Ritter Insurance Marketing, Craig Ritter

Health Insurance Exchange Enrollment Trends

CMS recently released two reports that shed some light on health insurance exchange enrollment trends and why shoppers leave exchange plans.

2017 Effectuated Enrollment Report Findings

To get a precise count of enrollees, it’s more accurate to look at the number of people who have paid their premiums than it is to look at the number of people who signed up for a plan.

CMS’ March Open Enrollment Report indicated 12.2 million shoppers picked or were automatically re-enrolled in health exchange plans throughout the 2017 Open Enrollment Period. However, according to the 2017 Effectuated Enrollment Snapshot, only 10.3 million individuals effectuated their coverage (paid their first month’s premium) for February 2017 as of March 15, 2017.

The Snapshot includes data on the individuals who effectuated their coverage from both state-based and federally-facilitated individual market exchanges.

Here are some of the other Snapshot stats that stuck out:

  • An average of 1 million enrollees who effectuate their enrollment leave their exchange plan by the end of the plan year.
  • The number of those who enroll on exchanges and qualify for Advance Payment Tax Credit (APTCs) or Cost-Sharing Reductions (CSRs) has stayed pretty constant.
  • The average APTC increased from $290 per month in 2016 to $371 per month in 2017. (That’s a 28% increase!)

The Health Insurance Exchange Trends Report Findings

Why do a number of under 65 beneficiaries terminate their Affordable Care Act insurance?

CMS’ Health Insurance Exchanges Trends Report analyzes how affordability, availability of financial assistance, and plan choice play a role in individuals ending their exchange coverage.

Per the report, the top two reasons why beneficiaries leave their exchange plans are high costs and lack of affordability.

CMS MIDAS data showed that those who terminated/canceled their plan had an average monthly premium of $209 per month, while consumers with active coverage as of April 25, 2017, paid an average of $150 per month.

Additionally, beneficiaries who lacked financial assistance via APTCs at the end of the 2017 Open Enrollment Period were 2.4 times more likely to end their coverage than those who received APTCs between January 31, 2017, and April 25, 2017.

Here are some of the other stats on health insurance exchange enrollment trends:

  • 18,212 individuals who left exchanges and responded to CMS’ exit surveys between August 2016 and April 2017 reported canceling or terminating their coverage.
    • 3,880 of these 18,212 individuals chose a plan but didn’t pay their first month’s premium.
      • 46% canceled their coverage due to cost.
      • 17% canceled their coverage due to not qualifying for financial assistance.
    • 14,332 of these 18,212 individuals paid their first month’s premium then quit paying.
      • 58% of these individuals specified they gained coverage through their employer.
  • Those who still had their 2016 issuer’s plans to choose from for 2017 were 7% more likely to retain their coverage (as of April 25, 2017) compared to those who didn’t have that choice.

Looking to the Future

The senate is currently reviewing and revising the house-passed version of the American Health Care Act (AHCA).

The latest Congressional Budget Office’s cost estimate of the AHCA estimated it would result in 23 million more Americans without insurance, and potentially lower premiums, by 2026.

As it stands, the AHCA plans to replace Affordable Care Act tax credits, which are based on a person’s income, age, and the local cost of coverage, with refundable tax credits based almost entirely on age.

Posted by filed under Affordable Care Act, CMS, Health Care Reform, Under 65 .


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