumers are experiencing below average increases. Moderate rate increases or rate
decreases in states like Arkansas, Indiana, Nevada, New Hampshire, New Jersey, North Dakota,
Michigan, and Ohio suggest that Marketplaces in states around the country are maturing and
approaching stable price points. Meanwhile, several of the states experiencing larger increases
had 2016 premiums that were well below the national average and especially far below the cost
of comparable employer plans in that state (for example, Arizona, Hawaii, Illinois, Kansas, and
Pennsylvania).11
While complete data on Marketplace premiums in the 12 states not using the HealthCare.gov
platform are not available, data on benchmark premiums are available for four states (California,
Connecticut, Massachusetts, and Minnesota) and the District of Columbia, constituting about 60
percent of State-Based Marketplace enrollment. If these states are included, we estimate that the
increase in the average second-lowest cost silver plan would be 22 percent. In particular,
benchmark premiums in California, which accounts for about half of State-Based Marketplace
enrollment, are increasing by an average of 7 percent.
TABLE 2. Change in Benchmark Premiums from 2016 to 2017, HealthCare.gov States and
Select State-Based Marketplaces for Which Data are Available Before Shopping and Tax Credits
Percent
Average Increase in 2017 Benchmark Premium for HealthCare.gov States

25%

Median Increase in 2017 Benchmark Premium for HealthCare.gov States

16%

Average Increase in 2017 Benchmark Premium for HealthCare.gov States and
State-Based Marketplaces for Which Data are Available
Average Premium Change for Returning Consumers IF All Consumers
Shopped and Selected Lowest-Cost Plan in Metal Level

22%
-20%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: State-Based Marketplaces for which data are available include California, Connecticut, District of Columbia,
Massachusetts, and Minnesota. We calculated a weighted average increase in the second-lowest cost silver plan including these
State-Based Marketplaces using plan selections in each state from February 1, 2016 (as reported in “Health Insurance
Marketplaces 2016 Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:
https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.). Plan and premium information were provided by
each state, with the exception of Minnesota; data for Minnesota were provided by the state and calculations were done by ASPE.

Financial Assistance
Most Marketplace enrollees will receive financial assistance to help with the cost of their
monthly premiums. Not only do 84 percent of Marketplace enrollees who selected a plan during

11

Blumberg, L., Holahan, F., & Wengle, E, “Are Nongroup Marketplace Premiums Really High? Not in
Comparison with Employer Insurance,” Urban Institute, September 2016, available at:
http://www.urban.org/sites/default/files/2000931-are-nongroup-marketplace-premiums-really-high-not-incomparison-with-employer-insurance.pdf.

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the third Open Enrollment period receive tax credits to help pay for coverage12, but we also
estimate that 84 percent of the uninsured who are eligible for coverage through the Marketplaces
have incomes between 100 percent and 400 percent of the Federal Poverty Level (FPL) and may
be eligible to receive tax credits for plan year 2017.13 In addition, ASPE recently estimated that
as many as 2.5 million people currently purchasing off-Marketplace individual market coverage
could be eligible for financial assistance if they purchase 2017 coverage through the
Marketplaces.14 In total, about 78 percent of all consumers who are uninsured, who purchase
Marketplace coverage, or who purchase individual market coverage outside the Marketplace
have incomes making them potentially eligible for advance premium tax credits.15
Consumers who receive premium tax credits are protected by the ACA’s cap on the amount they
pay for the benchmark plan, the second-lowest cost silver plan in their area. For those eligible for
premium tax credits, the law sets a maximum amount of family income (“applicable
percentage”) that can be paid toward Marketplace coverage. This means that no matter the cost
of the benchmark plan in an individual’s area, a tax credit eligible consumer’s premium is
capped. Because the dollar amount of the premium tax credit depends on the benchmark plan’s
premium, the tax credit amount a consumer is eligible for adjusts with the premium of the
benchmark plan. If premiums for all plans in an area rise similarly, the difference between the
maximum required monthly premium and the benchmark premium would increase, resulting in a
higher tax credit that would offset the dollar increase in premiums.
The applicable percentage varies only by household income as a percentage of the Federal
Poverty Level (FPL) and does not depend on household members’ ages, the number of people
within the household covered through the Marketplace, or Marketplace premiums. (For examples
of 2017 incomes and maximum applicable percentages for a single adult who is eligible for tax
credits, see Table 16 in Appendix B.) The applicable percentage is converted into a maximum
dollar amount the household is required to pay annually, and the tax credit is applied to make up
the difference, if any, between the maximum dollar amount and the benchmark premiums for the
family members who are seeking Marketplace coverage.16,17

12

This represents the percentage of individuals who have effectuated Marketplace coverage and qualified for an
advance premium tax credit (APTC), with or without a cost-sharing reduction and includes SEP enrollment. See:
U.S. Department of Health and Human Services, “First Half of 2016 Effectuated Enrollment Snapshot,” CMS,
October 19, 2016, available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Factsheets-items/2016-10-19.html.
13
U.S. Department of Health and Human Services, “Marketplace Enrollment Projections for 2017,” ASPE Issue
Brief, ASPE, October 19, 2016, available at: https://aspe.hhs.gov/pdf-report/marketplace-enrollment-projections2017.
14
U.S. Department of Health and Human Services, “About 2.5 Million People Who Currently Buy Coverage OffMarketplace May Be Eligible for ACA Subsidies,” ASPE Issue Brief, ASPE, October 4, 2016, available at:
https://aspe.hhs.gov/sites/default/files/pdf/208306/OffMarketplaceSubsidyeligible.pdf.
15
Ibid.
16
If the premium of the second-lowest cost silver plan falls below the maximum amount the household pays for
benchmark coverage, then the household does not receive a tax credit and pays the full premium for the benchmark
plan.
17
The maximum percent of income paid toward the second-lowest cost silver plan is adjusted annually by a measure
of the difference between premium growth and income growth.

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The textbox on page 9 provides an illustrative example for a single 27-year-old woman in Dallas,
TX earning $25,000 per year. Based on her income, her maximum monthly payment for the
benchmark plan is $143 in 2016. In the first example, the monthly premium for the benchmark
plan is $216; thus, the woman is eligible for a tax credit of $73 per month, which she may apply
to her choice of a qualified health plan. In the second example, premiums are adjusted to reflect
2017 plan options, making the monthly premium for the benchmark plan $232. Because the
applicable percentage of income that the consumer is required to contribute to the cost of the
benchmark premium remains approximately the same, her contribution to the benchmark plan
remains roughly the same as well at $142, and her tax credit increases to $90 per month to cover
the remaining premium cost. Thus, the consumer has a higher dollar amount of tax credit to
apply to a plan of her choice and, therefore, could pay less out-of-pocket for all plans with
premiums below the benchmark premium cost. This example illustrates that the tax credit
ensures that enrollees can obtain coverage at an affordable price.

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Premium Tax Credits: Examples
Example 1: Single 27-year-old in Dallas, TX with an income of $25,000 for 2016
Calculate her tax credit for 2016 coverage:
 Income as percentage of FPL: 212%
 Maximum monthly payment for second-lowest silver benchmark plan: $143
 Monthly total premium of second-lowest silver benchmark plan: $216
 Advance premium tax credit per month: $216 – $143= $73
Suppose she’s trying to decide among two silver plans and a bronze. She can apply her tax
credit to any of them.
 Before tax credit, the monthly premiums are
o Bronze: $180
o Lowest silver: $214
o Second-lowest silver: $216
 After applying her tax credit, the monthly premiums are
o Bronze: $180 – $73 = $107
o Lowest silver after tax credit: $214 – $73 = $141
o Second-lowest silver after tax credit: $216 – $73 = $143
Example 2: Premiums for a 27-year-old making $25,000 in Dallas, TX for 2017
Calculate her tax credit for 2017 coverage:
 Income as percentage of FPL: 210%
 Maximum monthly payment for second-lowest silver benchmark plan: $142
 Monthly total premium of second-lowest silver benchmark plan: $232
 Advance premium tax credit per month: $232 – $142 = $90
Even if premiums rose from 2016 to 2017, the tax credit protects consumers from higher
prices.
 Before tax credit, the monthly premiums are
o Bronze: $195
o Lowest silver: $227
o Second-lowest silver: $232
 After applying her tax credit, the monthly premiums are
o Bronze: $195 – $90 = $105
o Lowest silver after tax credit: $227 – $90 = $137
o Second-lowest silver after tax credit: $232 – $90 = $142
Shopping
The Marketplace enables consumers to comparison shop for a plan that meets their needs and
budget. In 2015, 47 percent of individuals who selected a plan in the Marketplace selected the
lowest cost (31 percent) or second-lowest cost plan (17 percent) in their metal tier, and in 2016,
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45 percent of individuals who selected a plan in the Marketplace selected the lowest cost (30
percent) or second-lowest cost plan (15 percent) in their metal tier.18 Previous ASPE analysis
illustrates that Marketplace consumers are active shoppers with a demonstrated willingness to
switch plans to get a better deal. In 2016, nearly 70 percent of HealthCare.gov consumers that
came back to the Marketplace actively selected a plan, and nearly 43 percent of consumers who
reenrolled in a Marketplace plan in 2016 switched to a new plan.19
The Marketplace continues to be dynamic, and plans that were the second-lowest cost silver plan
or lowest-cost silver plan in 2016 may not be the second-lowest cost or lowest-cost plan in 2017,
so it will be important for returning consumers to review other options in 2017. The actual
payment made by consumers for their insurance depends on the plan they choose when enrolling
in coverage through the Marketplace and the level of tax credit they qualify for.
In 2017, more than 7 in 10 (76 percent) current Marketplace enrollees can find a lower premium
plan in the same metal level by returning to the Marketplace to shop for coverage rather than
reenrolling in their current plan, as illustrated in Table 3 (next page). For example, the average
lowest-cost premium for a silver plan available to current silver-level enrollees is $433 per
month for 2017 before applicable tax credits. Consumers who bought a silver plan in 2016 would
save an average of $58 a month by switching to the lowest premium plan in 2017. This results in
total premium savings of $691 a year for these consumers.20 If all silver plan holders with
potential savings switch to the lowest-cost silver plan available to them for 2017, the total
savings for the year would be $3.2 billion. Across all metal levels, the total premium savings
would be $4.3 billion if all consumers with potential savings switch to the lowest-cost plan
within their 2016 metal level (state-level analyses are in Table 7 in Appendix A).

