2019 Individual Market Growth Outlook
The Affordable Care Act (ACA) exchange market has been marked by uncertainty following several modifications to existing regulations including ending cost-sharing reduction payments (CSRs), negating the individual mandate, and expanding non-ACA compliant plan options for consumers. Despite this, enrollment has only slightly declined, and the vast majority of consumers continue to actively select their plans—with 46% percent of those re-enrolling switching to different products entirely.
While ACA consumers have historically shown willingness to trade access to providers for lower price, as plan premiums converge consumers are increasingly discriminating products on provider network coverage. In turn, plans are crafting products with artificially broad network configurations that either limit out-of-network benefits or enlist non-traditional providers such as telehealth providers and retail clinics. Though such products are initially appealing to consumers, access restrictions are frustrating as they are likely to result in larger out-of-pocket costs, reduced access to out-of-network specialists and hospitals, and “surprise” medical bills from unforeseen out-of-network care.
Things You’ll Learn:
- Impact of policy changes on the ACA exchange market
- The latest trends in ACA provider network size and composition
- Implications of those trends on enrollment growth