Rural ACA Marketplaces

The Robert Wood Johnson Foundation recently released a report detailing the insurance plan choices and premiums available to rural residents.  Many rural advocates have feared that rural residents will face higher premiums or fewer choices in these marketplaces, and appears that these fears are valid, at least to a degree.

Some key takeaways from the report include:

• Rural residents have, on average, 1.2 fewer providers, 2.8 fewer plan choices, and 0.4 fewer plan types than urban residents
• Premiums were, on average, $18 more expensive (for the second most expensive silver plan) for rural residents
• HMOs and EPOs were less available, and POS more available, to rural residents
• States with a higher proportion of marketplace eligible residents living in rural counties were more likely to have higher premiums and fewer insurers, choices, and plan types than more urban states.

There was considerable state by state variation in premiums, with the range being $201 higher in Nevada to $72 cheaper in Mississippi.  

These results highlight the need to continue to monitor rural resident's enrollment options, and its relationship to actual enrollment proportions.  Higher premiums, particularly in more rural states, could potentially lead to a lower uptake in coverage, furthering an already existing gap in rural healthcare delivery.