Insurers are coming back to the ACA markets from their 2018 participation nadir. The big national insurers ran like hell in 2017-2018. Most of them are either entering new markets or re-entering areas that they ran from several years ago. The insurers that kept on selling in 2018-2019 are still selling. They are also likely expanding their footprint.
Insurers that want to sell ACA insurance have to file their initial plans and rates with their state regulators by mid-summer of the year before the policies go on sale. Insurers and regulators may go back and forth a couple of times to get to a mutually agreeable rate that should be sound enough to survive a catastrophe. Insurers are allowed to pull plans out during this back and forth but they can not add plans during this process.
There have always been a couple of counties with more than 100 plans sold on Healthcare.gov. These counties tend to be in Florida and Wisconsin. I’ve been hearing chatter that several very large metro areas outside of these states have insurers filing to sell well over 100 plans in 2022. Some of this is new insurers going into new markets but a decent chunk also looks to be old insurers deciding that the Cheese Cake Factory has the right idea on choice offerings.
The ACA has a choice problem. Choice is valuable as it allows for finer matching between individual ideal points and available options. Choice is value subtracting as cognitive overload can also lead to dominated choices and rage quitting.
I am not sure what the best number of choices is, especially in an environment where there is no meaningful difference between some of the choices being offered, but I suspect that the value of better matching gets overwhelmed by the search costs at some point before 100 options are on the menu.