Connecticut: Great News! More evidence that payment & retention rates are higher than 2014

In 2014, the overall average premium payment rate for those who selected a Qualified Health Plan (QHP) from the various ACA exchanges ended up being around 88% nationally. This varied from state to state and company to company, but in the end it was roughly 88%.

In 2014, the overall average net monthly attrition rate ended up being roughly 3% per month (by net, I mean after taking into account both new people enrolling during the off-season and existing enrollees dropping their coverage). Based on this, here's what the 2014 exchange enrollment looked like (click image for full-size version):

For 2015, back in November I speculated that the first-month payment rate would likely end up being somewhat higher than 88%, for a variety of reasons, including technical improvements and especially because around 1/2 of this year's enrollees are renewals from last year...and thus have already proven themselves to make their payments on a regular, reliable basis. In fact, many of them (including my wife and I) are set up with auto-payments. With that in mind, I speculated that the 2015 payment rate might conceivably end up being as high as 94%. However, I've stuck to my 88% guns in the absence of any hard evidence to the contrary.

Cut to a week ago, when Covered California--the largest state-based exchange in the country--released a comprehensive report on their 2015 enrollment data. Included with all of this was the following info:

I've confirmed that the number below represents actual paid, effectuated enrollments as of March 2015:

What does that mean? Well, remember, that was as of March, which means that it doesn't include the extra 117K who signed up since February 22nd.

That means that 1,342,956 out of 1,412,200 people paid their premiums in time for March 1st coverage...or 95.1%!

Now, it's possible that I'm misreading this, and that I need to divide by the larger, more recent number (1,529,224). If so, that would make the payment rate "only" 87.8%...which is exactly what I've been using as a rule of thumb for nearly a year now. However, even if that's the case, that would still be a substantial improvement for California specifically, which only hit a disappointing 81.7% last year.

IF, however, California has indeed managed to hit a 95% payment/effectuation rate, then that has huge implications for the rest of the numbers that I've been estimating...and due to CA's sheer size, it would have an impact whether it's representative of other states or not.

OK, so that's huge, if true. Unfortunately, I'm stil waiting on final confirmation that the 1.34M number is out of the 1.41M number as opposed to the more recent 1.53M number. Even if I'm wrong, it would still be a 6.1% payment rate improvement over last year.

That brings me to today: Access Health CT, Connecticut's ACA exchange, just held their monthly board meeting and stated the following:

Access Health private insurance membership down to 103,342; some cut off for not paying, some for not providing documents

— Arielle Levin Becker (@ariellelb) May 28, 2015

That's 103,342 people currently enrolled in ACA exchange-purchased QHPs. The official 2/22/15 tally of QHP selections for Connecticut was 109,839 people, and the confirmed number including #ACATaxTime enrollments is 111,268. Assuming roughly 2,000 more have selected plans for normal off-exchange reasons, it'd be around 113,000 total to date.

That means that Connecticut currently has either 94% of Open Enrollment people still effectuated, 93% if you include #ACATaxTime enrollees or, at the very worst, over 91% of the grand cumulative total still enrolled.

OK, so what does this mean? Well, assuming the same 88% paying / 3% net attrition as last year, the national effectuated enrollment number should be hovering around the 10.1 million mark at the moment.

However, 10.1 million = around 86.3% of the 11.7 million who selected QHPs nationally as of 2/22/15.

IF (and this remains a big if) the true percentage turns out to be more like 94%, that would mean that instead of 10.1 million being currently enrolled, it's closer to 11 million people.

That would be 900,000 more people currently enrolled than I've been estimating.

Again, two states (even with one being California) still don't provide enough hard data to be sure about this...but it certainly is looking like I was at least partially correct: The payment rate seems to be higher than 88%, and the attrition rate seems to be somewhat lower than 3%.

If I split the difference and assume, say, a 91% payment rate and a 2% net monthly attrition rate, that would make 2015 play out something like the following:

That would mean the effectuated enrollment level would peak at around 10.4 million later this summer instead of 10.1 million.

Of course, all of this still assumes that King v. Burwell doesn't destroy the whole system...