Maryland

When I updated my #OE3 state-level enrollment projections yesterday, I came across this official projection for #OE3 from Your Health Idaho's Sept. 18th board meeting minutes:

Rep. Rusche asked what our target enrollment is for this cycle and what barriers we see in making those targets. Mr. Kelly said the team is focused on the 80% goal of 92,000 as our enrollment target.Premium increases are a potential barrier. Net premium is a relatively small increase for most consumers, and each consumer will experience something different depending Page 5 of 14 on their plan, their location, their carrier, etc. We feel that while the premiums are increasing the relatively small net premium increase will mitigate this barrier to a large degree.

When I asked for clarification, they informed me that:

We currently have 86,659 effectuated enrollments with Your Health Idaho, as of September 15. The 92,000 would also refer to effectuated enrollments.

In my most recent Maryland exchange update, I noted that after months of ACA exchange enrollments increasing during the off-season (if slowly), net policy cancellations finally started to outweight off-season additions starting in August:

As of Aug. 13th, 606,226 Marylanders have enrolled in quality, affordable health coverage for 2015 through Maryland’s state-based insurance marketplace.

That includes 123,673 people enrolled in private Qualified Health Plans (QHP) and 482,553 people enrolled in Medicaid through the marketplace since open enrollment for the year began on Nov. 15, 2014. Nearly 94 percent of all Marylanders who have enrolled through Maryland Health Connection for coverage this year received financial assistance.

Today, the exchange tweeted out a quickie update ahead of the 2016 Open Enrollment period:

A couple of days ago I noted that Covered California is adding a very good feature this year: They're opening up 2016 enrollment nearly 3 weeks early...for those who are already currently enrolled. Starting this monday, Oct. 12, current enrollees will be able to renew or switch to a different CoveredCA plan, 19 days ahead of he official Nov. 1st Open Enrollment launch.

Today I discovered that at least one other state-based exchange (Kynect, in Kentucky) is doing this as well...sort of:

I clicked through and saw this listed under the Frequently Asked Questions:

1. How do I enroll in kynect?
Simply visit kynect.ky.gov or talk to your insurance agent. If your insurance plan is up for renewal, you may be eligible to enroll through kynect today. You can also call Customer Service at 1-855-4kynect (459-6328).

With the 2016 Open Enrollment Period quickly approaching (it launches on November 1st), the Maryland Health Connection has already officially launched 2016 Window Shopping!

They even whipped up a simple video stepping you through the process (oddly, the background music seems to have been lifted from "There's Something About Mary", which is either a good or bad omen depending on your POV):

MARYLAND:

In today's speech at the Howard University College of Medicine, HHS Secretary Sylvia Burwell started ramping things up for the 2016 Open Enrollment Season (which I'm gonna designate #ACA2016 unless someone else comes up with something better) by dropping some data points.

Among these was this one: 

Almost half of the uninsured individuals who are likely eligible for Marketplace plans are between the ages of 18 and 34.

This is really important, because only about 28% of those who enrolled in exchange-based policies this year fall into the 18-34 range, which is a problem from an actuarial/risk pool perspective. Younger people are generally healthier, so the insurance companies prefer to have a higher percentage of them in their risk pools in order to help keep premiums/deductibles from increasing too quickly.

If "almost half" of the 10.5 million uninsured people eligible for the ACA exchanges are in the 18-34 range, that's roughly 5 million young adults who the exchanges need to target.

Maryland was one of the first states to release their list of requested 2016 rate hikes, and caused quite a stir at the time due to the largest player in the state, CareFirst, asking for a whopping 30% rate hike. At the time, I didn't have much to go on in terms of hard enrollment numbers, but it looked like the weighted average request would be somewhat lower, perhaps around 22-23%.

Today, the Maryland Dept. of Insurance has released the final, approved rate changes, and while 5 of the 8 companies on the individual exchange saw reductions in their rate change (2 others were approved as is, and one, Kaiser Health Plan was actually increased from 4.8% to 10%), it's still difficult to lock down a fully weighted average due to some crucial enrollment data missing.

I was able to track down the "covered lives" data for 5 of the eight companies.

When I posted Maryland's July enrollment update, I noted that the effectuated exchange-based QHP number had actually gone up slightly from April through July (from 125,535 to 126,346). Not much of an increase, of course, but the fact that this number increased at all was significant since it indicated that, as I expected, new additions to the exchange QHP pool thanks to the "life event" options are slightly outpacing those dropping their policies during the off-season.

Last week the MD HealthBenefit Exchange released their August report and, as I've also been expecting, the tide is now starting to turn, with "drop-outs" finally starting to outpace the new additions:

BALTIMORE (Aug. 18, 2015) -- As of Aug. 13th, 606,226 Marylanders have enrolled in quality, affordable health coverage for 2015 through Maryland’s state-based insurance marketplace.