18

May not sum due to rounding. Percentages do not include tobacco users.
U.S. Department of Health and Human Services, “Health Insurance Marketplaces 2016 Open Enrollment Period:
Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:
https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.
20
Average premium savings by switching to the lowest-cost plan within metal level are calculated only for
consumers who would not be automatically crosswalked into the lowest-cost plan within their metal level and thus
have the ability to save by switching. Savings for individual enrollees may differ from this amount based on their
choice of plan, eligibility for premium tax credits, and other characteristics.
19

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TABLE 3. Potential Savings from Shopping Based on Premium if Current Marketplace
Enrollees Switch to 2017 Lowest-Cost Premium Plan within Metal Level, HealthCare.gov States
Current Marketplace Enrollees

All Plan
Types

Bronze

Silver

Gold

Platinum

Average Lowest-Cost 2017 Monthly
Premium within Metal Level before
Applicable Tax Credit
% of Enrollees Who Could Save on
Premium Costs by Switching to the
Lowest-Cost Plan in Metal Level
Average 2017 Monthly Premium Savings
from Switching to Lowest-Cost Plan
within Metal Level, Across All Enrollees

N/A

$366

$433

$538

$674

76%

74%

77%

67%

73%

$57

$50

$58

$71

$81

ANNUAL Average Savings in Premium
Costs per Enrollee Across All Enrollees

$682

$603

$691

$852

$967

MONTHLY Aggregate Amount of
Savings in Premium Costs Across All
Enrollees

$360 M

$67 M

$270 M

$21 M

$3 M

ANNUAL Aggregate Amount of Savings
in Premiums Costs Across All Enrollees

$4.3 B

$800 M

$3.2 B

$254 M

$32 M

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: Amounts presented here do not take into account potential premium tax credits. The lowest-cost premium refers to the plan
with the lowest premium within the county within each metal tier. In some cases, plans were tied for lowest premium. This
analysis includes only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users,
who may face additional surcharges. This analysis only includes enrollees who will be automatically crosswalked into a 2017
plan with the same issuer. Catastrophic plans, which are not available to all consumers, were not considered in these calculations.
We assume that all enrollee characteristics are unchanged and calculate premiums based on the same age, family composition,
and household income as in 2016. Metal-level analysis is based on the metal consumers would be automatically crosswalked into
for 2017, based on their metal choice in 2016. The lowest cost plan does not take into account other cost-sharing features, but
refers only to the cost of the premium charged for that plan. See the “Methods and Limitations” section at the end of this brief for
more details.

Health Insurance Plan Affordability for 2017 Taking Into Account Advance Premium Tax
Credits and Shopping
Table 1, on page 4, shows the percentage of current Marketplace enrollees in 38 states who could
get coverage for as little as $75 or less across all available plans. Table 4 (next page) shows the
share who could get coverage for $75 or less taking into account any applicable tax credits while
staying in their current metal level, thereby maintaining comparable responsibility for out of
pocket costs.21 For example, nearly 6 in 10 (58 percent) of all customers returning to the
Marketplace can get coverage for a premium of $75 or less if they selected a lower-premium
21

The health plan category or “metal level” determines how consumers and plans can expect to share the costs of
care. For example, with a silver level plan the health plan pays about 70 percent of the total costs of care for
essential health benefits, on average, and the consumer pays 30 percent of these costs. This takes into account the
plan’s deductibles, copayments, coinsurance, and out-of-pocket maximums.

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plan in their same metal level in 2017. Of those who selected a silver plan in 2016, 64 percent
could get silver plan coverage for a premium of $75 or less in 2017 if they choose a lower-cost
plan. (Percentages of those who could obtain coverage for a premium of $100 or less, $75 or
less, and $50 or less by state regardless of metal level are shown in Table 8 in Appendix A.)
TABLE 4. Percent of Current Marketplace Enrollees Who Could Obtain Coverage within Their
Current Metal Level for $100 or Less after Advance Premium Tax Credits in 2017, 38 States
Monthly Premium After
Advance Premium Tax Credits

All Plan
Types

Bronze

Silver

Gold

Platinum

$100 or less

66%

61%

73%

4%

0%

$75 or Less

58%

54%

64%

1%

0%

$50 or Less

48%

45%

52%

0%

0%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2017
premiums and tax credits based on the same age, family composition, and household income as in 2016. This analysis includes
only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users. This analysis
includes both enrollees who will be automatically cross walked into a 2017 plan with the same issuer and other returning
consumers. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. Metal-level
analysis is based on the metal level consumers would be automatically cross walked into for 2017, based on their metal choice in
2016. See the “Methods and Limitations” section at the end of this brief for more details.

In addition, if every returning consumer nationwide selected the lowest-cost plan available
within their current metal level, average premiums would decrease by $28 per month, or 20
percent, compared to average premiums in 2016 (taking tax credits into account). (Estimates by
state are shown in Table 9 in Appendix A.) In fact, many consumers do not choose the lowest
cost plan available, because they are willing to pay more for a wider network or other plan
features, but this calculation confirms that affordable options for 2017 coverage are available to
consumers who shop around to find a better deal.
SECTION II: CONSUMER CHOICE FROM 2016 TO 2017
With an average of 30 Marketplace plans to choose from in 2017, both new and returning
consumers have options when shopping for coverage.
Issuers
There are 167 issuers participating in the Marketplace in HealthCare.gov states in 2017 (see
Tables 10, 14 in Appendix A). Based on analysis at the county level, the average Marketplace
consumer can choose from 3 issuers in their county for 2017 coverage.22 Seventy-nine percent
(or about four in five) of consumers will have a choice of two or more issuers, and 56 percent
will have a choice of three or more (see Table 15 in Appendix B).
22

Note that some previous ASPE issue briefs on plan choice and availability presented analyses at the rating area
level. Because plans available in some parts of a rating area are not always available in all parts of a rating area,
conducting the analysis at the county level better captures the set of options consumers will see when they shop and
more closely matches consumers’ shopping experience.

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The number of issuers offering health plans in the Marketplace has decreased from 2016 to 2017,
as shown in Table 10 in Appendix A. Across the HealthCare.gov states, 15 new issuers will
begin offering Marketplace plans for the 2017 coverage year, while 83 issuers that offered plans
in 2016 will no longer offer plans through the Marketplace in 2017.23 Reduced participation in
large part reflects multi-state withdrawals by a few large insurers; in particular, withdrawals by
United Health and Aetna account for 26 and 17 issuer exits, respectively. A number of other
firms are entering the Marketplace or expanding their participation into new states (or new
service areas within states), but they are doing so more gradually.
Table 10 in Appendix A provides the number of issuers by state for the years 2016 and 2017.
(Not all issuers operate in all counties within a state, however, and thus the number of issuers
available to a particular consumer may be less than the number of issuers that operate anywhere
in the state.)
Plans
Issuers can sell multiple plans across the various metal levels. In 2017, consumers can choose
from 30 plans in their county on average, as shown in Tables 11, 12 in Appendix A, and all
consumers will have a choice of plans. That means all consumers will be able to choose among
different combinations of premiums, out-of-pocket costs, and networks of hospitals and
physicians. Among people with health insurance coverage through an employer, plan choice can
be considerably narrower. According to a 2015 survey 30 percent of employees who were
offered health insurance were offered only one plan by one issuer.24 Limited plan choice through
employers is not new. One leading survey estimated in 2005 that 37 percent of workers enrolled
in employer-provided health insurance coverage had only one issuer offering one plan and
another 20 percent of workers had only two plan options.25
As shown in Table 15 in Appendix B, there continues to be particularly robust choice among
silver and bronze plans, which were the choice of 68 percent and 23 percent of consumers who
selected a plan during the third Open Enrollment period respectively, with the least choice
among platinum plans and catastrophic plans, which were the choice of only 2 percent and 1
percent of consumers respectively.26 Table 15 shows additional details on the number of plans an
average consumer can choose from.
23

The total number of issuers is calculated based on identifying an issuer by its unique five-digit Health Insurance
Oversight System (HIOS) ID. In some cases, issuers with different HIOS IDs belong to the same parent company.
An issuing entity’s HIOS issuer ID is specific to the state in which it operates, such that a company offering QHPs
through the Marketplace in two states would be counted twice—once for each state. Issuer totals for 2017 and 2016
include 38 states and do not include Kentucky, which is beginning to use the HealthCare.gov platform for the 2017
coverage year.
24
Agency for Healthcare Research and Quality, “MEPS Insurance Component Chartbook 2015,” August 2016,
available at https://meps.ahrq.gov/mepsweb/data_files/publications/cb20/cb20.pdf.
25
Kaiser Family Foundation, “Employer Health Benefits, 2005 Annual Survey,” 2005, available at:
https://kaiserfamilyfoundation.files.wordpress.com/2012/09/2005ehbs.pdf.
26
U.S. Department of Health and Human Services, “Health Insurance Marketplaces 2016 Open Enrollment Period:
Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:
https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.

