Insurance Exchanges

A central aim of the Affordable Care Act is to increase the number of Americans with health insurance coverage. Over the past two years, significant progress has been made towards this goal as measured by the decline in the proportion of Americans who lack health insurance coverage, with an estimated 17.6 million uninsured people having gained health insurance coverage since several of the ACA coverage provisions took effect. This brief examines the composition of people that remained uninsured though the first quarter of 2015 and may be eligible to purchase insurance coverage from a Qualified Health Plan through the Marketplaces. It also presents data on the attitudes and experiences of the uninsured, drawn from a number of private surveys.

A central feature of the Affordable Care Act (ACA) is the establishment of health insurance marketplaces. The marketplaces offer consumers organized platforms to shop for health insurance coverage, apply for financial assistance, and purchase coverage without any medical underwriting or premium adjustment based on pre-existing conditions. A key objective of the marketplaces is to foster competitive environments in which consumers can choose from a number of affordable and high quality health plans. This issue brief provides a progress report on the evolution of the competitive dynamics of the marketplaces.

This guidance describes the alternative procedures for eligibility redetermination for enrollment in a qualified health plan through the Marketplace and insurance affordability programs for benefit year 2016. These procedures incorporate some modifications from the alternative procedures specified by the Secretary for benefit year 2015, and will be implemented by each Federally-facilitated Marketplace (FFM). Like the alternative procedures for benefit year 2015, the alternative procedures preserve a core feature of the annual redetermination process, namely that an enrollee may take no action and retain coverage for 2016, which is important in promoting continuity of coverage while limiting administrative burden for enrollees, issuers, and Marketplaces.

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics.

Research indicates that the Affordable Care Act (ACA) is working to enhance competition, expand choice and promote affordability among Marketplace health insurance plans in 2015. This brief presents analysis of qualified health plan data in the Marketplace for 35 states, providing a look at the plan choice and premium landscape that new and returning consumers will see for 2015. It also examines plan affordability in 2015 after taking into account premium tax credits. The findings presented here include states for which sufficient plan data were available for both 2014 and 2015.