Long-time readers (and anyone from Maryland, I presume) know that the Old Line State (I have no idea whether that nickname is actually widely used?) was among those whose 2014 ACA exchange website turned out to be a huge technical mess. Oregon and Nevada received most of the headlines because they both ended up scrapping theirs completely and moving home to HealthCare.Gov this year (to be followed by Hawaii in 2016), but along with Massachusetts, Maryland went the "Try, Try Again" route.

Not sure how this one got by me, but the Maryland Health Benefit Exchange actually released some updated enrollment numbers over a week ago:

Nearly a half-million Marylanders — 493,346 — have enrolled in quality, affordable health coverage through Maryland Health Connection for 2015.

That includes 126,346 people enrolled in private Qualified Health Plans and 367,000 enrolled in Medicaid from Nov. 15, 2014 through July 5, 2015. About 92 percent of enrollees through the state’s health insurance marketplace are receiving some form of financial assistance.

Medicaid enrollments are year-round. And while open enrollment for private health insurance for 2015 coverage ended in February, people may still enroll if they have a qualified “life event.”

The "92% receiving financial assistance" bit is slightly misleading; that's true, but only because the Medicaid enrollees are lumped in. If you're talking about QHPs only, it's more like 69% (87.2K out of 126.3K). Whether that's a good or bad thing obviously depends on your POV.

Maryland's rate request website is an exercise in frustration. At first glance, it looks very cut and dried: A full table of each health insurance company, broken out by either individual or small group market, whether the filing is for policies sold on or off the ACA exchange, and the "average % change requested", along with direct links to the actual filing documents (where, presumably, I can dig up the crucial enrollment numbers, which are vital to determining the weighted average rate requests).

Unfortunately, once you get into the actual documents...they're completely scattershot. Some companies list the number of enrollees who would be impacted by the requested rate changes; some don't. That makes it impossible to determine the market share, which in turn means there's no way of weighting the average.

Maryland is the second state to release their official, complete #ACATaxTime special enrollment period figures (Washington State ended their tax SEP on 4/17). Healthcare.Gov, DC Health Link and Covered California have released partial reports, while 3 states didn't offer the tax SEP at all, so this leaves 8 states which haven't given any #ACATaxTime numbers yet (Vermont has extended theirs even further, until the end of May).

For Maryland, here's the press release:

BALTIMORE (May 1, 2015) — More than 4,700 Marylanders took advantage of a special six week enrollment period that allowed them to enroll for health insurance to avoid an additional federal tax penalty for 2015 if they had already owed a tax penalty for lacking health coverage in 2014.

Marylanders who applied for the special enrollment period, which ran from March 15 through yesterday, attested that they owe the penalty for lacking health insurance in 2014 and that they became aware of this after the Feb. 15 close of open enrollment for 2015 coverage.

The Maryland Health Connection posted the following tweet at around noon Tuesday:

ALERT: Our call center has closed today due to the city disturbances. Find in-person help: http://t.co/HYoHhs8uRf

— MD Health Connection (@MarylandConnect) April 28, 2015

However, any impact on actual ACA enrollments should be nominal.

Maryland had 120,145 QHP selections during open enrollment. Assuming my combined #ACATaxTime + "normal" Off-Season enrollment rate estimate of roughly 10,500 people per day nationally (through Thursday the 30th, anyway) is accurate, MD's share of this should be roughly 1% of this, or around 108 people per day at the moment. Even then, only around 1/3 of the total would be specifically for the tax season special enrollment period (the others would presumably just be delayed by a few days).

Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:

Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.

An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.

I'm expecting final official #OE2 enrollment reports from Massachusetts and Minnesota later today, but otherwise have to catch up on a bunch of my actual day job work. Here's three quick things to note:

MARYLAND: The Maryland Health Connection has released a big slideshow PDF with a mountain of demographic info. The only gripe I have is that it only runs through 2/15, so doesn't include the extra folks who signed up during the #ACAOvertime period. Data nerds, rejoice!!

This Just In from Maryland...

MARYLAND HEALTH CONNECTION ADDING ENROLLMENT PERIOD FOR MARYLANDERS UNAWARE THEY WOULD OWE TAX PENALTY WITHOUT COVERAGE

Special Enrollment Period will run March 15 through April 30

BALTIMORE (Feb. 25, 2015) — Maryland Health Connection is allowing consumers who owe a tax penalty for not having health coverage in 2014 to still enroll for 2015 coverage through a special enrollment period that will run March 15 through April 30.

Consumers who owe or have paid a tax penalty for not having coverage in 2014 would pay a higher penalty for this year if they also did not enroll for 2015. The open enrollment period to buy a Qualified Health Plan for 2015 ended Feb. 15.

The special enrollment period is for Marylanders who must pay the penalty for lacking health insurance in 2014 and who attest that they became aware of the penalty during this income tax filing season after the Feb. 15 close of open enrollment for 2015 coverage.

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