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Conclusion
As the Health Insurance Marketplace matures, new and returning customers to the Marketplace
will continue to be able to choose affordable, quality health insurance in 2017. Premium tax
credits will also continue to play an important role in ensuring that consumers have access to
affordable options. Many consumers who purchased plans in 2015 through the Marketplace
realized substantial savings by switching plans for the 2016 plan year, and consumers can realize
substantial savings again this year if they shop around to find the plan that best meets their needs
and their budget. They can do so by going to HealthCare.gov, which provides information for
consumers looking to compare plans on premiums and other important plan features.

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Methodology and Limitations
Data
The plan and premium data reported here are from the Marketplace QHP landscape individual
market health plan files, which are publicly available at HealthCare.gov.27 Data were not
available for all states. This analysis focuses on the 39 states which were included in the 2017
Marketplace landscape file, including: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida,
Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan,
Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico,
North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South
Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. However,
some metrics are limited to the 38 states (39 states minus Kentucky) in the 2016 landscape file.
For most State-Based Marketplaces (SBMs) operating their own enrollment platforms,
comprehensive plan and premium data were not available. SBMs included in the analysis in this
brief are California, Connecticut, District of Columbia, Massachusetts, Minnesota, and New
York. Plan and premium information was provided by each state, with the exception of
Minnesota; data for Minnesota were provided by the state and calculations were done by ASPE.
SBMs not included in the analysis in this brief are Colorado, Idaho, Maryland, Rhode Island,
Vermont, and Washington. Some SBMs submit plan data to the Centers for Medicare &
Medicaid Services (CMS) for display using the HealthCare.gov eligibility and enrollment
platform. Idaho relied on the HealthCare.gov platform only in 2014 and is not included in this
brief. New Mexico, Oregon, Nevada, and Hawaii have utilized the HealthCare.gov platform to
support their eligibility and enrollment functions in past years and will continue to do so in 2017.
Kentucky is new to the HealthCare.gov platform for 2017.
Plan information is based on the plan landscape files for the states using the HealthCare.gov
platform as of July 2016 for the 2016 coverage year, and as of October 14, 2016, for the 2017
coverage year. The ASPE Issue Brief published last year, titled “Health Plan Choice and
Premiums in the 2016 Health Insurance Marketplace,” used an older version of the landscape file
for the 2016 coverage year.28 Numbers relating to the 2016 coverage year have been updated for
this brief using the July 2016 landscape file and plan selections as of February 1, 2016; as a
result, some 2016 coverage year estimates in this brief may differ from previously published
estimates. The 2017 plan landscape file used in this brief is a snapshot of issuer participation and
plans as of October 14, 2016 and does not reflect changes in issuer and plan offerings after that
date.
Enrollment information is based on active QHP selections in the CMS Multidimensional
Insurance Data Analytics System (MIDAS) as of February 1, 2016 for the 2016 and 2017
coverage years. In this brief, we use the term “enrollees” to refer to individuals with active

27

The Marketplace plan landscape files can be downloaded at: https://www.healthcare.gov/health-and-dental-plandatasets-for-researchers-and-issuers/.
28
Brief available at https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2016-health-insurancemarketplace.

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Marketplace individual market health plan selections; it does not refer to “effectuated
enrollees”—individuals who selected plans and paid the premium.
Weighted averages have been calculated at the county level for all counties in the
HealthCare.gov states and weighted by 2016 plan selections in 38 states as of February 1, 2016,
unless otherwise specified. The median for HealthCare.gov states reported in Table 6 is also
weighted by 2016 plan selections. Weighted averages that include SBM states were calculated at
the county level for all counties in HealthCare.gov states and weighted at the state level, using
plan selections as of February 1, 2016 (as reported in “Health Insurance Marketplaces 2016
Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016,
available at: https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.), for
SBM states, with the exception of Minnesota (data for Minnesota were provided by the state and
calculations were done by ASPE).
Additionally, we exclude tobacco users from our calculations of premiums because their
premium rates may be higher than standard, non-tobacco rates. We also exclude enrollees in
Virginia plans covering treatment of morbid obesity. Our calculations of the savings from
switching plans (Tables 3, 7, 9) and premium tax credits (Tables 1, 4 and 8) are based only on
enrollees whom we were able to link to complete premium and plan data for both 2016 and 2017.
Our calculations for Tables 3, 7 and 9 only include enrollees who will be automatically
crosswalked into a 2017 plan with the same issuer. Our calculations for Tables 1, 4 and 8 include
nearly all returning enrollees. Excluding tobacco users, non-tobacco users who were missing
required data, non-tobacco users who could not be linked to 2017 plans, and non-tobacco users
who selected catastrophic plans reduced the number of plan selections in the 38 HealthCare.gov
states as of February 2016 from 9.6 million to 9.0 million used for this analysis.
Issuers and Plans
We calculate the total number of issuers by unique five-digit Health Insurance Oversight System
(HIOS) issuer IDs. In some cases, issuers with different HIOS IDs belong to the same parent
company. An issuing entity’s HIOS ID is specific to the state in which it operates, such that a
company offering QHPs through the Marketplace in two states would be counted twice—once
for each state.
Some previous ASPE issue briefs on plan choice and availability presented analyses at the rating
area level. Because plans available in some part of a rating area are not always available in all
parts of a rating area, in this brief we have conducted the analysis at the county level. Conducting
the analysis at the county level better captures the set of options consumers will see when they
shop and thus more closely matches consumers’ shopping experience.
The analysis in this brief does not include stand-alone dental plans, child-only plans, or smallgroup Marketplace (SHOP) plans.
Premiums
In this issue brief, we examine the plans and premiums available at the county level. Because
some plans may not serve all counties within a rating area, county-level analysis provides a
better approximation of plan availability. Analyses in some previous ASPE briefs on
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Marketplace premiums was typically at the rating area level; therefore, numbers in this brief
should not be compared against those in previous briefs using rating area analysis.
Our analysis of premiums in Tables 1, 3, 4, 7, 8 and 9 considers only current enrollees, based on
the batch auto-reenrollment crosswalk developed by CMS or the state. Our calculations for
Tables 3, 7 and 9 only include enrollees who will be automatically crosswalked into a 2017 plan
with the same issuer. Our calculations for Tables 1, 4 and 8 include nearly all returning enrollees.
Consumers can be automatically crosswalked into other coverage within the same issuer or to
another issuer if their plan is not available for the next year.
In our dataset, we observe some households that are not receiving tax credits in 2016 but do
appear eligible on the basis of household income.29 New to this analysis for 2017, we impute the
maximum amount that these households would need to pay toward benchmark coverage by
applying the 2016 IRS applicable percentages and calculating the amount, if any, of tax credit
the household would be eligible for in 2017. We impute tax credits for these consumers because
some consumers who do not receive tax credits in 2016 due to benchmark premiums that were
below the maximum required monthly premium payment may see their 2017 premium increase
enough to qualify for tax credits.
Identifying Benchmark Plans
Plans in the Health Insurance Marketplace are required to offer a comprehensive package of
items and services, known as essential health benefits (EHB). Marketplace plans can also offer
benefits beyond these minimum benefits.
Each Marketplace plan reports what percentage of its premium is related to EHB. Most plans
have an EHB percentage of 100 percent. However, plans that cover benefits beyond EHB have
EHB percentages smaller than 100 percent, reflecting the fact that a portion of the premium pays
for these additional benefits. The amount of premium that covers EHB is used to rank silver
plans available to a consumer and determine which plan is the second-lowest cost silver plan—
also called the benchmark plan—for the purposes of calculating advance premium tax credits.
In this issue brief, the EHB amount enters into our analysis in two ways. We ranked silver plans
by the EHB amount of premium in order to determine what we define for analytic purposes as
each county’s “benchmark” plan.30 We then compared the full premium amount of each year’s
respective benchmark to calculate the increase in the second-lowest cost silver plan. Secondly,
EHB amounts affect the calculation of premiums after applicable advance premium tax credits.
Premium tax credits can be applied only to the portion of the plan’s premium that covers EHB.
29

There are various reasons a consumer may not appear to be receiving APTC but have a household income that
would suggest they may be eligible (i.e., from 100/138 percent to 400 percent of the Federal Poverty Level). For
example, the benchmark plan available to the consumer may be priced below the maximum monthly premium
payment, the household may receive an offer of affordable employer-sponsored coverage, or the plan selection or
income data in our analytic file are not up-to-date.
30
For the purposes of calculating the advance premium tax credit, a second-lowest cost silver level plan for a
specific taxpayer is identified based on what is available to the taxpayer at the time of enrollment, in the taxpayer’s
geographical area. In this brief for analytic purposes, at times we use the term “benchmark plan” to refer to the
second-lowest cost silver plan in a county, which may not be the benchmark plan for all individual consumers.

