Premium Variation and Plan Availability  As we have previously reported, the range of premiums for health plans  offered through the exchanges can vary widely across counties and  states, and the number and type of plans available in the health insurance  exchanges vary from year to year. As a result, the options  available to consumers can change from year to year. Although consumers’ premium tax credit amounts are determined in part  based on the cost of premiums for their local benchmark plan, the credit  can also be applied towards the premiums for other eligible exchange  plans. The tax credit cannot, however,  exceed the total value of the premium. Eligible returning consumers may enroll in a health insurance  plan through the exchange each year during an open enrollment period. Through automatic  re-enrollment a consumer is re-enrolled in the same plan for the next year  if that plan remains available to him or her; if the same plan is no longer  available (e.g., because the issuer decided to discontinue a particular  plan or to stop offering the plan in certain locations), then the consumer is  generally re-enrolled in a similar crosswalked plan. From 2015 to 2017, Most Plans Identified as Benchmark Plans Changed and Benchmark Plan Premiums Generally Increased

In most of the nearly 2,600 counties included in our analysis, the plan that  we identified as the benchmark plan changed from 2015 to 2017. For  example, in 85 percent of the counties included in our analysis, the 2015  benchmark plans were not benchmark plans in either 2016 or 2017, the  other 2 years we studied. In addition, benchmark plan premiums were more likely to increase than  decrease from year to year, and increases were higher from 2016 to 2017  than they were from 2015 to 2016. According to HHS, most exchange  consumers have been eligible for these tax credits; those who were not  eligible for tax credits would not have this protection from premium  increases. The premium increases for consumers who were not eligible  for premium tax credits, or for those who were eligible but who chose  plans that had higher premiums than their benchmark plan premiums,  could have had a more substantial financial impact, because premium tax  credits would not have offset, or fully offset, the higher premiums. This finding indicates that automatic re-enrollment from a  benchmark plan into a plan that was not a benchmark plan did not  necessarily result in substantially higher premiums compared to the  premiums for the new benchmark plans, and the same would be true for  consumers who actively chose their same or similar crosswalked plan. Thirty Percent of Consumers Who Re-enrolled in 2016 Were Automatically Re-enrolled, and the Remaining Consumers Actively Re-enrolled, Generally into Different Plans

Among consumers who were enrolled in plans through the federal  platform in both 2015 and 2016, 30 percent (about 1.7 million consumers)  were automatically re-enrolled. 3.) Consumers’ Financial Responsibility for Premiums Generally Increased Less with Active Re-enrollment than with Automatic Re-enrollment

Consumers’ median net monthly premiums (after premium tax credits)  generally increased less from 2015 to 2016 for those who actively  re-enrolled ($5) than for those who were automatically re-enrolled ($22). Our findings are consistent with other work by ASPE that suggested that  consumers consider possible cost savings when deciding to switch plans. Agency Comments

We provided a draft of this report to HHS for review and comment. HHS  provided technical comments, which we incorporated as appropriate. At that time, we will send copies to the Acting Secretary of  Health and Human Services and other interested parties.
Why GAO Did This Study

During open enrollment, eligible returning consumers may re-enroll in their existing health insurance exchange plan or choose a different plan. Those who do not actively enroll in a plan may be automatically reenrolled into a plan. According to the Department of Health and Human Services, automatic re-enrollment is intended to help ensure consumers' continuity in coverage. However, some have questioned whether automatic reenrollment could have unintended financial consequences for consumers.
GAO was asked to review automatic reenrollment and benchmark plans. GAO examined 1) the extent to which plans identified as benchmark plans remained the same plans from year to year, and how premiums for benchmark plans changed; 2) the proportion of exchange consumers who were automatically re-enrolled into the same or similar plans, and how these proportions compared to those for consumers who actively re-enrolled, and 3) the extent to which consumers' financial responsibility for premiums changed for those who were automatically re-enrolled compared to those who actively re-enrolled.
GAO reviewed relevant guidance and analyzed county-based data from the Centers for Medicare & Medicaid Services (CMS) for the 37 states that used the federal information platform, healthcare.gov, from 2015 through 2017. GAO also interviewed CMS and ASPE officials and analyzed information from ASPE on reenrollment from 2015 to 2016.

What GAO Found

Through the exchanges established under the Patient Protection and Affordable Care Act, consumers can directly compare and select among health plans based on a variety of factors, including premiums. Most consumers who purchase health plans through the exchanges receive tax credits to help them pay for their premiums. The value of a consumer's premium tax credit is based, in part, on the premium for the benchmark plan, which is the second lowest cost option available in the consumer's local area within the exchange's silver metal tier (one of four metal tiers that indicate the value of plans). Because plan premiums and plan availability can change over time, the benchmark plan in each local market can also change over time. GAO analyzed changes in benchmark plans and premiums from 2015 through 2017 and found:
In most of the nearly 2,600 counties included in the analysis, the plans identified as benchmark plans, and the premiums for these plans, changed from year to year. For example, in 85 percent of counties, the 2015 benchmark plans were not benchmark plans in either 2016 or 2017.
Gross benchmark premiums (exclusive of tax credits) increased from year to year, and increases were higher from 2016 to 2017 than they were from 2015 to 2016.
Premium tax credits would limit the costs of increasing premiums for most consumers, though some consumers, including those not eligible for premium tax credits, would have incurred more or all of the higher premium costs.
During the annual open enrollment period, consumers who do not make an active plan selection are automatically reenrolled into their existing plan or, if that plan is no longer available, they are generally re-enrolled into a similar plan if one has been identified. GAO analyzed information from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) for consumers enrolled in both 2015 and 2016 and found:
About 30 percent of consumers were automatically re-enrolled in 2016, while the remaining 70 percent chose to actively re-enroll.
Median net monthly premiums—what consumers paid after premium tax credits—increased less from 2015 to 2016 for those who actively enrolled ($5) than for those who were automatically reenrolled ($22), although there was variation. Our findings are consistent with other work by ASPE that suggests that consumers consider possible cost savings when deciding to switch plans.
The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate.