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Healthy Competition Boosts Record Signups in the Individual Market


Published Mar 1, 2023 • by AHIP

Did you enroll in individual health care coverage this year on You’re not alone.

More Americans than ever are enrolled in an Affordable Care Act (ACA) Marketplace health plan. A record 16.3 million people enrolled during the 2023 Open Enrollment Period, including a 21% increase of people who purchased from the Marketplace for the first time. It’s one of the reasons that the national uninsured rate is now at an all-time low.

The milestone is a testament to healthy competition among health insurance providers which offered a record number of choices in plans and more affordable options — helping enrollees select the care that was right for them and their families.

More Consumer Choices

Many consumers have been drawn to the Marketplace’s growing number of plans and choices during its 10-year tenure. This year was no exception:

  • Marketplace enrollees had a choice of between six and seven Qualified Health Plan issuers on average, up from four to five in 2021.
  • 220 health insurance providers offered coverage options, an increase of seven issuers from the year before.
  • Eleven states have more issuers participating this season than last.

This level of competition meant people and families had more plan options and higher-quality choices to protect their health and financial security.

More Affordable Care

More competition also means more affordable care. Research from 2019 showed that counties with one additional health insurance provider in the marketplace experienced a 2.5 percent reduction in the benchmark premiums compared to the year before.

During open enrollment, consumers found even more help affording coverage. In August of 2022, Congress passed the Inflation Reduction Act, which extended the enhanced subsidies made available under the American Rescue Plan Act through 2025. As a result, Marketplace enrollees saw more affordable health insurance options, including more $0 premium and low-cost plans. In fact, four-in-five people shopping on the Marketplace this year could find a plan for $10 or less after available tax credits.

Addressing Anticompetitive Practices

While most consumers qualify for Marketplace subsidies, medical cost inflation is still driving up health care costs, including a four percent premium increase for the benchmark silver level plan premiums compared to 2022 plan premiums.

Too often, these costs rise because hospital systems and drugmakers don’t embrace enough competition. For example, hospitals charge patients more for the same drug therapies than they would normally cost at specialty pharmacies. Drugmakers also raise costs for consumers by gaming the rules to their advantage and abuse the lack of laws and enforcement regarding competitive markets.

More must be done to continue to support fair, robust competition within the health care delivery system, which is the best way to expand choices, improve quality, and lower costs.

Healthier markets help create healthier people. Health insurance providers remain committed to working with officials to advocate for the laws, regulations, and needed enforcement to ensure more robust competition in health care markets.

Whether it’s offering more choices, more availability of integrated health coverage, or greater access to plans, increased competition in the individual market will continue driving immense value for the growing number of Americans that the program serves.

Healthier People Through Healthier Markets

Every American deserves access to affordable, comprehensive, high-quality coverage and care. But health care prices continue to escalate year after year, making coverage and care less accessible for everyone. Health insurance providers have developed detailed policy prescriptions to improve health care competition, and we are committed to working with state and federal officials as well as other health care leaders to take decisive action.

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