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For example, suppose a consumer has a $200 premium tax credit. If he selects a plan that costs
$200 before tax credit and has an EHB percent of 95%, the tax credit will cover $190 of the plan
premium and he will be responsible for covering the remaining $10.
The 2016 and 2017 QHP landscape files include a variable called “EHB percent of total
premium,” which represents the proportion the plan’s premium cost that covers EHB. For plan
years 2014 and 2015, the EHB percentage of premium variable is not available on the landscape
file but is available on the Health Insurance Marketplace public use files.31
In this analysis, we rank silver plans according to the percentage of premium that is related to
EHB; however, premiums reported in this brief are for the full premium amount, not just the
premium amount that covers EHB.

31

The Health Insurance Marketplace public use files are available at: https://www.cms.gov/cciio/resources/dataresources/marketplace-puf.html.

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APPENDIX A: TABLES BY STATE AND COUNTY
TABLE 5. Percent of 2016 HealthCare.gov Enrollees Receiving Financial Assistance, by State

State

HealthCare.gov States
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY

Percent of
Plan
Selections
with APTC

85%
86%
89%
87%
74%
82%
91%
86%
81%
85%
75%
81%
82%
89%
87%
83%
87%
90%
83%
89%
85%
88%
66%
80%
68%
87%
80%
84%
71%
76%
89%
88%
85%
84%
86%
82%
84%
85%
90%

Percent of
Plan
Selections
with CSRs

59%
42%
73%
55%
51%
43%
71%
65%
61%
51%
45%
45%
57%
61%
56%
51%
57%
74%
45%
64%
45%
51%
35%
50%
44%
58%
44%
60%
39%
51%
71%
60%
58%
57%
63%
56%
54%
51%
54%

Median
Income as
Percent of
FPL

165%
202%
144%
189%
189%
212%
137%
141%
164%
196%
194%
196%
168%
148%
188%
195%
157%
129%
196%
157%
209%
185%
211%
199%
200%
188%
203%
164%
216%
190%
153%
187%
159%
153%
177%
169%
187%
199%
198%

Percent of
Plan
Selections
with
Household
Income
<100%
FPL
3%
3%
4%
2%
2%
2%
2%
4%
29%
2%
3%
2%
4%
3%
2%
2%
3%
4%
2%
3%
1%
3%
2%
4%
2%
3%
2%
4%
2%
2%
2%
3%
4%
4%
2%
4%
1%
1%
2%

Percent of
Plan
Selections
with
Household
Income
100-250%
FPL
78%
68%
83%
75%
75%
63%
86%
82%
53%
71%
69%
68%
75%
80%
71%
72%
79%
89%
67%
79%
66%
73%
62%
66%
68%
75%
70%
77%
62%
71%
82%
73%
77%
81%
80%
75%
70%
69%
68%

Percent of
Plan
Selections
with
Household
Income
250-400%
FPL
17%
27%
12%
21%
19%
30%
10%
13%
16%
24%
23%
27%
18%
15%
24%
24%
16%
7%
27%
16%
29%
22%
30%
26%
25%
20%
25%
17%
31%
23%
15%
23%
17%
13%
16%
18%
25%
27%
27%

Percent of
Plan
Selections
with
Household
Income
>400%
FPL
2%
3%
1%
2%
3%
4%
1%
2%
2%
2%
4%
3%
2%
2%
3%
3%
2%
1%
3%
2%
3%
2%
6%
5%
4%
2%
3%
2%
5%
4%
2%
2%
2%
2%
2%
3%
3%
3%
2%

Source: U.S. Department of Health and Human Services, “Addendum to the Health Insurance Marketplaces 2016 Open
Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE, March 11, 2016, available at:
https://aspe.hhs.gov/sites/default/files/pdf/188026/MarketPlaceAddendumFinal2016.pdf.
Note: Columns may not sum due to rounding.

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TABLE 6
Average Monthly Premiums for Second-Lowest Cost Silver Plans for a 27-Year-Old (Before Tax
Credits), 2016–2017 in HealthCare.gov States & State-Based Marketplaces
for Which Data are Available
State

Average Second-Lowest Cost Silver Premium for a 27-Year-Old
2016
2017
% Change, 2016–2017

HealthCare.gov States
Average
$242
$302
25%
Median Change
N/A
N/A
16%
HealthCare.gov States and State-Based Marketplaces for Which Data are Available
Average
$243
$296
22%
HealthCare.gov States
AK
$590
$760
29%
AL
$244
$384
58%
AR
$244
$248
2%
AZ
$196
$422
116%
DE
$292
$347
19%
FL
$238
$270
14%
GA
$237
$273
15%
HI
$213
$288
35%
IA
$246
$308
25%
IL
$208
$298
43%
IN
$235
$229
-3%
KS
$217
$308
42%
KY
N/A
$259
N/A
LA
$290
$340
17%
ME
$275
$317
15%
MI
$213
$228
7%
MO
$257
$305
18%
MS
$230
$273
19%
MT
$264
$381
44%
NC
$319
$446
40%
ND
$270
$288
7%
NE
$272
$411
51%
NH
$215
$219
2%
NJ
$272
$286
5%
NM
$174
$224
29%
NV
$234
$249
6%
OH
$222
$226
2%
OK
$251
$424
69%
OR
$225
$287
27%
PA
$213
$327
53%
SC
$247
$319
29%
SD
$270
$374
39%
TN
$236
$385
63%
TX
$221
$261
18%
UT
$245
$294
20%
VA
$239
$264
10%
WI
$262
$304
16%
WV
$294
$386
32%
WY
$380
$413
9%
State-Based Marketplaces

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CA #
CT
DC
MA
MN

Page 21
$255
$291
$181
$227
$214

$272
$340
$222
$219
$340

7%
17%
22%
-3%
59%

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan
landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was
provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by
ASPE.
Note: The numbers in this table represent premiums before the application of advance premium tax credits. State and
HealthCare.gov average premiums are weighted by the number of Marketplace plan selections in each county, except for
Kentucky, in which all counties were weighted equally. Weighted averages that include SBM states were calculated at the county
level for all counties in HealthCare.gov states and weighted at the state level, using plan selections as of February 1, 2016 (as
reported in “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report,” ASPE Issue Brief, ASPE,
March 11, 2016, available at: https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf.), for SBM states, with
the exception of Minnesota (data for Minnesota were provided by the state and calculations were done by ASPE). The 2016 and
2017 averages use 2016 plan selections in 38 states. Kentucky, as well as State-Based Marketplaces using their own Marketplace
platforms, are not included in the HealthCare.gov states average. This analysis identifies the second-lowest cost silver plan in
each county based on the portion of the premium that covers essential health benefits (EHB); however, premiums reported in this
table are for the full premium amount, not just the premium amount that covers EHB. See the “Methodology and Limitations”
section for details.
# California averages are by rating region rather than county.

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TABLE 7
Potential Savings from Shopping Based on Premium if Current Marketplace Enrollees Switch to
2017 Lowest-Cost Premium Plan within Metal Level in HealthCare.gov States

State

HealthCare.gov States
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY

Average LowestCost 2017
Monthly Premium
Within Metal
Level

Average 2017 Monthly
Premium Savings if
Consumers Switch to
Lowest-Cost Plan
within Metal Level*

Annual Average
Potential Savings in
Premium Costs per
Enrollee*

N/A
$1,004
$552
$379
$620
$534
$407
$362
$444
$435
$431
$351
$439
$480
$498
$343
$438
$416
$515
$650
$378
$540
$348
$463
$344
$371
$330
$586
$420
$478
$507
$513
$575
$362
$330
$374
$476
$652
$594

$57
$7
$20
$60
$15
$63
$54
$76
$44
$18
$111
$119
$15
$83
$24
$88
$43
$53
$81
$24
$25
$14
$68
$46
$26
$25
$91
$34
$52
$29
$10
$30
$25
$74
$25
$42
$51
$61
$12

$682
$85
$245
$725
$175
$753
$653
$910
$531
$219
$1,332
$1,433
$183
$999
$290
$1,055
$518
$636
$968
$288
$300
$173
$821
$557
$310
$300
$1,097
$407
$628
$353
$121
$357
$305
$889
$302
$501
$608
$728
$144

% of Enrollees Who
Could Save on
Premium Costs by
Switching to the
Lowest-Cost Plan
within Metal Level*
76%
61%
54%
99%
30%
99%
80%
93%
76%
30%
95%
97%
83%
73%
89%
95%
79%
77%
76%
56%
74%
48%
87%
78%
46%
93%
94%
68%
91%
42%
100%
73%
37%
70%
54%
80%
82%
60%
50%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: Amounts presented here do not take into account potential premium tax credits. The lowest-cost premium refers to the plan
with the lowest premium within the county within each metal tier. In some cases, plans were tied for lowest premium. This

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 23

analysis includes only enrollees linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users,
who may face additional surcharges. This analysis only includes enrollees who will be automatically crosswalked into a 2017
plan with the same issuer. Catastrophic plans, which are not available to all consumers, were not considered in these calculations.
We assume that all enrollee characteristics are unchanged and calculate premiums based on the same age, family composition,
and household income as in 2016. Metal-level analysis is based on the metal consumers would be automatically crosswalked into
for 2017, based on their metal choice in 2016. The lowest cost plan does not take into account other cost-sharing features, but
refers only to the cost of the premium charged for that plan. See the “Methods and Limitations” section at the end of this brief for
more details.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 24

