2017 Health Insurance Exchange Snapshot

Transcription

1 2017 Health Insurance Exchange Snapshot Avalere Health An Inovalon Company January 2017

2 Figure 1. Exchange Enrollment Continues to Fall Below Expectations EXCHANGE ENROLLMENT AND PROJECTIONS, IN MILLIONS * 13.8** 11.4** CBO Projection as of March 2011 Plan Selections Effectuated Enrollment *Latest 2016 effectuated enrollment data. Represents average effectuated enrollment in June **Avalere estimates based on the Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE), October 19, Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed HHS enrollment reports for each year s open enrollment period. 2

3 Percent of Rating Regions Figure 2. Issuer Participation Dropped Significantly in 2017; Roughly 1 in 3 Regions Have Only 1 Issuer ISSUER PARTICIPATION IN EXCHANGE RATING REGIONS, 50 STATES AND DC 45% 67% 3+ Issuers 19% 2 Issuers 1 Issuer 29% 36% 4% Note: Through the use of public data sets and Avalere s analysis of the state-run exchange websites, Avalere compiled a county-level dataset of health insurer participation in the health insurance exchanges for the 2015, 2016, and 2017 plan years. Avalere compares insurer participation in each year to determine the ongoing trends within the market and the expected insurer choice that will be available for consumers. Additionally, to provide a fuller analysis of the data, Avalere enrollment weights the national roll-up of average health insurer participation in each county. This means issuer participation in regions with greater enrollment will be weighed more heavily in the national average of number of issuers per region. Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and state-based exchange websites; 2016 Federally Facilitated Exchange County Plan Selections: Department of Health and Human Services Plan Selections File; Census Current Estimates Data by County; ASPE Health Insurance Marketplaces Open Enrollment Period 2016 Final Enrollment Report. 3

4 Figure 3. Silver Premiums Are Increasing by 12% from 2016 to 2017 AVERAGE PLAN PREMIUMS, FFE STATES, 2014 TO 2017 $892 $475 $408 $359 $373 $554 $496 $434 $453 $712 $602 $530 $505 $555 $645 $ Bronze Silver Gold Platinum Average premium increases in 2017 exceed the increases from 2015 to Note: Premium rates are for a nonsmoking 50-year-old individual. Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. 4

5 Figure 4. Popular Low-Cost Silver Plan Premiums Rise in 2017 $600 AVERAGE SILVER PLAN PREMIUMS, BASED ON 50-YEAR-OLD, NON-SMOKER, FFE STATES, % $ % +25% $400 $300 $200 $496 $554 $521 $537 $417 $431 $100 $0 Average Silver Plan Average Lowest Cost Silver Plan Average Second Lowest Cost Silver Plan Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. 5

6 Figure 5. Issuers Are Increasingly Limiting Their Offerings to Narrower Network Plans PERCENT OF PLAN OFFERINGS BY PLAN TYPE, FFE STATES 28% 39% 35% 12% 13% 11% 7% 11% 7% 41% 47% 49% 21% 10% 13% 55% Less restrictive networks 1 PPO POS More restrictive networks 2 EPO HMO EPO: Exclusive Provider Organization; POS: Point of Service Plan; HMO: Health Maintenance Organization; PPO: Preferred Provider Organization 1 Compared to HMOs and EPOs, POS and PPO plans generally offer broad in-network coverage of providers; out-of-network coverage is usually offered in exchange for higher cost sharing. 2 HMOs and EPOs often have comparatively fewer providers in their network and across specialties compared to POS and PPO plans; coverage is usually exclusive to in-network providers. Note: Compared to prior slides, analysis of number of plans is based on the number of unique benefit designs offered by each issuer in a state in 2017, rather than by rating region. Catastrophic plans and New York plans are excluded from this analysis. Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. 6

7 Figure 6. Combined Deductibles for Silver Plans Increase by 20% to $3,703 in 2017 AVERAGE COMBINED* DEDUCTIBLE BY METAL LEVELS, CA, NY, AND FFE STATES, $7,000 $6,000 $5, Average 2015 Average 2016 Average 2017 Average $6,014 $5,719 $5,249 $5,024 $4,000 $3,000 $2,000 $1,000 $- $3,703 $3,075 $2,658 $2,480 $1,080 $1,161 $1,023 $1,051 $154 $189 $182 $110 Bronze Silver Gold Platinum Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. *In the FFE landscape file, plans note either a combined deductible which includes the medical and drug deductible, and other plans note separate medical and drug deductibles. The information above examines only plans with a combined deductible. 7

8 Figure 7. Silver Plans Generally Use Copayments for Generics and Coinsurance for Specialty Drugs in 2017 Percent Of Plans Avg. Coinsurance: 21% Avg. Copay: $13 Avg. Coinsurance: 27% Avg. Copay : $49 Avg. Coinsurance: 37% Avg. Copay : $95 Avg. Coinsurance: 37% Avg. Copay : $224 PERCENT OF PLANS USING COPAY VS. COINSURANCE BY FORMULARY TIER, SILVER PLANS, CA, NY, AND FFE STATES, % 10% 19% Copayment Coinsurance 80% 53% 60% 84% 40% 90% 81% 20% 47% 16% 0% Generic Preferred Non-Preferred Specialty Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. Note: These data include the FFE landscape file as well as data from Covered California and New York State of Health. Notably, the FFE landscape file forces plans into four tiers of data which excludes some cost-sharing detail. When plans indicated no charge in the FFE landscape file, Avalere assigned the plan to $0 copayment or 0 percent coinsurance depending on which cost-sharing type was most prevalent for the specified benefit. For Tiers 1 2 Avalere used $0 copayment, and for Tiers 3 4 Avalere used 0 percent coinsurance. Avalere did not include heath plans in which there was no cost sharing across service categories or that had deductibles that were equal to the out-of-pocket maximum. 8

9 Percent Of Plans Figure 8. Substantial Increase in Coinsurance of 31% or More for Specialty Drugs in Bronze, Silver Plans 80% 70% PERCENT OF PLANS WITH COINSURANCE 31+ PERCENT FOR SPECIALTY DRUGS, CA, NY, AND FFE STATES 73% % 50% 40% 30% 20% 38% 52% 50% 50% 41% 36% 36% 37% 27% 20% 22% 32% 26% 25% 17% 10% 0% Bronze Silver Gold Platinum In 2017, plans are increasingly requiring coinsurance of 31% or more for specialty tier drugs, particularly among bronze and silver level plan offerings. Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. Note: These data include the FFE landscape file as well as data from Covered California and New York State of Health. Notably, the FFE landscape file forces plans into four tiers of data which excludes some cost-sharing detail. When plans indicated no charge in the HHS Landscape file, Avalere assigned the plan to $0 copayment or 0 percent coinsurance depending on which cost-sharing type was most prevalent for the specified benefit. For Tier 4 Avalere used 0 percent coinsurance. Avalere did not include heath plans in which there was no cost sharing across service categories or that had deductibles that were equal to the out-ofpocket maximum. 9

10 Figure 9. Average Silver MOOPs Increase Moderately in 2017 Maximum Out-of-Pocket Limit COMBINED* MOOP LIMIT BY METAL LEVEL, CA, NY, AND FFE STATES, 2017 Minimum Average Maximum $8,000 $7,000 $6,000 $5,000 $7,150 $6,885 $6,100 $7,150 $7,150 $7,150 $6,528 $5,332 $4,000 $3,000 $3,600 $3,140 $2,000 $2,000 $1,000 $- Bronze Silver Gold Platinum $1,000 Average MOOPs in silver plans increased 6% from 2016 to Source: Avalere PlanScape, a proprietary analysis of exchange plan features, December Avalere analyzed data from the FFE Individual Landscape File released October 2016 and the California and New York state exchange websites. MOOP: Maximum Out-of-Pocket *In the FFE landscape file, plans note either a combined MOOP limit, which includes one MOOP for all medical and drug spending, or separate medical MOOP and drug MOOP limits. The information above examines only plans with a combined MOOP limit. 10