Rural residents paid higher premiums and had fewer options on the Patient Protection and Affordable Care Act exchanges in 2014 than their urban counterparts, according to new analysis.
The average monthly premium for a silver plan, the second-cheapest exchange plan designed to cover 70 percent of medical costs, was $387 in rural counties, while city dwellers pay $369 for the same kind of plan, according to research from the Robert Wood Johnson Foundation and the University of Pennsylvania. But in some states the gap grew much wider.
In Nevada, for example, residents of rural counties spend, on average, $554 a month for a silver plan. That's 57 percent more than their city peers.
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And in states where 50 percent or more of those eligible to enroll in exchanges live in rural counties, the average premium of a silver plan for a 50-year-old nonsmoker is $452; it's $402 in states where less than 5 percent of those eligible live in rural counties.
Lack of competition is the main culprit for the discrepancy. While city shoppers had, on average, their pick of five carriers and 11.8 plans on the exchanges, those who live in rural areas had only 3.8 carrier options and 8.2 plans, the study found.
"Competition, or lack thereof, seems to be having the expected effect on marketplace premiums," said Katherine Hempstead of the Robert Wood Johnson Foundation. "It remains to be seen how the entry of new insurers will affect prices in 2015 and beyond."
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