TABLE 8
Percent of Current Marketplace Consumers Who Could Obtain Coverage for $100 or Less after
Applicable Tax Credits in 2017, Regardless of 2016 Metal Level, HealthCare.gov States
State
HealthCare.gov States Total
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY

Monthly Premium After Advance Premium Tax Credits
$100 or less
$75 or less
$50 or less
77%
72%
65%
82%
79%
76%
90%
89%
87%
62%
52%
38%
78%
74%
70%
63%
55%
45%
84%
80%
74%
81%
76%
70%
76%
71%
67%
71%
65%
56%
60%
53%
43%
56%
48%
36%
74%
69%
62%
84%
81%
76%
68%
60%
50%
73%
65%
55%
78%
73%
67%
85%
81%
75%
80%
77%
72%
85%
82%
77%
77%
71%
62%
82%
77%
70%
49%
42%
34%
61%
54%
46%
65%
56%
48%
76%
70%
61%
60%
51%
38%
86%
84%
82%
62%
56%
49%
75%
71%
66%
74%
68%
59%
83%
79%
71%
83%
81%
77%
78%
73%
66%
82%
76%
66%
73%
67%
60%
69%
63%
56%
69%
63%
55%
74%
68%
60%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.
Note: Columns may not sum due to rounding. This analysis holds all enrollee characteristics unchanged and calculates 2017
premiums and tax credits based on the same age, family composition, and household income as in 2016. This analysis includes
only enrollees who could be linked to complete plan and premium data for both 2016 and 2017, and excludes tobacco users. This
analysis includes both enrollees who will be automatically crosswalked into a 2017 plan with the same issuer and other returning
consumers. Catastrophic plans, which are not available to all consumers, were not considered in these calculations. See the
“Methods and Limitations” section for more details.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 25

TABLE 9
Potential Savings Compared to 2016 Premium if Current Marketplace Enrollees Switch to
Lowest Premium Plan within Metal Level in 2017, HealthCare.gov States

State

Average Net
Premium
2016

Average Net Premium 2017 if
Selecting the Lowest Cost Plan
within Metal Tier

$137
$218
$122
$149
$155
$195
$107
$122
$148
$143
$189
$190
$136
$112
$137
$169
$121
$110
$154
$126
$163
$129
$215
$210
$169
$129
$192
$110
$189
$186
$121
$128
$132
$118
$105
$129
$164
$190
$149

$109
$172
$78
$138
$173
$184
$74
$80
$138
$126
$158
$135
$124
$90
$150
$119
$105
$76
$112
$102
$129
$99
$178
$178
$135
$112
$130
$113
$169
$167
$115
$102
$95
$89
$115
$110
$138
$164
$134

HealthCare.gov States
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY

Difference in
2016 Net
Premium and
2017 Net
Premium of
Lowest Cost
Plan in Metal
Tier
-$28
-$46
-$44
-$10
$18
-$11
-$32
-$43
-$10
-$18
-$32
-$54
-$12
-$23
$14
-$50
-$15
-$34
-$43
-$25
-$34
-$30
-$37
-$33
-$34
-$17
-$63
$3
-$21
-$19
-$6
-$25
-$37
-$29
$10
-$19
-$26
-$25
-$15

% Difference

-20%
-21%
-36%
-7%
11%
-6%
-30%
-35%
-7%
-12%
-17%
-29%
-9%
-20%
10%
-30%
-13%
-31%
-28%
-19%
-21%
-23%
-17%
-15%
-20%
-13%
-33%
2%
-11%
-10%
-5%
-20%
-28%
-24%
9%
-15%
-16%
-13%
-10%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data
Analytics System (MIDAS) for 38 states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to the
HealthCare.gov platform in 2017 and is not included in this analysis.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 26

Note: This analysis considers enrollees who do and do not receive tax credits. The lowest premium plan refers to the plan with
the lowest premium in the county within each metal tier and is based on all plans available in 2016. In some cases, plans were
tied for lowest premium. This analysis includes only enrollees linked to complete plan and premium data for both 2016 and 2017,
and excludes tobacco users, who may face additional surcharges. This analysis includes both enrollees who will be automatically
cross walked into a 2017 plan and other returning consumers. Catastrophic plans, which are not available to all consumers, were
not considered in these calculations. We assume that all enrollee characteristics are unchanged and calculate premiums based on
the same age, family composition, and household income as in 2016. Metal-level analysis is based on the metal level consumers
would be automatically cross walked into for 2017, based on their metal choice in 2016. The lowest premium plan does not take
into account other cost-sharing features, but refers only to the cost of the premium charged for that plan. See the “Methods and
Limitations” section at the end of this brief for more details.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 27

TABLE 10
Number of Marketplace Issuers by State, 2016–2017 in HealthCare.gov States & State-Based
Marketplaces for Which Data are Available
Number of Issuers in
State

232

167

-68

15

Number of
Issuers
Exiting the
State in
2017*
83

298

228

-73

16

89

2
3
5
8
3
10
9
2
4
9
8
4
N/A
5
2
14
7
3
3
3
3
4
4
6
4
4
16
2
9
13
4
2
4
19
4
11
16
2
1

1
1
4
2
3
7
5
2
5
5
4
3
3
4
3
10
4
2
3
2
3
2
4
3
4
4
11
1
6
8
1
2
3
10
3
11
15
2
1

-1
-2
-1
-6
0
-3
-4
0
1
-4
-4
-1
N/A
-1
1
-4
-3
-1
0
-1
0
-2
0
-3
0
0
-5
-1
-3
-5
-3
0
-1
-9
-1
0
-1
0
0

0
0
0
0
0
1
0
0
2
1
0
1
N/A
0
1
0
0
0
0
1
0
1
0
0
1
0
0
0
0
1
0
0
0
0
0
2
3
0
0

1
2
1
6
0
4
4
0
1
5
4
2
N/A
1
0
4
3
1
0
2
0
3
0
3
1
0
5
1
3
6
3
0
1
9
1
2
4
0
0

State
2016
HealthCare.gov States Total
Total for HealthCare.gov States and
State-Based Marketplaces for Which
Data are Available
HealthCare.gov States
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
KY*
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY

ASPE Office of Health Policy

2017

Net Change in
Number of
Issuers in State,
2016–2017*

Number of
New Issuers
to the State
in 2017*

October 2016

 ASPE Research Brief
State-Based Marketplaces
CA #
CT **
DC
MA
MN
NY - Basic Health Plan ±
NY - Marketplace ±

Page 28

12
4
2
11
5
14
18

11
2
2
10
4
15
17

-1
-2
0
-1
-1
1
-1

0
0
0
0
0
1
0

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan
landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was
provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by
ASPE.
Note: An issuer is counted as “new” in 2017 if it did not offer an individual market health plan in a given state’s Marketplace in
2016 based on its HIOS issuer ID number, and “exiting” if it was active in a given state’s Marketplace in 2016 but not in 2017.
State-Based Marketplaces using their own Marketplace platforms are not included in the HealthCare.gov states totals.
*Kentucky is not included in the net change in the number of issuers from 2016 to 2017, the sum of new issuers in 2017, and the
sum of issuers exiting in 2017.
± New York has begun enrolling eligible Marketplace enrollees in its Basic Health Program (BHP), known as the "Essential
Plan" in New York, including individuals with incomes less than or equal to 200% of FPL, who would have otherwise been
eligible for QHP or state-funded Medicaid enrollment. BHP includes QHP enrollees who were re-determined eligible for the
Essential Plan on or after 11/1/2015, and the majority of the lawfully residing non-citizens below 138 percent of FPL who were
previously eligible for state-funded Medicaid who were re-determined eligible for BHP since 4/1/2015.
# California averages are by rating region rather than county.
** Counts include catastrophic plans.

ASPE Office of Health Policy

October 2016

1
2
0
1
1
0
1

 ASPE Research Brief

Page 29

TABLE 11
Average Number of Marketplace Qualified Health Plans per County, 2016–2017 in
HealthCare.gov States & State-Based Marketplaces for Which Data are Available
State
HealthCare.gov States
Average (38 States)
HealthCare.gov States
AK
AL
AR
AZ
DE
FL
GA
HI
IA
IL
IN
KS
KY
LA
ME
MI
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI
WV
WY
State-Based Marketplaces
CA #
CT

Average
Number of
QHPs
2016
2017

Change in
Average Number
of QHPs, 20162017*

Average Number
of QHPs per
Issuer
2016
2017

Change in Average
Number of QHPs
per Issuer, 20162017*

47

30

-17

10

10

1

15
13
40
65
28
52
48
20
26
55
61
26
N/A
34
30
88
37
23
30
24
21
31
39
38
20
49
81
22
73
31
70
19
57
50
70
35
60
18
28

5
6
24
4
19
55
32
22
15
29
44
13
11
19
25
62
17
18
21
10
19
13
32
19
20
26
45
13
28
12
25
17
7
26
22
34
44
13
28

-10
-7
-16
-61
-9
3
-16
2
-11
-25
-17
-13
N/A
-15
-5
-25
-20
-5
-9
-14
-2
-18
-7
-20
0
-24
-36
-9
-45
-18
-45
-2
-50
-24
-48
-1
-16
-5
0

8
6
8
9
9
10
8
10
9
9
11
10
N/A
8
10
10
10
9
10
10
7
8
8
8
7
13
9
11
9
7
19
10
19
9
18
9
11
15
28

5
6
6
4
6
14
12
11
6
12
12
6
7
6
8
10
10
13
7
9
6
6
8
6
5
8
11
13
7
5
25
9
4
10
8
9
12
7
28

