in premiums to fall 2% in 2021

Health insurance premiums for benchmark Affordable Care Act exchange plans will decrease in 2021 for the third year in a row, and most shoppers will have more plan choices, CMS said Monday.

The average premium for the benchmark health insurance plan on for a 27-year-old will decline by about 2% to $369 per month compared with plans sold this year. For a family of four, premiums will decrease 2% to $1,486, though most people shopping on the exchanges receive subsidies to help afford the premium costs.

But “middle-income Americans continue to struggle to afford coverage,” CMS said in a statement.

The number of health insurers selling plans in 2021 will increase to 181 insurers from 175 in 2020.

The lower premiums and added insurance companies show the federal insurance marketplace continues to stabilize after a rough few years of regulatory uncertainty, premium hikes and dwindling choice of health plans.

Even so, the Senate is on schedule to confirm Judge Amy Coney Barrett before the justices hear arguments on Nov. 10 in California v. Texas, a case in which Republican attorneys general and the Trump administration argue the entire ACA should be struck down because Congress zeroed out the individual mandate. The lawsuit threatens to topple the ACA and eliminate health insurance for nearly 11 million people enrolled in exchange coverage and millions more with insurance under Medicaid expansion.

Open enrollment for 2020 coverage begins on Nov. 1 and ends Dec. 15 in states that use the federal exchange.

In 2021, the average premium for the benchmark plan, which is the second-lowest-cost silver plan, will decline by double-digit percentages for a 27-year-old in four states—Iowa, Maine, New Hampshire and Wyoming. On a percentage basis, Iowa’s premiums will decrease the most of any state at 29%.

Twenty-two more health insurers will sell plans on the federally run exchange in 2021 than in 2020. The portion of counties with only a single issuer dropped from 24% in 2020 to 9% in 2021, CMS said in a statement. About 4% of enrollees will have access to only one insurer, compared with 12% in 2020.

“More than three-quarters of enrollees will have access to at least three issuers in 2021,” CMS said in a statement.

Most people who purchase coverage on the exchanges are eligible for a subsidy to help cover their premium costs. These advance premium tax credits are available to people with incomes of less than 400% of the federal poverty level. In 2020, 88% of enrollees were eligible for the subsidy. Those who aren’t eligible, however, must shoulder the entire cost.

CMS projects the average maximum premium tax credit in 2021 for all eligible enrollees to be $509. More than 70% of exchange enrollees in 2020 would have access to a health plan of the same metal level that costs less than $75 after premium tax credits in 2021, the CMS said.

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