A Commonwealth Fund report published Thursday found that customers who purchased insurance through the Affordable Care Act (ACA) exchanges tended to absorb considerably smaller price increases this year than consumers who bought their plans off the exchanges.
CNBC reported that while on-exchange customers generally experienced lower price increases, many of them have closed network plans that restrict where they can receive covered health services.
According to official government estimates, 21 million people this year will be enrolled in non-group health plans. Of those 21 million, 12 million will purchase individual plans through the ACA exchanges—either through the federal HealthCare.gov marketplace or through one of the state exchanges formed under the health law.
The remaining 9 million will buy similar health plans that are sold “off-exchange.”
The report prepared by Commonwealth Fund compared the on- and off-exchange markets by using projections from insurance companies about their ACA-compliant plans. It found that monthly insurance premiums per plan member grew by an average of $40 per month for all types of plans sold through the ACA exchanges. For plans sold outside the exchanges, however, the average monthly premium price hike per member was $48.
This 20% difference is due to insurers expecting more consumers to be enrolled in closed network plans on the exchanges, the report observed.
Closed network plans, either health maintenance organizations (HMOs) or exclusive provider organizations (EPOs), do not cover medical costs for treatment from providers not in their network, although exceptions are made in emergencies. Through this arrangement, insurers can better control costs.
Insurers estimated a 37% increase in HMO and EPO plans sold on the exchanges this year.
The report noted that closed network plans sold on the exchanges had premium price increases per member of $30 per month in 2016.
Closed network plans sold off-exchange had an average premium hike of $40.
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