-3
0
-2
-5
-3
5
4
1
-3
3
1
-3
N/A
-2
-2
0
0
4
-3
-1
-1
-1
0
-2
-2
-5
3
2
-2
-1
6
-1
-14
2
-10
0
0
-7
0

ASPE Office of Health Policy

27
37

30
17

3
-20

5
9

6
9

1
0

October 2016

 ASPE Research Brief
DC
MA
MN
NY - Basic Health Plan ±
NY - Marketplace ± **

Page 30
24
70
47
5
75

18
53
18
6
65

6
17
-29
1
-10

12
7
10
2
4

9
6
6
2
4

-3
1
-5
0
0

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan
landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was
provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by
ASPE.
Note: Numbers may not sum due to rounding. With the exception of Connecticut and New York’s Health Insurance Marketplace,
counts do not include catastrophic plans. Issuers that only offer a catastrophic plan in a county (applicable to 33 counties in New
Mexico in 2016 and 1 county in Arizona in 2017) are excluded when calculating the average number of QHPs per issuer.
Average number of plans from 2016-2017 represent the number of Marketplace QHPs per county, weighted by plan selections in
the county. State and HealthCare.gov average premiums are weighted by the number of Marketplace plan selections in each
county, except for Kentucky, in which all counties were weighted equally. The 2016 and 2017 averages use PY2016 plan
selections in 38 states. Kentucky, as well as State-Based Marketplaces using their own Marketplace platforms, are not included in
the HealthCare.gov states average.
*Numbers may not sum due to rounding.
# California averages are by rating region rather than county.
± New York has begun enrolling eligible Marketplace enrollees in its Basic Health Program (BHP), known as the "Essential
Plan" in New York, including individuals with incomes less than or equal to 200% of FPL, who would have otherwise been
eligible for QHP or state-funded Medicaid enrollment. BHP includes QHP enrollees who were re-determined eligible for the
Essential Plan on or after 11/1/2015, and the majority of the lawfully residing non-citizens below 138 percent of FPL who were
previously eligible for state-funded Medicaid who were re-determined eligible for BHP since 4/1/2015.
** Counts include catastrophic and child only plans.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 31

TABLE 12
2017 Average Monthly Marketplace Premiums, Issuers, Available QHPs in HealthCare.gov States & State-Based Marketplaces
For Which Data are Available

State

Total
Number
of
Issuers
in State

HealthCare.gov
States Average
(39 States)
HealthCare.gov States
AK*
AL
AR
AZ
DE
FL
GA
HI*
IA**
IL
IN
KS
KY
LA
ME
MI
MO**
MS
MT**
NC
ND

Average
Number
of QHPs
per
County

2017
27-Year-Old with a Household Income of $25,000
Average
SecondPercent
SecondLowest
Increase in
Lowest
Advance
Silver
Advance
Silver After Premium
Before
Premium
Advance
Tax Credit
Advance
Tax Credit
Premium
Amount
Premium
Amount
Tax Credit
Tax Credit
over 2016

Family of Four with a Household Income of $60,000
Average
SecondPercent
SecondLowest
Increase in
Lowest
Advance
Silver
Advance
Silver After
Premium
Before
Premium
Advance
Tax Credit
Advance
Tax Credit
Premium
Amount
Premium
Amount over
Tax Credit
Tax Credit
2016

6

30

$302

$142

$160

62%

$1,090

$405

$686

47%

1
1
4
2
3
7
5
2
5
5
4
3
3
4
3
10
4
2
3
2
3

5
6
24
4
19
55
32
22
15
29
44
13
11
19
25
62
17
18
21
10
19

$760
$384
$248
$422
$347
$270
$273
$288
$308
$298
$229
$308
$259
$340
$317
$228
$305
$273
$381
$446
$288

$103
$142
$142
$142
$142
$142
$142
$117
$142
$142
$142
$142
$142
$142
$142
$142
$142
$142
$142
$142
$142

$657
$242
$106
$280
$205
$128
$131
$171
$166
$156
$87
$166
$117
$198
$175
$86
$163
$131
$239
$304
$146

35%
140%
5%
428%
38%
35%
39%
80%
61%
140%
-5%
124%
N/A
35%
33%
23%
43%
51%
98%
73%
15%

$2,750
$1,392
$897
$1,529
$1,257
$979
$987
$1,042
$1,116
$1,078
$829
$1,114
$939
$1,230
$1,146
$827
$1,103
$989
$1,378
$1,613
$1,044

$316
$405
$405
$405
$405
$405
$405
$348
$405
$405
$405
$405
$405
$405
$405
$405
$405
$405
$405
$405
$405

$2,434
$987
$492
$1,124
$852
$574
$582
$694
$711
$673
$424
$709
$534
$825
$741
$422
$698
$584
$973
$1,208
$639

34%
106%
3%
270%
31%
26%
28%
63%
46%
94%
-5%
87%
N/A
28%
25%
15%
33%
37%
77%
61%
11%

ASPE Office of Health Policy

October 2015

 ASPE Research Brief

State

Page 32

Total
Number
of
Issuers
in State

NE
NH
NJ**
NM
NV
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
WI**
WV**
WY
State-Based Marketplaces
CA **#
CT **
DC**
MA**
MN**

Average
Number
of QHPs
per
County

2
4
3
4
4
11
1
6
8
1
2
3
10
3
11
15
2
1

13
32
19
20
26
45
13
28
12
25
17
7
26
22
34
44
13
28

11
2
2
10
4

30
17
18
53
18

2017
27-Year-Old with a Household Income of $25,000
Average
SecondPercent
SecondLowest
Increase in
Lowest
Advance
Silver
Advance
Silver After Premium
Before
Premium
Advance
Tax Credit
Advance
Tax Credit
Premium
Amount
Premium
Amount
Tax Credit
Tax Credit
over 2016
$411
$142
$269
109%
$219
$142
$77
7%
$286
$142
$144
12%
$224
$142
$82
165%
$249
$142
$107
18%
$226
$142
$84
6%
$424
$142
$282
161%
$287
$142
$145
77%
$327
$142
$185
164%
$319
$142
$177
70%
$374
$142
$232
83%
$385
$142
$243
161%
$261
$142
$119
53%
$294
$142
$152
49%
$264
$142
$122
27%
$304
$142
$162
36%
$386
$142
$244
62%
$413
$142
$271
14%
$272
$340
$222
$219
$340

$142
$142
$142
$142
$142

$130
$198
$80
$77
$198

16%
34%
111%
-8%
179%

Family of Four with a Household Income of $60,000
Average
SecondPercent
SecondLowest
Increase in
Lowest
Advance
Silver
Advance
Silver After
Premium
Before
Premium
Advance
Tax Credit
Advance
Tax Credit
Premium
Amount
Premium
Amount over
Tax Credit
Tax Credit
2016
$1,487
$405
$1,082
87%
$792
$405
$387
3%
$1,036
$405
$631
9%
$813
$405
$408
82%
$903
$405
$498
12%
$819
$405
$414
4%
$1,536
$405
$1,131
124%
$1,040
$405
$635
55%
$1,185
$405
$780
113%
$1,154
$405
$749
53%
$1,355
$405
$950
66%
$1,393
$405
$988
121%
$945
$405
$540
37%
$950
$405
$545
42%
$957
$405
$552
19%
$1,099
$405
$694
28%
$1,399
$405
$994
51%
$1,495
$405
$1,090
12%
$985
$1,231
$980
$765
$1396

$405
$405
$405
$405
$405

$580
$826
$575
$360
$991

12%
27%
46%
-7%
109%

Source: Plan information is from the plan landscape files and active plan selections in the CMS Multidimensional Insurance Data Analytics System (MIDAS) for 39 states using
the HealthCare.gov platform in 2017. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was provided by the state. Plan and
premium information from Minnesota was provided by the state and calculations were done by ASPE.
Note: Averages for premiums and number of QHPs per county are weighted by the county’s number of Marketplace 2016 plan selections except for California, which reports by
rating region rather than county. In this example, the family of four is one 40-year-old adult, one 38-year-old adult, and two children under the age of 21. For households eligible
for premium tax credits, after-tax-credit benchmark premiums are capped at a given percentage of household income. After-tax benchmark premiums will differ slightly between

ASPE Office of Health Policy

October 2015

 ASPE Research Brief

Page 33

2016 and 2017 for identical family compositions and income amounts because of changes in the applicable percentages and the Federal Poverty Guidelines. The 2016 guidelines
are used to calculate benchmark premiums for coverage in 2017. Because poverty guideline thresholds generally increase each year, a given dollar amount of income may equate
to a smaller percentage of the Federal Poverty Level (FPL) in one year than it did in the previous year. For example, a four-person family with an income of $60,000 was at 247
percent of the FPL by 2016 and 2015 guidelines, but at 252 percent of the FPL by 2014 guidelines. As a result, the percentage of income the family could pay for the benchmark
plan in one year could be smaller in the next year.
* Alaska and Hawaii’s federal poverty guidelines are higher than those for the continental United States; consequently, the after tax credit premium is lower for a given amount of
income.
** In all 39 states, our calculations of premiums after tax credits assume that all members of the family of four making $60,000 would be eligible for premium tax credits.
However, in states with higher Medicaid/CHIP thresholds the children would be eligible for Medicaid/CHIP and not eligible for premium tax credits.
*** For purposes of this analysis, counties in Kentucky were weighted equally because corresponding plan selection information by county was not available. Kentucky is new to
the HealthCare.gov platform in 2017 and is not included in the HealthCare.gov state averages. State-Based Marketplaces using their own Marketplace platforms are not included in
the HealthCare.gov states averages.
# California averages are by rating region rather than county.

