Exchange Make-Up Varies, But Most Large Issuers Participate

In more than two-thirds of states, insurance issuers with the largest market share in 2012 participated in Health Insurance Exchanges in 2014, according to a report from the Government Accountability Office (GAO). In fact, most states saw Marketplace participation by issuers with at least 5 percent of the market share. Issuers with smaller market shares tended not to participate.

At the Senate’s request, the GAO prepared a report addressing the extent to which issuers that previously offered health plans in the individual and small group markets participated in the 2014 Exchanges, as well as the specific issuers and the health plans they offered. The report, which was based on an audit conducted from January to August 2014, found variations among participation in the 17 state-based individual and small business health options (SHOP) Exchanges, the 32 federally-facilitated Exchanges, and remaining Exchanges in two states in which the individual Exchange was federally-facilitated and the SHOP Exchange was state-operated.

Most states had multiple issuers participating in the Exchanges, with an average of six participants per individual Exchange and four participants per SHOP Exchange. However, the number varied greatly by state, ranging from one to 17 issuers in individual Exchanges and one to 13 issuers in SHOP Exchanges. More than half of the 323 issuers participated in both individual and SHOP Exchanges. The total number of individual plans in a given rating area ranged from seven to 178, with an average of 41 individual plans per rating area. All rating areas offered at least one bronze, one silver, and two gold level plans; 58 percent of rating areas also offered catastrophic and platinum plans.

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