Choices, Competition Abound in 2022 ACA Exchange Market

by Leslie Small

Consumers who search for plans during the annual open enrollment period for the Affordable Care Act exchanges — which began Nov. 1 — will be shopping in a market that is experiencing a surge of insurer competition and a dizzying array of plan choices.

Competition heats up:

• In 2021, approximately 45% of people younger than 65 who earned under 400% of the federal poverty level [FPL] and who lived in counties served by HealthCare.gov had at least 50 plan choices, says David Anderson, a research associate at the Duke-Margolis Center for Health Policy. For 2022, that share jumps to more than 65%, and of that 65%, 35% will have 100 or more plan choices.
• That surge of plans is being driven, in part, by more insurer participation. For the 2022 plan year, 213 issuers will offer coverage through HealthCare.gov, an increase of 32 issuers compared to the 2021 plan year, according to CMS.

The policy shifts behind the trends:

• In terms of what is driving more insurers to the marketplaces, Katherine Hempstead, senior adviser to the executive vice president at the Robert Wood Johnson Foundation, points out that the American Rescue Plan temporarily made ACA subsidies more generous in 2021 as well as in 2022.
• She also notes that the exchanges are likely to see an influx of new members when the public health emergency ends and states resume Medicaid eligibility redeterminations. Insurers that have both Medicaid and ACA exchange plans, such as Centene Corp., are trying to position themselves to turn one business line’s loss into another’s gain.
• “Because of the first year of the [expanded] subsidies and because of the [looming Medicaid] redetermination, plans might be thinking, ‘This year’s a bonanza. This year is the time to capture new members,’” Hempstead says.

More plan choices, more problems?

• Anderson says having more options can sometimes lead to consumer confusion. “Trying to make a well-considered choice out of 200 options is extremely challenging; trying to make a well-considered choice out of 100 options is extraordinarily challenging,” Anderson adds.
• To that end, CMS says it has awarded 60 Navigator organizations $80 million in grants for the 2022 plan year, and with $11.5 million in additional funding available to support additional outreach, education and enrollment activities during the HealthCare.gov open enrollment period, which will last through Jan. 15.

From Health Plan Weekly