By Brieanne Lyda-McDonald
The Affordable Care Act Health Insurance Exchange (referred to here as the “Exchange”) began open enrollment for health plans on November 1, 2019. The open enrollment period will end on December 15 with coverage beginning January 1, 2020. This year, there is an increase in the number of plans available across many counties in North Carolina and a decrease in average plan costs. There are 22 counties with an additional plan offered on the Exchange compared to the number available for coverage in 2019 . None of the plans that offered 2019 coverage have chosen to exit the marketplace for 2020 coverage. Health plan enrollees also have access to plans from more issuers for 2020 coverage (Table 1).
Table 1. Percent of Enrollees with Access to Health Plans Offered by 1, 2, or 3 or More Issuers, 2018-2020
|Number of Qualified Health Plan Issuers||Year of Health Plan Coverage|
Source: Centers for Medicare & Medicaid Services. Health Insurance Exchange Public Use Files (Exchange PUFs). https://www.cms.gov/cciio/resources/data-resources/marketplace-puf. Accessed October 30, 2019.
Costs are also decreasing in North Carolina for individuals and families seeking health insurance plans on the Exchange. The monthly premium costs for the second-lowest cost silver plan (SLCSP) were down from an average of $508/month (individual) and $1,984/month (family) for 2019 coverage to $457/month (individual) and $1,790 (family) for 2020 coverage .[a] Table 2 shows SLCSP average premiums for individuals and families in three North Carolina counties for 2019 and 2020 coverage. A majority of individuals who enroll in health plans on the Exchange choose a silver-level plan, with 64% of enrollees in North Carolina doing so for 2019 coverage . The second-lowest cost silver plan is used as the benchmark for calculating premium tax credits that are available based on income.
Table 2. Average Cost of Second-Lowest Cost Silver Plan for Individuals and Families in Three North Carolina Counties, 2019 and 2020
|County||Premium Cost per Month for Average Second-Lowest Cost Silver Plan|
|2019||2020||% Change||2019||2020||% Change|
While plan premiums are decreasing overall in North Carolina, median individual medical deductibles are increasing for plans at some metal levels. Table 3 compares these deductibles for plans in 2019 and 2020.
Table 3. Median Individual Deductible by Plan Metal Level, 2019 and 2020
|Metal Level||Median Individual Medical Deductible|
|Silver (73% AV CSR)||$3,714||$4,144||12%|
|Silver (87% AV CSR)||$642||$736||15%|
|Silver (94% AV CSR)||$208||$205||-2%|
|Platinum||Not Applicable||Not Applicable||Not Applicable|
AV = Actuarial Value; CSR = Cost Sharing Reduction. Actuarial value refers to the percent of health care costs a plan will pay for. Cost Sharing Reductions refer to discounts that lower the amount individuals pay for deductibles, copayments, and coinsurance.
So far during the 2020 enrollment period, nationwide counts of enrollments are down from the same week of enrollment in 2018 with over 932,000 enrolled, compared to 1.1 million in 2018 [3,4]. A possible explanation for this decrease is that individuals who are satisfied with their plans do not need to take action to keep them for the next year. Also, funding for services that help people navigate their health plan options has decreased nationwide for the third year in a row.[b] For North Carolina, CMS provided $3,405,954 for navigation services in 2016, and that has been reduced by 84% to $550,000 in 2019 .
 Centers for Medicare & Medicaid Services, The Center for Consumer Information & Insurance Oversight. Health Insurance Exchange Public Use Files (Exchange PUFs). https://www.cms.gov/cciio/resources/data-resources/marketplace-puf. Accessed October 30, 2019.
 Kaiser Family Foundation. Marketplace Plan Selections by Metal Level. Open Enrollment 2019. https://www.kff.org/health-reform/state-indicator/marketplace-plan-selections-by-metal-level-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed November 20, 2019.
 Centers for Medicare & Medicaid Services. Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 2. November 13, 2019. https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-weekly-enrollment-snapshot-week-2.
 PBS News. Obamacare signups are down, but the marketplaces are still healthy. November 13. 2019. https://www.pbs.org/newshour/health/obamacare-signups-are-down-but-the-marketplaces-are-still-healthy
 Kaiser Family Foundation. Data Note: Limited Navigator Funding for Federal Marketplace States. November 13, 2019. https://www.kff.org/private-insurance/issue-brief/data-note-further-reductions-in-navigator-funding-for-federal-marketplace-states/
[a] Plan costs are average premiums for a 27-year-old individual and a family of four defined as two 40-year old parents with two 0-14 year-old children.
[b] Legal Aid of North Carolina, Inc. is the only organization providing navigation services in the state. These services include outreach, education, and enrollment services. https://www.kff.org/private-insurance/issue-brief/data-note-further-reductions-in-navigator-funding-for-federal-marketplace-states/