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October 2015

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Page 34

TABLE 13
Second-Lowest Cost Silver Plan Monthly Premiums, 27-Year-Old (Before Tax Credits), 2016–
2017 in Selected Counties in HealthCare.gov States & State-Based Marketplaces
for Which Data are Available
State

County

City in County

HealthCare.gov States
AK
Anchorage
AK
Juneau
AL
Jefferson
AR
Pulaski
AZ
Maricopa
AZ
Pima
DE
New Castle
FL
Broward
FL
Duval
FL
Hillsborough
FL
Miami-Dade
FL
Orange
FL
Palm Beach
GA
Fulton
HI
Honolulu
IA
Linn
IL
Cook
IN
Marion
KS
Sedgwick
KS
Wyandotte
KY
Fayette
KY
Jefferson
LA
Orleans
ME
Cumberland
MI
Wayne
MO
St. Louis
MS
Jackson
MT
Gallatin
NC
Guilford
NC
Mecklenburg
NC
Wake
ND
Cass
NE
Douglas
NH
Hillsborough
NJ
Essex
NM
Bernalillo
NV
Clark
OH
Cuyahoga
OH
Franklin
OH
Hamilton
OH
Montgomery
OK
Oklahoma
OK
Tulsa
OR
Multnomah

Anchorage
Juneau
Birmingham
Little Rock
Phoenix
Tucson
Wilmington
Ft. Lauderdale
Jacksonville
Tampa
Miami
Orlando
West Palm Beach
Atlanta
Honolulu
Cedar Rapids
Chicago
Indianapolis
Wichita
Kansas City
Lexington
Louisville
New Orleans
Portland
Detroit
St. Louis
Jackson
Bozeman
Greensboro
Charlotte
Raleigh-Durham
Fargo
Omaha
Manchester
Newark
Albuquerque
Las Vegas
Cleveland
Columbus
Cincinnati
Dayton
Oklahoma City
Tulsa
Portland

ASPE Office of Health Policy

Second-Lowest Cost Silver Monthly Premium
for a 27-year-old
2016
2017
% Change
$590
$590
$236
$254
$170
$178
$292
$239
$220
$206
$216
$256
$235
$210
$213
$233
$160
$266
$203
$240
N/A
N/A
$272
$236
$185
$235
$228
$267
$292
$335
$294
$249
$256
$214
$271
$153
$214
$189
$240
$197
$217
$242
$247
$215

$741
$760
$404
$257
$416
$286
$347
$249
$254
$258
$251
$298
$244
$224
$288
$247
$255
$235
$296
$324
$205
$188
$306
$280
$194
$254
$297
$399
$440
$469
$401
$271
$302
$219
$289
$212
$231
$196
$247
$195
$209
$404
$423
$256

26%
29%
71%
1%
145%
61%
19%
4%
16%
25%
16%
16%
4%
6%
35%
6%
60%
-12%
46%
35%
N/A
N/A
13%
19%
5%
8%
30%
49%
51%
40%
37%
9%
18%
2%
7%
39%
8%
4%
3%
-1%
-3%
67%
71%
19%

October 2016

 ASPE Research Brief

State

County

PA
Allegheny
PA
Philadelphia
SC
Richland
SD
Lincoln
SD
Minnehaha
TN
Davidson
TN
Shelby
TX
Bexar
TX
Comal
TX
Medina
TX
Dallas
TX
El Paso
TX
Harris
TX
Hidalgo
TX
Travis
UT
Salt Lake
VA
Henrico
WI
Milwaukee
WV
Cabell
WV
Wayne
WY
Laramie
State-Based Marketplaces
CA
Los Angeles
CA
Los Angeles
CA
San Diego
CA
San Francisco
CT
Fairfield
DC
Washington
MA
Suffolk
MN
Hennepin
MN
Ramsey

Page 35

City in County
Pittsburgh
Philadelphia
Columbia
Sioux Falls
Sioux Falls
Nashville
Memphis
San Antonio
San Antonio
San Antonio
Dallas
El Paso
Houston
McAllen
Austin
Salt Lake City
Richmond
Milwaukee
Huntington
Huntington
Cheyenne
Los Angeles - 1*
Los Angeles - 2*
San Diego
Francisco
Stamford
Washington
Boston
Minneapolis
St. Paul

Second-Lowest Cost Silver Monthly Premium
for a 27-year-old
2016
2017
% Change
$156
$193
24%
$226
$343
51%
$258
$331
29%
$253
$367
45%
$253
$367
45%
$230
$344
49%
$229
$341
49%
$186
$227
22%
$194
$232
20%
$201
$399
99%
$216
$232
7%
$197
$218
11%
$210
$236
13%
$159
$180
13%
$222
$252
13%
$229
$275
20%
$227
$243
7%
$267
$311
16%
$260
$343
32%
$260
$343
32%
$350
$380
9%
$201
$209
$243
$318
$321
$181
$231
$184
$184

$212
$222
$252
$364
$372
$222
$216
$286
$286

6%
6%
4%
15%
16%
22%
-6%
55%
55%

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan
landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was
provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by
ASPE.
Note: The premiums in this table represent premiums before the application of tax credits. The number of QHPs in the county
does not include catastrophic plans. This brief identifies the second-lowest cost silver plan based on the portion of the premium
that covers essential health benefits (EHB); however, premiums reported in this table are for the full premium amount, not just
the premium amount that covers EHB.. See the “Methodology and Limitations” section for details.
*Los Angeles County is divided into two regions for premium determinations.

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October 2016

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Page 36

TABLE 14
Number of Marketplace Issuers in County, 2016–2017 for Selected Cities in HealthCare.gov
States & State-Based Marketplaces for Which Data are Available
Number of Issuers
State
HealthCare.gov States
AK
AK
AL
AR
AZ
AZ
DE
FL
FL
FL
FL
FL
FL
GA
HI
IA
IL
IN
KS
KS
KY
KY
LA
ME
MI
MO
MS
MT
NC
NC
NC
ND
NE
NH
NJ
NM
NV
OH
OH
OH
OH
OK
OK
OR
PA
PA

County

Anchorage
Juneau
Jefferson
Pulaski
Maricopa
Pima
New Castle
Broward
Duval
Hillsborough
Miami-Dade
Orange
Palm Beach
Fulton
Honolulu
Linn
Cook
Marion
Sedgwick
Wyandotte
Lexington
Louisville
Orleans
Cumberland
Wayne
St. Louis
Jackson
Gallatin
Guilford
Mecklenburg
Wake
Cass
Douglas
Hillsborough
Essex
Bernalillo
Clark
Cuyahoga
Franklin
Hamilton
Montgomery
Oklahoma
Tulsa
Multnomah
Allegheny
Philadelphia

ASPE Office of Health Policy

City in County

Anchorage
Juneau
Birmingham
Little Rock
Phoenix
Tucson
Wilmington
Ft. Lauderdale
Jacksonville
Tampa
Miami
Orlando
West Palm Beach
Atlanta
Honolulu
Cedar Rapids
Chicago
Indianapolis
Wichita
Kansas City
Fayette
Jefferson
New Orleans
Portland
Detroit
St. Louis
Jackson
Bozeman
Greensboro
Charlotte
Raleigh-Durham
Fargo
Omaha
Manchester
Newark
Albuquerque
Las Vegas
Cleveland
Columbus
Cincinnati
Dayton
Oklahoma City
Tulsa
Portland
Pittsburgh
Philadelphia

2016
2
2
3
5
8
5
3
7
5
5
7
4
7
8
2
3
7
6
3
2
N/A
N/A
5
2
12
4
2
3
3
3
3
3
4
4
6
4
4
11
8
10
10
2
2
7
5
4

2017

Net Change in
Number of Issuers,
2016-2017

1
1
1
4
1
2
3
5
4
5
5
2
5
4
2
3
3
4
2
2
3
3
4
3
9
2
1
3
1
1
2
3
2
4
3
4
3
5
4
6
6
1
1
5
3
2

-1
-1
-2
-1
-7
-3
0
-2
-1
0
-2
-2
-2
-4
0
0
-4
-2
-1
0
N/A
N/A
-1
1
-3
-2
-1
0
-2
-2
-1
0
-2
0
-3
0
-1
-6
-4
-4
-4
-1
-1
-2
-2
-2

October 2016

 ASPE Research Brief

Page 37
Number of Issuers

State
SC
SD
SD
TN
TN
TX
TX
TX
TX
TX
TX
TX
TX
UT
VA
WI
WV
WV
WY
State-Based Marketplaces
CA
CA
CA
CA
CT
DC
MA
MN
MN
NY - Basic Health Plan ±
NY - Marketplace ± #
NY - Basic Health Plan ±
NY - Marketplace ± #
NY - Basic Health Plan ±
NY - Marketplace ± #
NY - Basic Health Plan ±
NY - Marketplace ± #
NY - Basic Health Plan ±
NY - Marketplace ± #

