2022 OEP Week 1 HC.gov Snapshot Report: 774K enrollees w/133K new (w/updates)

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

Marketplace Weekly Enrollment Snapshot: Week One

The Centers for Medicare & Medicaid Services (CMS) is reporting that in week one of the 2022 Open Enrollment Period, approximately 774,000 people selected individual market plans in the 33 states that utilize the HealthCare.gov platform. During Open Enrollment, CMS will release weekly enrollment snapshots that provide point-in-time estimates of weekly plan selections, Marketplace Call Center activity, and visits to HealthCare.gov and CuidadoDeSalud.gov for states that utilize the platform.

“Health care coverage is more affordable and accessible than ever and we’re see that in the first six days of this Open Enrollment period. Due to the American Rescue Plan, during these first six days close to 40% of people who enrolled were able to find a plan for $10 or less per month after tax credits,” said Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services. “We’re excited to kick-off Open Enrollment with such a strong first week – particularly when you factor in the unprecedented more than 2 million individuals who gained coverage earlier this year.”

2.1 million people newly gained access to affordable health care coverage during the 2021 Special Enrollment Period (SEP) on HealthCare.gov ahead of the 2022 Open Enrollment Period. Additionally, three states including Kentucky, Maine and New Mexico, transitioned to State-Based Marketplaces (SBMs) for the 2022 Open Enrollment Period. These factors should be considered in any year-over-year HealthCare.gov enrollment comparisons. As in past years, the final Open Enrollment numbers, including SBM numbers, will be provided after the Open Enrollment Period ends in all states. Learn more about the 2021 SEP, please visit here.

At first glance this may seem disappointing compared to last year's Week One tally of over 818,000 enrollees (and it's certainly a far cry from my back-of-the-envelope spitball take of 1.16 million based on raw 3rd-party web broker numbers).

HOWEVER, there's two vitally important things to keep in mind:

First, last year's Week One total included seven days...whereas this year's only includes six (the Snapshot Reports run from Sunday - Saturday; last year November 1st happened to fall on a Sunday, this year it was on a Monday). On a per-day basis, 2022 enrollment is actually up 10.3% over last year:

  • OEP 2022: 128,926/day
  • OEP 2021: 116,909/day

Going forward, the reports will be comparing 7 days to 7 days.

Secondly, as noted above, this year three states split off from HC.gov onto their own exchanges (Kentucky, Maine and New Mexico). Last year, 16,497 of the 818,365 Week One HC.gov enrollees were from those three states, or 2% of them. When you remove those, 2021's first week only had 801,868 Week One enrollees.

When you correct for that, 2022 Week One HC.gov enrollment is actually up 12.5% vs. last year:*

  • OEP 2022: 128,926/day
  • OEP 2021: 114,552/day

Also noteworthy is the number of new enrollees in the first week: 133,274 this year vs. 173,344 last year. This is 23% lower...except that again, when you account for the missing day it's actually only 10.3% lower, and if you assume 2% of last year's new enrollees were from KY/ME/NM, it's only 8.5% lower year over year.*

When you consider that many of the 2.03 million people who enrolled over the spring/summer via the COVID Special Enrollment Period in the 33 states now hosted via HealthCare.Gov likely would have been new enrollees had they not already done so, this is pretty remarkable.

*CORRECTION: I originally made a clerical error which made me think adjusted enrollment was up 19.8% and new enrollment was oly down 2.5% year over year; the data has been corrected for both figures. Apologies for my error.

Update: It's also worth noting that active renewals (again, when adjusted for the missing day & states) are up 25.9% vs. last year:

  • OEP 2022: 106,714/day
  • OEP 2021: 84,774/day

This stat doesn't necessarily mean all that much (it could simply be people actively renewing sooner rather than later), but it does suggest that more people are beginning to understand the importance of actively re-enrolling instead of letting themselves be passively auto-renewed, which often means losing out on far better values and/or thousands of dollars in additional savings.

Update x2: I completely forgot another important factor to take into account: Both Oklahoma and Missouri expanded Medicaid earlier this year (Oklahoma started in July; Missouri's state goverment was dragged into it kicking & screaming in October).

While most of the 275,000 Missouri residents & 190,000 Oklahomans who are eligible for Medicaid via ACA expansion weren't eligible for ACA exchange plans, a portion of them were (those earning between 100 - 138% of the Federal Poverty Level). I don't know exactly how many of those were actually enrolled in ACA plans prior to being shifted over to Medicaid, but according to the final 2021 OEP Public Use File report, nearly 150,000 of those who enrolled during the 2021 Open Enrollment Period earned between 100 - 150% FPL. Assuming an even spread across that income range, this suggests perhaps 113,000 who earned between 100 - 138% FPL.

On the one hand, that doesn't take into account net attrition over the course of the year; on the other hand, it also doesn't include any of the 89,402 MO/OK residents who enrolled during the COVID SEP either (remember, while Oklahoma started their expansion program on schedule in July, which was halfway through the SEP, Missouri residents had no clue whether Medicaid would be expanded at all or not until after the SEP ended in mid-August). Assuming a similar ratio of all SEP enrollees were in the 100 - 150% FPL income bracket to the Open Enrollment Period, that means something like 26,000 additional 100 - 138% FPL enrollees will be shifted over to Medicaid as well.

Around 10% of all 2021 OEP HC.gov enrollments happened in the first week last year. If you assume a proportionate number of the 100 - 138% crowd signed up the first week, that's another ~11,000 who need who need to be discounted for an apples to apples comparison, which would mean 2022's first week is actually running 21.6% higher on a per-day basis!

  • OEP 2022: 128,926/day
  • OEP 2021: 106,012/day

Unfortunately, this first Weekly Snapshot doesn't include a state-by-state breakout, but that should be coming by Week Three based on prior experience. Stay tuned...