ACA marketplace premiums decline for 3rd straight year while employer-sponsored premiums go up, study finds

Health insurance premiums in Affordable Care Act marketplaces declined in most states in 2022 for a third straight year, while employer-sponsored insurance premiums increased, according to a new study from the Washington, D.C.-based Urban Institute.

The study was released April 12 and was funded by the Princeton, N.J.-based Robert Wood Johnson Foundation. 

Nine key takeaways:

  • Marketplace plan premiums decreased for the third straight year:
    • 2022: 1.8 percent decrease
    • 2021: 1.7 percent decrease
    • 2020: 3.2 percent decrease
  • Employer-sponsored plan premiums increased:
    • 2021: 3.6 percent increase
    • 2020: 3.9 percent increase 
  • Most states saw marketplace premiums decrease:
    • Thirty-two states decreased.
    • Eighteen states increased.
    • One state remained the same.
    • Eleven states had average benchmark premiums of over $500 a month for a 40-year-old nonsmoker.
    • Six states had premiums less than $365 per month for a 40-year-old nonsmoker.
  • Variations in the amount of increase in marketplace premiums were affected by two factors: higher unemployment rates and more payers in 2022
  • The number of payers participating in the marketplace increased from 198 to 288 between 2020 and 2022 in the regions analyzed. 
  • The presence of Blue Cross Blue Shield payers, national and regional insurers, and provider-sponsored payers was associated with greater-than-average benchmark premiums. 
  • The presence of a Medicaid payer in a rating region was associated with lower benchmark premiums. 
  • The presence of one payer meant premiums were $189.50 per month higher on average compared to a market with five or more payers. 
  • Premiums were lower if the rating region was in a state that expanded Medicaid, had a reinsurance policy or had a state-based marketplace. 

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