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Monday, August 2 • 10:45am - 12:15pm
1D1 Are Health Insurance Marketplace Plans Subsidized by Off-marketplace Plans?

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Bo Shi, Morehead State University; Thomas Sager, University of Texas at Austin; Etti Baranoff, Virginia Commonwealth University; Dalit Baranoff, Johns Hopkins

Under the Affordable Care Act (ACA), health insurers voluntarily list qualified health plans on the marketplaces. Although marketplace plans are subject to rigorous regulatory coverage and rate requirements, the ACA requires that insurers use a single risk pool for both marketplace and off-marketplace plans when developing premiums. Instead of the marketplace plans premiums that are usually under the spotlight, our study focuses on off-marketplace private individual plan premiums. Nationwide individual plan Per Member Per Month (PMPM) premium experience of marketplace insurers is consistently higher than off-marketplace insurers and is as high as 23.19% by 2019 ($563 vs. $457). It is imperative to check whether off-marketplace individual plan policyholders paid higher premiums involuntarily as marketplace plans offered generous coverage at competitive rates. In other words, are marketplace plans subsidized by off-marketplace private plans? Our perspective is pertaining to the benefit of more than 7.28 million off-marketplace individual health plan policyholders by 2019.


Yoshihiko Suzawa

Professor, Kyoto Sangyo University


Bo Shi

Morehead State University

Monday August 2, 2021 10:45am - 12:15pm EDT