Richland
Lincoln
Minnehaha
Davidson
Shelby
Bexar
Comal
Medina
Dallas
El Paso
Harris
Hidalgo
Travis
Salt Lake
Henrico
Milwaukee
Cabell
Wayne
Laramie

Columbia
Sioux Falls
Sioux Falls
Nashville
Memphis
San Antonio
San Antonio
San Antonio
Dallas
El Paso
Houston
McAllen
Austin
Salt Lake City
Richmond
Milwaukee
Huntington
Huntington
Cheyenne

4
2
2
4
4
8
6
3
8
5
7
7
8
4
4
6
2
2
1

1
2
2
2
2
4
3
1
3
3
3
4
3
3
4
4
2
2
1

Net Change in
Number of Issuers,
2016-2017
-3
0
0
-2
-2
-4
-3
-2
-5
-2
-4
-3
-5
-1
0
-2
0
0
0

Los Angeles - 1*
Los Angeles - 2*
San Diego
Francisco
Fairfield
Washington
Suffolk
Minneapolis
St. Paul
Albany
Albany
Erie
Erie
New York
New York
Monroe
Monroe
Onondaga
Onondaga

Los Angeles
Los Angeles
San Diego
San Francisco
Stamford
Washington
Boston
Hennepin
Ramsey
Albany
Albany
Buffalo
Buffalo
New York City
New York City
Rochester
Rochester
Syracuse
Syracuse

6
7
6
5
4
2
10
5
5
5
7
5
4
8
10
5
3
3
3

6
7
6
6
2
2
9
4
4
4
6
7
4
8
9
5
3
3
3

0
0
0
1
-2
0
-1
-1
-1
-1
-1
2
0
0
-1
0
0
0
0

County

City in County

2016

2017

Source: For states using the HealthCare.gov platform in 2016 and 2017, plan and premium information is from the plan
landscape files. For State-Based Marketplaces using their own Marketplace platforms, plan and premium information was
provided by the state. Plan and premium information from Minnesota was provided by the state and calculations were done by
ASPE.
Note: Qualified health plan issuers are counted based on unique HIOS issuer ID number.
* Los Angeles County is divided into two regions for premium determinations.
± New York has begun enrolling eligible Marketplace enrollees in its Basic Health Program (BHP), known as the "Essential
Plan" in New York, including individuals with incomes less than or equal to 200% of FPL, who would have otherwise been
eligible for QHP or state-funded Medicaid enrollment. BHP includes QHP enrollees who were re-determined eligible for the
Essential Plan on or after 11/1/2015, and the majority of the lawfully residing non-citizens below 138 percent of FPL who were
previously eligible for state-funded Medicaid who were re-determined eligible for BHP since 4/1/2015.
# Data does not include stand-alone dental plans, child-only plans, or small-group Marketplace (SHOP) plans

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 38
APPENDIX B: ADDITIONAL TABLES

TABLE 15
Summary of Marketplace Health Plans and Issuers for HealthCare.gov States, 2016 – 2017

Number of HealthCare.gov States Included in Calculations
Issuers in State
Issuers in County
Percent of consumers with choice of 3 or more issuers
Percent of consumers with choice of 2 or more issuers
Qualified Health Plans in County (excluding catastrophic)
Plans in County
Catastrophic Plans
Bronze Plans
Silver Plans
Gold Plans
Platinum Plans

2016 Average

2017 Average

Weighted by 2016
Plan Selections

Weighted by 2016
Plan Selections

38
10
5
88%
98%
47
50
3
15
19
11
2

38
6
3
56%
79%
30
32
1
10
14
5
1

Source: Information on plans and issuers is from the plan landscape files and active plan selections in the CMS Multidimensional
Insurance Data Analytics System (MIDAS) for states using the HealthCare.gov platform in 2016 and 2017. Kentucky is new to
the HealthCare.gov platform in 2017 and is not included in this analysis.
Note: All averages in this table are weighted based on plan selections in the county. The 2016 and 2017 averages use 2016 plan
selections in 38 states.The number of issuers per state is calculated by finding the total number of issuers offering QHPs
anywhere in each state, then taking an average over all states weighted by plan selections in the state. Numbers may not sum due
to rounding.

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 39

TABLE 16
Examples of Maximum Monthly Health Insurance Premiums for the Second-Lowest Cost
Silver Plan for Marketplace Coverage for a Single Adult in 2017
Single
Adult
Income

Percent of the
Federal Poverty
Level

$11,880
$17,820
$23,760
$29,700
$35,640
$41,580
$47,520

100%
150%
200%
250%
300%
350%
401%

Maximum Percent of
Income Paid toward
Second-Lowest Cost
Silver Plan
2.04%
4.08%
6.43%
8.21%
9.69%
9.69%
No Limit

Maximum Monthly
Premium Payment
for Second-Lowest
Cost Silver Plan
$20
$61
$127
$203
$288
$336
No Limit

Source: Applicable percentages for 2017 coverage are available at: https://www.irs.gov/pub/irs-drop/rp-16-24.pdf. The 2016
Federal Poverty Guidelines, used for premium tax credits for 2017 coverage, are at: https://aspe.hhs.gov/poverty-guidelines.
Notes: Income examples are based on the 2016 federal poverty guidelines for the continental United States. Alaska and Hawaii
have higher federal poverty guidelines, which are not shown in this table. In states expanding Medicaid, individuals and families
at between 100 and 138 percent of the FPL who are eligible for Medicaid coverage are not eligible for premium tax credits. For
more information on premium tax credits, see the Internal Revenue Service final rule on “Health Insurance Premium Tax Credit,”
(Federal Register, May 23, 2012, vol., 77, no. 100, p. 30392; available at: http://www.gpo.gov/fdsys/pkg/FR-2012-0523/pdf/2012-12421.pdf).

ASPE Office of Health Policy

October 2016

 ASPE Research Brief

Page 40

APPENDIX C: COMPARING 2017 MARKETPLACE PREMIUMS TO CBO PROJECTIONS
In November 2009, the Congressional Budget Office (CBO) projected that the national average
premium for the second-lowest-cost Marketplace silver plan would be $5,200 for single coverage
in 2016 under the version of the ACA debated by the Senate.32 This is the only projection of the
benchmark premiums under the law that CBO issued in advance of the law’s passage.33,34 CBO
did not report its corresponding projection for 2017, so ASPE approximated CBO’s premium
projection for 2017 by trending the 2016 projection forward to 2017 using information reported
in later CBO publications.
Specifically, CBO reported in March 2012 that its average underlying annual rate of growth in
private insurance premiums for the period 2012 to 2022 was 5.7 percent; CBO further indicated
that the average growth rate for this period was approximately 0.8 percentage points below the
growth rate used in its March 2011 projections, implying that the average growth rate in those
earlier projections had been around 6.5 percent.35 CBO had previously indicated that the
assumptions used in its March 2011 projections were similar to those used in its original
estimates of the ACA.36
On that basis, ASPE used a trend rate of 6.5 percent to trend CBO’s projection for 2016 forward
to 2017 and estimated that CBO’s November 2009 estimate of the national average premium for
the second-lowest cost Marketplace silver plan in 2017 was around $5,538. For comparison,
ASPE estimates that the weighted average premium for single coverage under the second-lowest
cost silver plan will be $5,586 in the HealthCare.gov states in 2017, assuming that the age and
geographic distribution of 2017 plan selections matches distribution of 2016 plan selections.37 As
discussed elsewhere in this brief, complete data are not available for State-Based Marketplaces
using their own enrollment platforms. Available data on 2016 premiums and premium growth
from 2016 to 2017 indicate, however, that a nationwide average for 2017 would be very similar
to this average for the HealthCare.gov states. Thus, nationwide 2017 Marketplace premiums
appear to be very close to CBO’s November 2009 projections.
32

Congressional Budget Office. November 2009. An Analysis of Health Insurance Premiums Under the
Patient Protection and Affordable Care Act. http://cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10781/1130-premiums.pdf.
33
The version of the ACA considered by the Senate differed somewhat from the final version of the law. CBO
subsequently stated that premium projections under the final version of the ACA would have been “quite similar” to
those included in this November 2009 letter. See Congressional Budget Office. March 2011. CBO’s Analysis of the
Major Health Care Legislation Enacted in March 2010. http://www.cbo.gov/sites/default/files/03-30healthcarelegislation.pdf.
34
Another recent analysis has used this November 2009 projection to assess how CBO’s initial projections of
Marketplace premiums have compared to actual Marketplace premiums. See Larry Levitt, Cynthia Cox, and Gary
Claxton August 2016 How ACA Marketplace Premiums Measure Up to Expectations. http://kff.org/healthreform/perspective/how-aca-marketplace-premiums-measure-up-to-expectations.
35
Congressional Budget Office. March 2012. Updated Estimates for the Insurance Coverage
Provisions of the Affordable Care Act. https://www.cbo.gov/sites/default/files/112th-congress-20112012/reports/03-13-Coverage%20Estimates.pdf.
36
Douglas Elmendorf. March 2011. CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010.
http://www.cbo.gov/sites/default/files/03-30-healthcarelegislation.pdf.
37
Using the 5.7 percent growth rate implies a CBO estimate of the national average premium for the second-lowest
cost Marketplace silver plan of around $5,496 in 2017 which would be about 1.6 percent below the ASPE estimate
of $5,586 for weighted average premium for single coverage under the second-lowest-cost silver plan.

ASPE Office of Health Policy

October 2016