2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

2020 Week Four Snapshot Report: 704K QHPs on HC.gov; remember the Thanksgiving factor

The Week 4 HealthCare.Gov Snapshot Report from CMS should be released at any time, covering enrollment in 38 states from Nov. 10th - Nov. 23th.

As a reminder, here's what the Week 3 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around ~120,000 of the difference. Secondly, Nevada split off from HC.gov this year, which accounts for around ~19,000 of the gap the first 3 weeks. In addition, a small portion of the difference is likely due to Idaho and Maine expanding Medicaid; exchange enrollees earning between 100-138% FPL should be tranferred over to Medicaid instead.

All three of these factors still leave 2020 Open Enrollment around 90,000 short of the same time period last year on HealthCare.Gov.

I originally projected Week 4 to have around 530,000 enrollees, but was reminded that Thanksgiving feel in Week 4 in 2018 but is Week 5 in 2019. There's always a significant drop-off Thanksgiving week, as no one wants to think about enrolling in health insurance on a holiday weekend, but it generally snaps back the following week. With that in mind, I'm going to assume around 750,000 QHP selections between 11/17 - 11/23 on HealthCare.Gov this year.

Check back in a few hours to see how close I was, as well as the state-level and new/renewal enrollee analysis.

UPDATE: Here's the actual report. I was right about enrollments being up significantly for the same week vs. last year, but wrong about by how much: 703,556 QHP selections via HC.gov, which is 41% higher than the same period last year (due to the Thanksgiving factor), but still not as much higher as I was expecting:

Thanks to the Thanksgiving week discrepancy, cumulative enrollments have officially made up nearly all of the gap from last year. In fact, if you account for the missing 24th day, official HCgov enrollments are now actually ahead of last year so far.

That will almost certainly change next week, however, when the reverse effect will be felt: This year, Thanksgiving will be included in the Week 5 report, which likely means it'll come in a couple hundred thousand fewer than last year's Week 5.

As you'd expect, both new and renewing enrollment numbers are also up significantly over last year...cumulatively, new enrollees are up nearly 6% while renewals are still down almost 5%. Again, expect both of these numbers to drop again when next week's report comes out.

On the state-by-state level, here's what it looks like vs. last year:

Once again, Maine remains the worst-performer year over year, mostly due to their expansion of Medicaid. Idaho isn't listed because they're a state-based exchange and haven't reported any data yet. Mississippi, on the other hand, continues to be the top out-performer vs. last year, which is interesting because there doesn't seem to be any particular reason for it.

Unlike some states, Mississippi hasn't implemented any additional subsidies, a mandate penalty or a reinsurance program of any sort. They haven't had any new carriers join the ACA market, nor have any of them left. I don't think either of the carriers on the exchange have significantly expanded their territory or changed their offerings that much either...in fact, average premiums are essentially flat year over year.

In other words, by all rights, Mississippi should be performing almost exactly as they did last year...but enrollments are up 15.5% to date. Huh.