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New ACA Data—Improper Enrollment Barely Changed while Out-of-Pocket Premiums Remain Very Low

11AW Median ACA Enrollee Pays 42 A0wUU000005J2uTYAS
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Brian Blase

President at Paragon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and served as its CEO.

Mark Howell Headshot SMALLER V2

Mark Howell is a Research Assistant at Paragon Health Institute. He is passionate about advancing free-market solutions to improve healthcare access and affordability.

While the share of enrollees in zero-premium plans has declined—from 41 percent of sign-ups to 29 percent—it remains a central feature of the program. Subsidies continue to be extremely generous. The median enrollee pays approximately $42 per month after advanced subsidies to their insurer, with the federal government covering 94 percent of total premium costs.

Enrollment has shifted significantly away from silver plans (down from 56 percent to 43 percent) toward bronze and gold plans, reflecting intensified silver loading and likely continued enrollment fraud as brokers switch people out of zero-premium silver plans and into zero-premium bronze and gold plans with the expiration of the COVID-era subsidy boosts. At the same time, 87 percent of enrollees continue to receive subsidies, and average subsidized premiums increased only modestly—about $22 per month—despite large increases in underlying premiums. 

11AW Median ACA Enrollee Pays 42 A0wUU000005J2uTYAS

While the share of enrollees in zero-premium plans has declined—from 41 percent of sign-ups to 29 percent—it remains a central feature of the program. Subsidies continue to be extremely generous. The median enrollee pays approximately $42 per month after advanced subsidies to their insurer, with the federal government covering 94 percent of total premium costs.

Enrollment has shifted significantly away from silver plans (down from 56 percent to 43 percent) toward bronze and gold plans, reflecting intensified silver loading and likely continued enrollment fraud as brokers switch people out of zero-premium silver plans and into zero-premium bronze and gold plans with the expiration of the COVID-era subsidy boosts. At the same time, 87 percent of enrollees continue to receive subsidies, and average subsidized premiums increased only modestly—about $22 per month—despite large increases in underlying premiums. 

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Brian Blase

President at Paragon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and served as its CEO.

Mark Howell Headshot SMALLER V2

Mark Howell is a Research Assistant at Paragon Health Institute. He is passionate about advancing free-market solutions to improve healthcare access and affordability.