How new carriers in your marketplace could affect your coverage options

Recent news about health insurance for individual markets has largely centered around the US bailout and how it made coverage in 2021 more affordable than it was before. Now, as we approach the ACA’s annual open enrollment period, it’s time to look forward to what we can expect to happen with our 2022 coverage.

Fortunately, ARP-enhanced subsidies will remain in effect in 2022 — and possibly longer, if Congress can agree to an extension. This means that benefits will continue to be greater than they were before, and more widely available, including to families earning more than 400% of the poverty level.

For 2022 single/family coverage, we’re seeing some wide variation in proposed and final rate changes across the country. Average rates will decrease in some areas and increase in others, with modest single-digit rate changes in most places.

(Because the ARP has eliminated the income cap for subsidy eligibility for 2021 and 2022, few enrollees will see these price changes reflected in their actual premiums, since most enrollees receive premium subsidies. But price changes affect the size of the subsidy amount, and can lead to changes in post-support premiums, as described below.)

The insurance company’s growing participation in the market continues

But we’re also seeing a widespread continuation of the growing trend of co-insurances that’s been going on since 2019. In 2017 and 2018, insurers fled ACA exchanges — or even the entire individual/family market. But that started to shift in 2019, and insurance company participation increased again in 2020 and 2021.

For 2022, this trend continues. Some of the big name insurers that previously reduced their market participation are rejoining the different markets, and some smaller regional insurers are joining the markets or expanding their existing footprints.

Where will new carriers enter the 2022 ACA market?

Here is a summary of some of the individual/family insurance companies entering new markets for 2022:

  • Aetna CVS Health It joins the market in Arizona, Florida, Georgia, Missouri, Nevada, North Carolina, Virginia and Texas.
  • AmeriHealth Caritas Joins the market in North Carolina.
  • Bright Healthcare It joins the market in California, Texas, Utah, Virginia and Georgia.
  • capital health plan Join the market in Florida.
  • Centene / Ambetter / WellCare / Celtic / Sunshine State Health Plan It joins the market in Kentucky, New Jersey, Florida, Oklahoma, New Jersey, Nebraska, and North Carolina.
  • Cigna It joins the market in Georgia, Mississippi and Pennsylvania.
  • ConnectiCare Insurance Company Joins the market in Connecticut.
  • Friday health plans It joins the market in Oklahoma, Georgia and North Carolina.
  • Muscat health plan Joins the market in Nevada.
  • Health plan for innovation Joins the market in Virginia.
  • Medica Join the market in Arizona
  • fashion Join the market in Texas.
  • Molina Join the market in Idaho, Kentucky and Illinois
  • Oscar Health It joins the market in Arkansas, Illinois and Nebraska.
  • Presbyterian Health Plan Back to the market in New Mexico.
  • united health care Rejoins/rejoins the market in Alabama, Texas, Georgia, Florida, Illinois, Louisiana and Michigan.
  • Health and life in the United States It joins the market in Indiana, Kansas and Michigan.
  • Mississippi’s Vantage Health Plan Joins the market in Mississippi.

More carriers = more plan options…

This is in addition to the numerous expansions of the coverage area by insurance companies present in the market in many countries. Based on the price filings we’ve analyzed thus far, we expect that many – if not most – market registrants will have more plan options available for 2022 than they did this year.

One of the goals of the ACA was to increase competition in the individual health insurance market. The exchanges were created to facilitate this, with registrants able to compare options from all participating insurance companies and choose the plan that best suits their needs.

From this perspective, increasing insurer participation and competition in the exchange is a good thing. It also gives people more plans to choose from, which can also be a good thing. But too many choices can confuse applicants and lead to poor decisions.

… and the new carrier can also affect the premium support

In addition to offering more plan options, carriers expanding into an area may also affect premium subsidies in that area. The amount of impact depends on how new plans are priced compared to existing plans – bearing in mind that prices change every year on January 1 regardless of whether any new insurers enter the market.

Premium support amounts are based on the cost of the Standard plan in each region. But since that only refers to the second least expensive silver plan, it’s not necessarily the same plan from year to year. If a new insurer enters the market with lower-rate plans, the insurer may reduce the existing standard and take on the second lowest cost spot. If the premium is lower than the standard plan price it would otherwise be, the result is lower premium support for everyone in the business.

For people in that area who would rather keep their current plan (rather than switch to the new, lower-cost options), this can lead to more in post-subsidy premiums, as the subsidies are lower than they would otherwise be. We can see an example of this in the Phoenix area in 2019 and 2020, when new insurers entered the market with lower-rate plans that reduced the amount of premium subsidies in the area.

To be clear, anything that reduces the cost of the standard premium will result in lower subsidies. This could be a new, low-cost insurer entering the market, or existing insurers cutting their rates. An example of this can be seen in how post-subsidy premiums increased for many of those listed on the Colorado Stock Exchange in 2020, when the state’s new reinsurance program cut average pre-support premiums by about 20%. The reduction helped unsubsidized enrollees (most of them with incomes over the threshold, which was repealed at least through 2022) but led to higher net premiums for many enrollees eligible for benefits.

Although the vast majority of exchange registrants are eligible for premium subsidies (especially now that the US bailout has scrapped the “support cliff” for 2021 and 2022) some registrants do not. For those enrolled, introducing a new insurance company simply expands their plan options, and doesn’t affect their premiums unless they choose to switch to the new plan.

Of course, if the new insurer has plans that are priced higher than the current reference plan, the carrier’s entry will not affect the net premiums paid by subsidized enrollees.

Plan to compare your coverage options during open enrollment

It will be several weeks before all the details are clear in terms of price changes and availability of the plan to cover 2022. But it seems that the trend of increased competition on the exchanges will continue.

And although the enhanced support structure of the US bailout will remain in place in 2022 — making support larger and more widely available than it would otherwise — it is still possible for a new insurer to disrupt the market and wind up adjusting the premium size. subsidies in a particular area.

Open enrollment for the 2022 coverage will begin on November 1. Actively comparing your options during open enrollment is always the best approach, and this is especially true if your new insurance company will offer plans in your area. Allowing your existing plan to auto-renew without comparison shopping will never be in your best interest.

If a new insurance company joins the market, you may find that their plans are well suited to your needs. Or you may find that your best option is to switch to a different plan because post-support premiums are increasing because the new insurance company lowers the price of the existing standard plan. Switching plans may not be a start because of your provider network or prescribing needs, but you won’t know for sure until you consider the different options available to you.

Ask a professional how the new carrier will affect your coverage

We have an overview of the factors to consider when choosing a health plan, but it is also helpful to seek professional advice. Registration assistance is available from brokers, registration consultants and navigators.

Brokers are licensed and regulated by state insurance departments, and they must also be certified by the exchange to help people register for health plans offered through the exchange. Training and testing are necessary in order to obtain licensing and certification, and brokers must also complete a continuing continuing education in order to maintain their credentials.

Broker training covers a wide range of topics, including ethics, fraud prevention, sophisticated insurance laws and regulations, and health plan details. Training and regulatory oversight make the mediators a reliable source of information and assistance in determining initial plans and enrollment as well as future issues that may arise when using a health plan.

Navigators should be widely available this fall, as the Biden administration has earmarked $80 million for this year’s Navigator grants in states using HealthCare.gov. (The previous high was $63 million in 2016; the Trump administration subsequently reduced it to $36 million in 2017 and to $10 million annually from 2018 through 2020). Consumers who have increased access to post-registration assistance with their coverage.

In short, registration assistance should be widely available this fall, and it is in your best interest to use it. A recent report by Young Invincibles highlights the myriad ways registry assistants help consumers — it’s more than just choosing a plan.

No matter where you seek help, it won’t cost you anything – and your broker, Navigator or Enrollment Consultant will be able to help you determine the impact of any new insurers offering plans in your area for 2022, and help you make sense of the options available to you.


Louise Norris is an individual health insurance broker who has been writing on health insurance and health reform since 2006. She has written dozens of opinions and educational articles about the Affordable Care Act for healthinsurance.org. The state’s health exchange updates are regularly cited by media covering health reform and other health insurance experts.

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