Study: ACA marketplaces more competitive this year

The Affordable Care Act's Marketplace plans got more competitive in 2019, but there are still more regions with only one or two plans to pick from, according to a new study.

The number of people living in areas with five or more marketplace insurers increased by 8% in 2019, from 18.6% to 20.1%, according to the analysis by the Urban Institute and the Robert Wood Johnson Foundation.

At the same time, the analysis showed that the number of people living in areas with only one or two plans in 2019 dropped by 17%, from 45.1% to 37.5%, which the report said signals an increase in marketplace competition between 2018 and 2019.

However, the study found wide swings in plan availability depending upon geography.

More than 20% of Americans live in an area with five or more marketplace insurers, the 322 least competitive rating regions are disproportionately concentrated in less populated areas of the country, especially the South.

"It's encouraging to see signs of stabilization in the individual market," said Anne F. Weiss, managing director at the Robert Wood Johnson Foundation, in comments accompanying the study.

"However, geographic location still plays too great a role in consumers' coverage options and how much they cost. Everyone should have affordable health insurance options, regardless of where they live, given the impact of coverage on health," Weiss said.

Among the findings:

• The Northeast leads the nation in marketplace insurer competition, with a little more than 40% of its population living in areas with five or more marketplace insurers.
• In the South, only 4% of residents live in areas with five or more marketplace insurers, while a majority (just under 53%) live in areas with only one or two marketplace insurers.
• Approximately 26% of the population in both the West and the Midwest live in areas with five or more insurers, with 19% and 40% living in areas with only one or two insurers, respectively.
• Consumers in areas with fewer marketplace insurers typically pay higher premiums. In 2019, the median benchmark silver plan premium for a 40-year-old non-smoker in regions with one insurer cost $592 per month compared to $376 per month in regions with five or more insurers, a difference of more than 36%.