More than 40 percent of counties could see only one exchange plan in 2018 and some counties may have no commercial options, according to a new Avalere report.
The report mirrors that of a recent federal study showing 47 counties nationwide with no Affordable Care Act insurer for 2018 and as many as 40 percent nationwide with only one issuer, according to Centers for Medicare and Medicaid Services data.
[Also: CMS releases map showing 47 counties without an insurer in the exchange market]
Insurers face a deadline of Wednesday to submit qualified health plans for the federally-facilitated exchanges. Final rates will vary from proposed premiums.
The Avalere report shows an average 18 percent premium increases over last year for the popular silver plan among eight states that have submitted filings.
Most consumers still have the opportunity to select lower premium plans, Avalere said. Initial rate filings show premium increases of 11 and 12 percent respectively, for lowest-cost and second lowest-cost silver plans.
[Also: Two out of 12 million haven't paid ACA premiums, CMS says]
The premium growth is due to the uncertainty surrounding the future of the Affordable Care Act and cost sharing reductions for insurers, as well as inadequate risk-mitigation programs, lower-than-expected exchange enrollment, and declining plan participation, Avalere said.
[Also: Lack of CSRs one reason Anthem BCBS to leave ACA market in Ohio]
"The debate over the Affordable Care Act and cost sharing reduction funding casts uncertainty over the market," said Dan Mendelson, president of Avalere. "But despite all of this activity, the vast majority of consumers will still have commercial exchange options in 2018."
In 2017, silver premiums increased 12 percent on average, with significant geographic variation. As in prior years, the majority of exchange consumers continue to choose silver plans, with most gravitating toward the lowest or second lowest cost option.
Avalere analyzed data from Connecticut, District of Columbia, Maryland, Maine, New York, Oregon, Virginia and Vermont. These states and D.C. showed rate increases for the average silver plan from a low of 8 percent in Vermont to 32 percent in Maryland, rounding out to an average 18 percent.
Twitter: @SusanJMorse