END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Just how many New Off-Exchange QHP Enrollments could there be, anyway?

Hat Tip To: 
Caitlin Sweany

For months I've been talking about the "holy grail" of missing ACA data: Direct, or Off-Exchange enrollments: People buying ACA-compliant health insurance policies directly via the insurance companies without bothering to do so via the Federal or State exchanges. I've documented nearly a half-million of these already from just a handful of companies (and 1 state, Washington), and over the weekend launched a new effort to try and crowdsource the missing data.

Until I have that information, however, the question is just how many of these are there out there? I know that around 4.2 million have enrolled via the exchanges, and I already know of at least 456,000 off-exchange enrollments, or around 4.7 million total. Even if every single exchange-based enrollee already had insurance (and that's absolutely not the case), there should still be several million people out there who have either switched from one private plan to another (directly) or enrolled in a policy for the first time (directly).

I also know that there are hundreds of insurance companies out there which I don't have off-exchange data for (or, alternately, 49 states +DC which I don't have that data for).

For the individual companies which I do have off-exchange data for, the ratios of off-exchange to exchange-based enrollments are:

  • WellPoint: Around 19% (around 95,000 out of 500,000, through around mid-January)
  • CoOportunity: Around 64% (around 28,000 out of 43,600, through January 24)
  • eHealth Insurance: 100%...completely off-exchange (around 148,000 after removing Washington State & other adjustments)

A story posted today by Tami Luhby of CNN mentions two more companies: 

At Physicians Health Plan of Northern Indiana, nearly a quarter [24% according to Luhby] of people signing up are picking policies off the exchange. It offers eight HMO plans on and off the exchange, but an additional 11 options outside of it, including point-of-service plans that offer out-of-network coverage...

For Health First Insurance, the off-exchange market is particularly important because it serves Florida's Space Coast, which has the most engineers per capita in the nation. That means many potential enrollees don't qualify for subsidies, said Ed Griese, the insurer's chief executive.

Some 40% of the insurer's 1,470 applicants picked plans outside the exchange.

Luhby doesn't know the total number of Physicians Health Plan enrollees, so I don't know what that 24% is out of, but that's still a useful data point. Meanwhile, Health First does provide both numbers...40% of 1,470 is only 588 people, but again, the large point is that we're seeing numbers ranging from around 19% up to 100%. Even setting aside the online brokerages like eHealth, you're still looking at 19% - 64%.

My guess (and I reiterate, this is just a guess) is that the number of direct enrollments is probably around 50% of exchange-based enrollments overall, which would mean around 2.1 million so far, give or take.

I should also note that even this doesn't tell the whole picture--the total private individual market was around 11 million before the exchanges launched, which means there are also several million more people who are on existing private healthcare plans which were already compliant and don't need to be renewed. Those presumably won't show up on any of these data points, as they're existing customers simply continuing their policies as is.