Happy Birthday #ACA! (Part 6: Metal Levels)

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If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.

Catastrophic ACA plans aren't available at all 10 states (up from 9 last year), and only 0.3% of enrollees choose Catastrophic plans in the other 40 states (+DC)...just 59,000 nationally (which is also down several thousand y/y). Of the states that even offer them, Catastrophic plans don't reach higher than 2.8% of the ACA exchange market, and that's only in DC where you're talking about just 420 people.

At the opposite end, Platinum plans are only available in 16 states (+DC)...and again, just 0.6% of all exchange enrollees choose Platinum plans (even with those 17 states it's only 1.3%). This ranges from 0.2% in Georgia to 16.5% in, again, DC. It's kind of interesting that DC has the highest percent of both low-end (Catastrophic) and high-end (Platinum) plans...I don't know if this is tied to DC having such a low percent of CSR-eligible enrollees (due to Medicaid covering residents earning up to 210% FPL) or what, but it's a bit curious.

In any event, of the other three levels of ACA exchange plans, 31.2% chose Bronze, 54.4% chose Silver and the remaining 13.5% chose Gold plans this year nationally. I'm happy to see that Gold plans have inched upwards a bit from 11.9% last year.

The states with the highest Gold plan takeup this year are New Mexico (a whopping 71.8%), followed by Wyoming (58.7%) and Maryland (47.8%). The states with the lowest Gold takeup are Mississippi (just 1.1%), New Jersey (1.4%) and Utah (2.3%).

However, it's important to note that a stunning 67.6% of Mississippi enrollees have "Secret Platinum" plans (ie, CSR Silver plans w/actuarial values of 87% or higher), which means 68.7% have Gold or Better (Gold+) plans. Similarly, 50.1% of Utah enrollees have high CSR plans, so 52.4% have "Gold+" coverage.

Unfortunately the breakout of CSR enrollment isn't available for the state-based exchanges so I don't know how many New Jersey enrollees have Gold+, though it's likely something like 50% or so (52% of all NJ enrollees have all types of CSR help).