While the percentage of counties with free plans declined from 98% to 95% from 2018 to 2019, the vast majority of low-income enrollees (at 150% of the federal poverty level [FPL] or below) in Healthcare.gov states have the option to enroll in a $0 premium bronze plan.

Consumers in Healthcare.gov states also have access to free silver and gold plans as well. Highly subsidized enrollees have free silver plan options in 32% of counties (up from 18% in 2018), and free gold plan options in 25% of counties (up from 10% in 2018).

“For subsidized enrollees, the exchanges remain an attractive option,” said Chris Sloan, director at Avalere. “As with last year, many enrollees can find free plans with comprehensive coverage.”

Figure 1: Percentage of Healthcare.gov Counties with Free Subsidized Options by Metal Level, Individual at 150% FPL, Age 50, 2019

Avalere analysis found that in 2019 there were 13,075 instances of free plans offered in counties in Healthcare.gov states for low-income consumers earning 150% of the FPL or less. With subsidies tied to premiums of silver plans, consumers may be able to significantly reduce or eliminate their monthly premium by applying the subsidy to bronze plans, which typically have lower premiums than silver or gold plans. However, importantly for consumers, bronze plans also have higher out-of-pocket costs in the form of deductibles and coinsurance.

Figure 2. Number of Available Fully Subsidized Premium Plans in Healthcare.gov States by County, Individual at 150% FPL, Age 50, 2019

“While consumers may be able to save monthly premium dollars by choosing a bronze plan, they will likely face higher costs when visiting a doctor or hospital,” said Elizabeth Carpenter, senior vice president at Avalere. “The final days of open enrollment are a good time to remind shoppers to look not only at premiums, but also out-of-pocket costs, when picking insurance for 2019.”

Methodology

To conduct the analysis, Avalere utilized the recently released 2019 Individual Market HHS Landscape Files of 2019 exchange plan premiums in 39 Healthcare.gov states and DC. Avalere then calculated the expected advance premium tax credits (APTCs) in each of the 2,721 counties in these states, by income, for a 50-year old non-smoker, using the second lowest silver plan in each region. This subsidy amount was then applied to each bronze, silver, gold, and platinum plan in counties served by Healthcare.gov to determine the number of “free” plans available to subsidized consumers of different income levels. Avalere used the most up to date Internal Revenue Service (IRS) determinations of subsidy eligibility and the 2018 Federal Poverty Level (FPL) Guidelines for all states. Additionally, Avalere used the Alaska-specific and Hawaii-specific federal poverty guidelines for the analysis of Alaska’s and Hawaii’s health plans.