Analysis: Health Plans in Medicaid and the Marketplace Provide Low Premiums, Continuity of Care Amid COVID-19 Pandemic

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


WASHINGTON—A new analysis of issuers offering Qualified Health Plans (QHP) through Marketplaces for 2020 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 81 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, more than three-quarters of the 34 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.

The streamlined coverage across multiple lines of business offered by overlap plans can also mitigate the effects of the “churn” of enrollees between Medicaid programs and subsidized Marketplace coverage owing to slight changes in income. People who churn off of Medicaid or Marketplace coverage often delay or forego care, or leave prescriptions unfilled because they cannot afford them. Others may need to find a new primary care provider should they enroll in a Medicaid or Marketplace health plan offered by a different issuer.

This regular flux in enrollment has been exacerbated by the COVID-19 pandemic. A recent Families USA study estimates that 5.4 million adults have lost their coverage owing to job losses between February and May of this year. The Urban Institute estimates that 25 million to 43 million people could ultimately lose their employer-sponsored health insurance coverage owing to the pandemic.

“If you have a gap in health coverage, your health can suffer as a result. This is doubly true in a pandemic,” said ACAP CEO Margaret A. Murray. “Overlap plans are able to offer continuous, affordable health care coverage at a time when consumers need it most. And the data show that they tend to offer some of the most competitive prices around.”

ACAP has studied 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 2020, the total number of QHPs participating in the Marketplace rose from 219 to 258. 102 of those issuers also offer a Medicaid managed care plan in the same state – a total of 40 percent.

The full study and analysis of QHP issuers is available at

About ACAP:

ACAP represents 77 health plans, which collectively provide health coverage to more than 20 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit