As Open Enrollment for 2018 coverage gets underway, consumers who have health coverage through the Affordable Care Act (ACA) Marketplace are again receiving renewal notices from their health insurers.  Though the insurer renewal notices are based on the same model notice required in the past, this year for many consumers, it may be causing significant – and misleading – sticker shock.

That is because renewal notices sent by insurers are required to inform consumers what their 2018 monthly premium will be, assuming they receive the same amount of advanced premium tax credit (APTC) next year that they did in 2017.  Insurer renewal notices have been required to present information this way since 2014.

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More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Trump’s assertion that the marketplace was collapsing.

In a report on the first four days of open enrollment, the Trump administration said Thursday, 601,462 people selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.

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Uncertainty over the future of the Affordable Care Act was a challenge for insurers and state regulators as they prepared for the 2018 plan year. Various insurers exited or reduced service areas in the health insurance marketplaces, while others threatened exits or delayed participation decisions. In several states, some or all counties seemed likely to have no insurance plan available for residents seeking marketplace coverage. But as of the start of open enrollment, no states had counties without an insurer for plan year 2018

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Since the Affordable Care Act health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. Our earlier analyses of insurer participation and some notable company exits can be found here.  Note that we consider affiliated insurers serving the same areas as one insurer.

In 2014, there were an average of 5.0 insurers participating in each state’s ACA marketplace, ranging from 1 company in New Hampshire and West Virginia to 16 companies in New York. 2015 saw a net increase in insurer participation, with an average of 6.0 insurers per state, ranging from 1 in West Virginia to 16 in New York. In 2016, insurer participation changed in a number of states due to a combination of some new entrants and the failure of a number of CO-OP plans. In 2016, the average number of companies per state was 5.6, ranging from 1 in Wyoming to 16 in Texas and Wisconsin.

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The premiums for 2018 Marketplace plans were recently released to give consumers a chance to look at their plan options before open enrollment begins on November 1. Premiums are rising significantly in many counties across the country, in part due to the decision of the Trump Administration to cease payments to insurers for cost-sharing reductions. Insurer participation also declined in many areas, leaving more counties with only one insurer, which likely contributed to the high rate of premium growth.

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In an odd twist, low-income people in about half of U.S. counties will now be able to get a taxpayer-subsidized ACA policy for free. The Kaiser Family Foundation found that in 1,540 counties a hypothetical 40-year-old making $25,000 a year can get a basic “bronze” plan under the ACA next year for zero monthly premium. This could become a springboard for marketing pitches by insurers as they try to sign up more consumers.

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The House and the Trump administration are asking to keep a pause on a years-long court battle over the legality of crucial ObamaCare payments to insurers, while Democratic attorneys general are seeking for the case to proceed.

In 2014, the House sued the Obama administration, arguing it was funding key payments to insurers illegally, alleging that there wasn’t a direct appropriation from Congress. The House won, and the Obama administration appealed the ruling.
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Federal health officials are proposing changes to rules for coverage sold through the ACA’s insurance marketplaces that, starting in 2019, would let states alter the benefits that health plans must provide and limit enrollment help for consumers. In envisioning a larger role for states in setting benefits, the draft rule would still require ACA plans to cover 10 categories of medical services. But for the first time, any state could adopt benefits standards already in use by another state—or rewrite its own standards.

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The average price of the most popular types of Obamacare health plans sold on the federal insurance marketplace will be at least 34 percent higher in 2018, according to an analysis released Wednesday.

The Avalere Health analysis also found lower — but still double-digit — average price hikes for the other types of Obamacare plans, which go on sale Nov. 1.
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President Donald Trump plans to end a key set of Obamacare subsidies that helped lower-income enrollees pay for health care, the White House said Thursday, a dramatic move that raises questions about the law’s future.

The late-night announcement is part of Trump’s aggressive push to dismantle aspects of his predecessor’s signature health law after several failed attempts by Congress to repeal it earlier this year.
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