2021 OEP Week 5 HC.gov Snapshot Report: 915K QHPs, 3.8M total

Hot off the presses, via the Centers for Medicare & Medicaid:

Week Five, November 29 - December 5, 2020

In Week Five of the 2021 Open Enrollment period, 915,118 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own State-based Exchange platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections or 7% of all plan selections during the 2020 Open Enrollment Period. These enrollees’ selections will not appear in our figures until we announce the State-based Exchange plan selections.

It's a bit tricky to compare the first weekly report against the previous year because the snapshot reports run Sunday - Saturday:

  • Last year Nov. 1st fell on a Friday, so "Week 1" was actually only 2 days
  • "Week 2" included the following 7 days, for 9 days total
  • "Week 3" included just 16 days total
  • "Week 4" included 23 days total
  • "Week 5" included 30 days total

With the fifth week included, I can compare 35 days in OEP 2021 vs. 37 days in OEP 2020, which is still apples to oranges but a lot closer. With Thanksgiving out of the way, enrollments understandably shot back up again, although not as much as last year; so far the 2021 season is running 4.0% higher than last year on a daily basis:

  • First 35 days of OEP 2021: 109,104 QHP selections/day (3,818,665 total)
  • First 37 days of OEP 2020: 104,937 QHP selections/day (3,882,671 total)

Keep in mind, however, that this is if you include Pennsylvania and New Jersey! Those two states enrolled a total of 248,639 people in the first 37 days last year, so it's actually:

  • First 35 days of OEP 2021: 109,104 QHP selections/day (3,818,665 total)
  • First 30 days of OEP 2020 (w/out NJ/PA): 98,217 QHP selections/day (3,634,032 total)

...or 11.1% higher per day than last year, which is pretty good, especially under the circumstances (the pandemic, the looming Supreme Court decision and the ongoing coup attempt by Donald Trump to overthrow the election results).

However, it's also important to note the breakout between current enrollees actively renewing their policies and new consumers enrolling.

Last year, in the first 37 days, it was a 73% / 27% split between the two. This year, for the first 35 days it's split 76/24.

Renewals of existing enrollees are way up: 2,902,911 vs. around 2,633,640 last year (when adjusted for NJ/PA), or 82,940/day vs. 71,179/day. That's 16.5% higher.

NEW enrollment, however, is concerning. Last year there were 1,067,545 new enrollees via HC.gov in the first 37 days. If you adjust for NJ/PA splitting off, that's around 1,007,872, or 27,240 new enrollees per day. This year it's just 915,754 in 35 days, or 26,164 per day...or 4% fewer per day.

Given the massive number of people who have lost their employer-sponsored health insurance since March, you'd normally think that there'd be a surge in new enrollees, especially since many parts of the country have zero premium policies...including zero-premium GOLD plans for many people. And yet, so far, the number of new enrollees is pretty much flat.

This is where a proper awareness/marketing/outreach campaign from the federal government could do wonders...yet Trump's CMS Administrator, Seema Verma, has basically gutted HC.gov's marketing budget.

It's important to note, however, that a big chunk of the surge in renewals could also simply be people who enrolled via Special Enrollment Periods (SEPs) earlier this year who are renewing. Even if they've only been enrolled for a month or two, they're still considered current enrollees, not new enrollees. In addition, a chunk of current exchange enrollees likely had to downshift to Medicaid instead if they lost their jobs/income...meaning the net impact on total exchange enrollment could be pretty minimal.

Finally, here's the state-level breakout for the 36 states hosted via HC.gov. I've included last year's "Week 6" (37 day) numbers for comparison, and have adjusted them to account for the 2 missing days this year to get an idea of how each state is performing year over year so far:

As you can see, on a per-day average basis, 27 out of 36 states are outperforming last year so far. The state with the highest increase is now Texas, which is up nearly 22% year over year. The worst-performing state relative to last year is still Kentucky, which is down 7.6% year over year on a per-day basis for reasons unknown.