Analysis: Health Plans in Medicaid and Marketplace in the Same State Often Offer the Lowest Premiums


FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515,

WASHINGTON—A new analysis of issuers offering Qualified Health Plans (QHP) through Marketplaces for 2019 shows that “overlap” issuers – organizations which offer coverage through both a Medicaid managed care plan and a QHP in the Marketplace in the same state – offer the lowest or second-lowest silver-level premium to a 27-year-old in 94 percent of rating areas where they exist. The analysis was performed by the Association for Community Affiliated Plans (ACAP).

A rating area is a geographic division set by states under the Affordable Care Act in which all households must have the same adjustments applied for the purposes of setting premiums. At the state level, nearly three-quarters of the 35 states where one or more “overlap” plans are offered feature an overlap issuer offering the lowest or second-lowest silver-level premium in the state to a 27-year-old.

“This report shows what we’ve known all along – that plans which participate in both Medicaid and the Marketplaces are well-poised to compete and thrive,” said ACAP CEO Margaret A. Murray. “The provider networks, provider rates and innovative care management approaches undertaken by Medicaid plans carry over to the Marketplaces, and the data bear that out.”

Overlap issuers can also soften the effect of “churn,” a phenomenon where people move between eligibility for Medicaid programs and subsidized Marketplace coverage. Minor fluctuations in income can shift working adults with low incomes out of Medicaid eligibility and into Marketplace coverage, or vice versa. These fluctuations can arise from seasonal employment, extra or fewer hours at work, or even a month that has five weeks rather than four.

ACAP has tracked the prevalence of overlap issuers since the opening of the Marketplaces in 2014 and has found the proportion of overlap issuers to generally be about 45 percent of all QHP plans, with minor fluctuation from year to year. In 2019, 100 of 219 QHP issuers also offer a Medicaid managed care plan in the same state – a total of 46 percent.

The full study and analysis of QHP issuers is available at

About ACAP:
ACAP represents 69 health plans, which collectively provide health coverage to more than 20 million people with low incomes or significant health needs. ACAP Safety Net Health Plan and Partner members serve their communities through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit