Illinois consumers who bought health insurance on the state’s Affordable Care Act exchange are paying 26% more for coverage, on average, than they did last year, and the number of people who enrolled in the plans dropped nearly 4%, according to the state. 

Though that 26% average increase in monthly premiums is surely tough for many, it’s a far cry from the 78% average jump that state regulators previously said could occur if the federal government didn’t renew enhanced premium tax credits and people stayed on their plans from last year. 

After several contentious months that included a government shutdown over the issue, Congress failed to reach a deal to extend those more generous tax credits. The enhanced tax credits expired at the end of the year, meaning fewer people now qualify for tax credits to help offset the costs of their monthly premiums, and those who do still qualify may be getting smaller credits than in the past.

Many had worried that without that financial help, some people would opt to go without coverage. Most people get health insurance through employers, Medicare or Medicaid, but each year hundreds of thousands of Illinois residents buy coverage through the exchange.

State data show that about 3.7% fewer people enrolled in exchange plans during open enrollment, which went from Nov. 1 to Jan. 31 in Illinois, compared with last year.

In all, 448,568 Illinois residents enrolled in exchange plans during this most recent open enrollment window, compared with 465,985 who enrolled in exchange plans last year.

Illinois consumers with exchange plans are paying average monthly premiums of $328 per household for exchange coverage this year, compared with $260 last year, according to Get Covered Illinois, which is Illinois’ new state-run exchange.

Get Covered Illinois attributed the lower-than-expected price increases to several efforts, in a presentation to the Illinois Health Benefits Exchange Advisory Committee in March. 

“We are proud of the work both the Illinois Department of Insurance (IDOI) and Get Covered Illinois did to ensure our enrollees had access to information that helped them find a plan that worked for their budget and health care needs,” a Get Covered Illinois spokesperson said in an email.

For one, Get Covered Illinois implemented a new strategy this year that made gold plans more affordable, in some cases, than silver plans. Movement out of more expensive silver plans to gold and bronze plans helped reduce the average price increase for many households.

Get Covered Illinois also cited its public awareness campaign about the importance of actively shopping for the best value plans (as opposed to having plans automatically renewed), as well as the work of navigators, brokers and a new plan comparison tool.

“If we lose less people than we thought and premiums went up less, then we’ve mitigated harm from the enhanced premium tax credits (expiring) as much as a state could,” said Stephanie Altman, who is a member of the Illinois Health Benefits Exchange Advisory Committee and of counsel with the Legal Council for Health Justice. “I think Illinois has done a great job with what we’ve had to work with.”

Altman noted, however, that the price increases are still significant for many people, even if they’re smaller than expected.

“It is still a higher cost at a time when everything is higher cost – gas, food, everything,” Altman said. “Twenty-five percent is still high and it would have been lower with enhanced premium tax credits.” 

Altman also noted that it’s possible enrollment will drop further. More than 190,000 Illinois residents had their plans automatically renewed for this year and may be unhappy with the new, higher bills they’ve received in recent months. 

People who receive tax credits have a 90-day grace period to pay for their coverage or lose it. The state will likely know in coming weeks how many people opted not to pay their new, higher bills and had their coverage terminated.

Illinois saw a smaller decrease in enrollment this year compared with the nation as a whole. Nationally, 23.1 million consumers enrolled in exchange coverage, which is about 5% fewer than the number who enrolled during the previous open enrollment season, according to the federal Centers for Medicare & Medicaid Services.

The strategy Illinois used to make gold plans more affordable for many consumers this time around is called premium alignment. It’s a tact that’s used by a number of states.

Exchanges offer plans at various metal levels including bronze, silver and gold. Typically, higher metal level plans cost more in premiums each month but have lower out-of-pocket costs for care. 

But in recent years, some silver plans have actually had lower out-of-pocket costs for care than gold plans. Premium alignment is a strategy to have the premiums of different metal plans better reflect their relative out-of-pocket costs so that consumers can maximize the value of the premium tax credit, said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation. 

“If you look at states where net premiums didn’t go up as much, one of the reasons can be that they’ve done some premium alignments that have increased affordability for customers,” Hempstead said.

In Illinois, more than 78,000 enrollees switched to gold plans from silver or bronze plans this open enrollment season, according to Get Covered Illinois.

More than 37,000 people switched from silver to bronze plans, which traditionally have the cheapest monthly premiums. 

This past open enrollment season was the first in which Illinois offered its new state-run exchange, GetCoveredIllinois.gov. Previously, Illinois residents bought health insurance on the federal exchange healthcare.gov. 

State leaders have touted Illinois’ move to run its own exchange, saying it gives the state more flexibility, such as by being able to help people more easily move between Medicaid and exchange plans, as their income changes. It also means Illinois can open up more special enrollment periods for Illinois residents.