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In 2014, Affordable Care Act (ACA) federal requirements went into effect that dramatically changed the regulatory framework for the individual market in most states. The ACA also applied separate regulatory changes to the group market, with the small group market having to undergo more adjustments than large group, but in general these reforms had less of a disruptive impact than in the individual market. This paper compares average claims expense across the individual and group markets by analyzing total incurred medical claims, both before and after the ACA’s requirements went into effect, from 2010 to 2016. Because we examined the years 2010 to 2016, this paper does not take into account recent changes that may affect costs and premiums in 2018 and beyond. We find that at the national level, individual market costs are coming into increasing alignment and achieving parity with costs in the group markets. Our findings suggest the ACA’s 2014 regulations brought the individual market into greater cost parity with the more mature group market. If costs in the individual market rise beyond the point of parity with the group market, then the increases may be more indicative of the structure and makeup of the market than with just underlying health care costs.

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August 15th, 2017

Given the well-publicized challenges with the individual market, carriers’ product development and pricing process for 2018 has been particularly difficult. In an effort to give insurers some reprieve, last week the Centers for Medicare and Medicaid Services extended the deadline for issuers to make changes to their rate filings from August 16 to September 5.[1]  However, […]

The Affordable Care Act (ACA) established health insurance marketplaces for two purposes: to allow individuals to purchase insurance and gain subsidies for that insurance, and to increase competition and product comparability among insurers. Many Americans are using the federal and state-based exchanges to purchase coverage. In 2017, 12.2 million people selected policies through the marketplaces. With so many Americans buying health care […]

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March 27th, 2015

As public insurance marketplaces mature and pursue long-term sustainability, their willingness to continue supporting Navigator Programs may wane – leaving the future of the health care law’s hallmark consumer assistance program in question. Section 1311(i) of the Affordable Care Act (ACA) established the Navigator Program as a mandatory function of the health insurance marketplaces. The […]

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November 11th, 2014

For states looking to ease in step-by-step with State-Based Marketplaces, the Supported State-Based Marketplace appears to be that practical option.

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October 2nd, 2013

Austin Bordelon was quoted in a Reuters article examining how web glitches slowed the Affordable Care Act exchanges launch. Bordelon points to a lower level of exchange functionality and accessibility than was anticipated.

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December 11th, 2012

A new and innovative model for insurance coverage has the charm and the audacity to change the healthcare landscape. But when new markets go live in 2014, will they be able to compete?

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