Monthly health insurance premiums on the federal exchange for Kentucky, neighboring states and Wyoming, which has the highest. Rates in Kentucky and about half the 39 states that participate on the exchange will rise next year, though Kentucky’s rates will remain in the lowest third. Premiums are for the most popular plan and exclude federal subsidies. | Illustration by Boris Ladwig. Source: CMS

Average insurance premiums for Affordable Care Act customers are declining for the first time across the nation — but not in Kentucky, according to federal authorities. Indiana’s rates aren’t changing, but Hoosiers will pay the lowest rates in the nation.

Premiums for 2019 will fall by 1.5 percent for the most popular insurance plan available on the federal health care exchange — though they will rise 9 percent in Kentucky, according to a new report by the Centers for Medicare and Medicaid Services.

Across the country, people who get their health insurance through the ACA, also known informally as Obamacare, next year will pay average annual premiums of $4,872 — before subsidies — for so-called silver plans, which are the most popular and come with moderate premiums. That’s down $72, or 1.5 percent from this year.

However, consumers are seeing vastly different premium trajectories depending on where they live. Customers in 17 of the 39 states that are using the platform will see declines, and in another three, will see no change, but patients in 20 states will face higher premiums next year.

ACA customers in Tennessee, for example, will get a 26 percent premium reduction next year, the largest, while Kentuckians’ premiums for silver plans will, on average, rise 9 percent, tied for the fourth-highest increase.

Premiums, too, vary drastically from state to state. Customers in Wyoming will pay annual premiums of $8,508, the highest in the nation, while Hoosiers will pay the lowest, at $3,336. Despite getting the largest break, Tennesseans will pay an average $5,388, which is still nearly $900 more than Kentuckians will pay next year.

Rates in Kentucky for 2019 will remain in the lowest third among the 39 states.

Seema Verma

CMS Administrator Seema Verma said in a news release that rates next year are declining because of actions taken by the administration of President Donald Trump. However, experts told the Kaiser Family Foundation that rates for 2018 increased in part because the Trump administration lowered subsidies it paid to insurers. They also said that rates will decline next year mostly because insurers who are offering Obamacare plans are profitable.

Since the implementation of the ACA, several insurers, including Louisville-based Humana, had abandoned that market because they were losing hundreds of millions of dollars, partially because the patients who signed up on the exchanges were sicker — and more costly — than the insurers had expected.

In Kentucky, only CareSource and Anthem are offering Obamacare plans. The Kentucky Department of Insurance in August approved average rate increases for 2019 of 4.3 percent for Anthem and 19.4 percent for CareSource — though individual premiums can differ depending on factors including age, smoking habits and geographic location. Average rates for this year increased 41.2 percent for Anthem and 56 percent for CareSource.

The rates affect about 77,500 Kentuckians. Nationwide about 9 million people get insurance through the ACA. Most Americans, including 511,000 Kentuckians, get health insurance through their employers.

The KDI, CareSource and Anthem could not be reached Monday morning.