Analysis: Rural Residents Pay Higher Premiums for ACA Health Plans

Rural U.S. residents on average pay slightly higher premiums for mid-level plans purchased through the Affordable Care Act's health insurance exchanges than residents of urban areas, according to a new analysis by Robert Wood Johnson Foundation, Modern Healthcare reports.

For the analysis, researchers working with RWJF and the University of Pennsylvania's Leonard Davis Institute of Health Economics defined urban areas as those that include or are next to a metropolitan population of at least 50,000. About 40 million urban residents were eligible through the exchanges, compared with 6.6 million rural residents.

Researchers found that for silver plans, rural residents paid an average monthly premium of $387, compared with $369 for urban residents. Further, in states with more than 50% of residents living in rural areas, premiums averaged $452, compared with $402 in states with less than 5% of the population in rural areas.

According to the analysis, rural residents also had fewer options. Specifically:

• Rural county residents on average could choose from about 14 plans through four insurers, compared with 17 plans through five insurers in urban counties; and
• Only 18% of rural counties offered less-costly, narrow-network plans, compared with 38% of urban counties.

In addition, the premium gaps varied by state. For example, rural residents in Nevada paid about $200 more for premiums than their urban counterparts, while Colorado residents saw a $181 difference. In 15 states, the gap was $10 or less (Demko, Modern Healthcare, 8/5).