2022 ACA Marketplace Premiums Depend on Enrollee Income, Location

Affordable Care Act (ACA) marketplace premiums for 2022 depend largely on where individuals live, what their income is, and which plan they select, according to a Kaiser Family Foundation (KFF) issue brief.

Under the American Rescue Plan Act, low-income individuals and families can receive temporary premium subsidies for ACA marketplace plans through December 31, 2022. The Build Back Better Act could extend this eligibility through 2025.

To understand how marketplace premiums are shifting before and after subsidies in 2022, KFF researchers analyzed county-level rate filing data obtained from state regulators, state exchange websites, and HealthCare.gov. All of the data reflects findings that apply to a 40-year-old with various incomes.

In order to receive the highest amount of savings, individuals must consider their income level, the subsidies they are eligible for, and their plan options, as different combinations can yield different savings.

On average, before tax credits, the lowest-cost bronze plan premiums are generally staying the same, while the lowest-cost silver plans, benchmark silver plans, and lowest-cost gold plans are seeing premium decreases of 1.8 percent, 3.1 percent, and 4.1 percent, respectively.

Premium changes and tax credits will fluctuate depending on the benchmark premium. Since the lowest-cost bronze plan premium is not decreasing, subsidies will cover a smaller amount of the premium in 2022 than in 2021. Likewise, the subsidies may cover a larger share of the lowest-cost gold plan premiums because the premiums are falling at a faster rate than benchmark premiums.

Enrollees who have incomes between 100 and 150 percent of poverty are eligible for zero-dollar premium bronze plans or silver plan premiums of less than $1 to $4 per month. Enrollees with incomes of 155 percent of poverty are also eligible for nearly free silver level plans in 66 percent of counties, the brief said. In 2021, 72 percent of counties offered this option.

After tax credits, lowest-cost gold plans saw the biggest premium decreases for every income level between 155 and 311 percent of poverty, but the plans also had the most expensive premiums.

The lowest-cost bronze premiums either stayed the same or increased by as much as 33 percent for a 40-year-old with an income of $30,000. The lowest-cost silver premiums did not change for most of the income groups except for individuals with incomes of $30,000 and $40,000, for whom the premiums increased slightly by 1.4 percent and 0.5 percent, respectively.

The ARPA tax credits may cover the full premium of a marketplace plan depending on where an individual lives. All of the counties included in the analysis cover the full premium for lowest-cost bronze plans for enrollees with incomes between 155 and 194 percent of poverty.

However, these enrollees may see higher savings if they enroll in a silver level plan, due to cost-sharing reductions. Cost-sharing reductions set lower out-of-pocket cost-sharing maximums which can lead to lower copayments, deductibles, and coinsurance, the brief stated. This benefit is only offered on silver plans.

For this reason, low-income individuals who are eligible to receive cost-sharing reductions may save more by choosing a silver plan with a small premium and lower deductible rather than a bronze plan with no premium and a high deductible.

“Marketplace enrollees eligible for cost-sharing subsidies are often best off in a silver plan, which will reduce their out-of-pocket costs when they need medical care,” the brief stated.

Bronze level plans may produce the highest savings for individuals with incomes between 233 and 311 percent of poverty who are not eligible for additional financial aid. For a 40-year-old with an income of $30,000, the subsidies cover the full bronze plan premium in 79 percent of counties. A handful of counties also offer zero-dollar premium bronze plans to individuals with incomes between $35,000 and $40,000.

While bronze premiums have increased slightly for 2022, silver premiums have stayed the same, and gold premiums have decreased, specific premium amounts and savings are largely dependent on an individual’s income, tax credit eligibility, and location, the brief summarized.