While the 2021 Open Enrollment Report for the ACA marketplace released by CMS yesterday shows an overall increase in enrollment over 2020, the attendant Public Use Files show acceleration in a troubling trend: decreased selection of silver plans by enrollees with incomes below 200% of the Federal Poverty Level. Selecting bronze below that income threshold, as almost all who don't select silver plans do, means forgoing the strong Cost Sharing Reduction (CSR) that attaches to silver plans only.
Silver Plan Selection
at 100-200% FPL
HealthCare.gov states
|
Year |
Total enrolled |
Silver enrolled |
Percent silver |
|
2017 |
5,258,797 |
4,574,172 |
87.0% |
|
2018 |
4,865,014 |
4,152,230 |
85.4% |
|
2019 |
4,712,094 |
3,944,471 |
83.7% |
|
2020 |
4,725,360 |
3,864,275 |
81.8% |
|
2021 |
4,933,622 |
3,830,086 |
77.6% |
Source (all enrollment tables): CMS State-level Public Use Files. See note below.
For enrollees below the 200% FPL income threshold, silver plans are enhanced by strong Cost Sharing Reduction subsidies that sharply reduce out-of-pocket costs. CSR raises the actuarial value of a silver plan (the percentage of the average enrollee's medical costs allegedly* paid by the plan) to 94% for enrollees with incomes up to 150% FPL and to 87% for those with incomes in the (150-200% FPL) range. Bronze plans have an actuarial value of approximately 60%. Here's how that difference translates into deductibles in the 36 states using the federal exchange, HealthCare.gov, according to the OE Report:
