Summary Cost Data for Federally-Facilitated
Exchanges, 2014

Nicholas Elan
Research Associate
Bernadette Fernandez
Specialist in Health Care Financing
Annie L. Mach
Analyst in Health Care Financing
April 16, 2014
Congressional Research Service
7-5700
www.crs.gov
R43484


Summary Cost Data for Federally-Facilitated Exchanges, 2014

he Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) contains a
number of provisions that may affect the individual health insurance market. These
Tprovisions will alter the amount that individuals and families can expect to pay for plans
sold through the health insurance exchanges (“marketplaces”) established under ACA, both in
terms of premiums and cost-sharing measures.
In general, the ACA provisions that may affect exchange premiums and cost-sharing requirements
may also affect plans sold to individuals and families outside of exchanges. For a listing of ACA
market reforms that apply inside and outside of exchanges, see Table 2 in CRS Report R43233,
Private Health Plans Under the ACA: In Brief. For a broader discussion of ACA market reforms,
see CRS Report R42069, Private Health Insurance Market Reforms in the Affordable Care Act
(ACA)
.
The Department of Health and Human Services established a data website that makes premium
and cost-sharing data, for plans offered through federally-facilitated exchanges (FFEs), available
to researchers and the general public.1 CRS developed a fact sheet for each of the 34 FFEs that
offer private health plans to individuals and families.2 Each fact sheet provides summary data
about the range of costs and options for plans in a specific state’s marketplace.3
Given that these fact sheets are data documents, they do not discuss the factors that insurance
carriers consider when developing premium rates or cost-sharing requirements. For example,
medical claims represent the largest component of premiums by far, but claims costs are subject
to a variety of factors, which may range from being plan-specific (e.g., limited provider network)
to more general (e.g., market power of the carrier in negotiations with providers). Likewise, there
are multiple considerations represented in cost-sharing requirements. For example, a given
medical deductible may reflect heavy use of managed care techniques (as is the case in a
traditional health maintenance organization [HMO], for example); presence of a separate
prescription drug deductible; emphasis on consumer incentives to manage their use of health care
services (e.g., a high-deductible plan that is paired with a health savings account [HSA]; and
other plan features. Given the variability in the factors underlying both premiums and cost-
sharing, caution should be used when comparing amounts across geographic areas and, in certain
instances, across plans in the same area.
The links to the fact sheets are included in the table below, by state name (alphabetical order).
Click the appropriate link to load each FFE fact sheet.

1 The data are available from Data.Healthcare.gov. CRS did not attempt to verify the accuracy of this data set. To
access cost and other data for individual health plans sold through FFEs, see “QHP Landscape Individual Market
Medical,” https://data.healthcare.gov/dataset/QHP-Landscape-Individual-Market-Medical/b8in-sz6k.
2 These exchanges offer plans for direct purchase by consumers (individual exchanges). ACA also requires each state to
have an exchange designed to sell health plans to small businesses (SHOP exchanges); these fact sheets do not provide
information about coverage available through SHOP exchanges.
3 Exchange plans may vary in characteristics, such as the share of medical spending the plan will cover (“actuarial
value,” or AV). Under ACA, each plan that meets a specific AV is designated by a precious metal: platinum, gold,
silver, or bronze. However, insurance carriers are only required to offer at least one silver plan and one gold plan, for
exchange certification purposes, per ACA § 1301(a)(1)(A)(ii). Therefore, carriers are not required to offer either bronze
or platinum plans, but may choose to do so.
Congressional Research Service
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Summary Cost Data for Federally-Facilitated Exchanges, 2014

Table 1. Fact Sheets for Federally-Facilitated Exchanges Offering Individual Plans
State
Links to Fact Sheets
Alabama
CRS Report R43485, Summary Cost Data for Health Plans Available in Alabama’s
Exchange, 2014: Fact Sheet

Alaska
CRS Report R43486, Summary Cost Data for Health Plans Available in Alaska’s
Exchange, 2014: Fact Sheet

