The 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 provisions 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.

Footnotes