Arizona
CRS Report R43488, Summary Cost Data for Health Plans Available in Arizona’s
Exchange, 2014: Fact Sheet

Arkansas
CRS Report R43487, Summary Cost Data for Health Plans Available in Arkansas’s
Exchange, 2014: Fact Sheet

Delaware
CRS Report R43499, Summary Cost Data for Health Plans Available in Delaware’s
Exchange, 2014: Fact Sheet

Florida
CRS Report R43500, Summary Cost Data for Health Plans Available in Florida’s
Exchange, 2014: Fact Sheet

Georgia
CRS Report R43501, Summary Cost Data for Health Plans Available in Georgia’s
Exchange, 2014: Fact Sheet

Illinois
CRS Report R43502, Summary Cost Data for Health Plans Available in Illinois’s
Exchange, 2014: Fact Sheet
Iowa
CRS Report R43503, Summary Cost Data for Health Plans Available in Iowa’s
Exchange, 2014: Fact Sheet

Indiana
CRS Report R43512, Summary Cost Data for Health Plans Available in Indiana’s
Exchange, 2014: Fact Sheet

Kansas
CRS Report R43513, Summary Cost Data for Health Plans Available in Kansas’s
Exchange, 2014: Fact Sheet

Louisiana
CRS Report R43514, Summary Cost Data for Health Plans Available in Louisiana’s
Exchange, 2014: Fact Sheet

Maine
CRS Report R43515, Summary Cost Data for Health Plans Available in Maine’s
Exchange, 2014: Fact Sheet

Michigan
CRS Report R43516, Summary Cost Data for Health Plans Available in Michigan’s
Exchange, 2014: Fact Sheet

Idaho
CRS Report R43525, Summary Cost Data for Health Plans Available in Idaho’s
Exchange, 2014: Fact Sheet

Mississippi
CRS Report R43526, Summary Cost Data for Health Plans Available in Mississippi’s
Exchange, 2014: Fact Sheet

Missouri
CRS Report R43527, Summary Cost Data for Health Plans Available in Missouri’s
Exchange, 2014: Fact Sheet

Montana
CRS Report R43528, Summary Cost Data for Health Plans Available in Montana’s
Exchange, 2014: Fact Sheet

North Carolina
CRS Report R43529, Summary Cost Data for Health Plans Available in North Carolina’s
Exchange, 2014: Fact Sheet

North Dakota
CRS Report R43530, Summary Cost Data for Health Plans Available in North Dakota’s
Exchange, 2014: Fact Sheet

Nebraska
CRS Report R43549, Summary Cost Data for Health Plans Available in Nebraska’s
Exchange, 2014: Fact Sheet

New Hampshire
CRS Report R43550, Summary Cost Data for Health Plans Available in New
Hampshire’s Exchange, 2014: Fact Sheet

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Summary Cost Data for Federally-Facilitated Exchanges, 2014

State
Links to Fact Sheets
New Jersey
CRS Report R43551, Summary Cost Data for Health Plans Available in New Jersey’s
Exchange, 2014: Fact Sheet

New Mexico
CRS Report R43552, Summary Cost Data for Health Plans Available in New Mexico’s
Exchange, 2014: Fact Sheet
Ohio
CRS Report R43553, Summary Cost Data for Health Plans Available in Ohio’s
Exchange, 2014: Fact Sheet

Oklahoma
CRS Report R43554, Summary Cost Data for Health Plans Available in Oklahoma’s
Exchange, 2014: Fact Sheet

[Additional states forthcoming]
Source: CRS compilation of available data through Data.HealthCare.gov.



Author Contact Information

Nicholas Elan
Annie L. Mach
Research Associate
Analyst in Health Care Financing
nelan@crs.loc.gov, 7-0688
amach@crs.loc.gov, 7-7825
Bernadette Fernandez

Specialist in Health Care Financing
bfernandez@crs.loc.gov, 7-0322


Congressional Research Service
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