2024 OEP State By State: Actual confirmed QHPs: 4.7M; Y/Y changes range from -64% to +125% so far

Earlier today I posted the initial above-the-fold numbers for the 2024 ACA Open Enrollment Period as reported by the Centers for Medicare & Medicaid Services (CMS):

...The graph below shows how these numbers have increased since the same time period last year. I've had to adjust slightly for the fact that there's one fewer day included for both the federal exchange (18 days vs. 19) and the state exchanges (11 days vs. 12).

I've also had to adjust for the fact that Virginia moved from the federal exchange to its own state-based exchange this year, which is further complicated by CMS reporting 3 weeks for the federal exchange but only 2 weeks for state-based exchanges. I've done my best to adjust for all of these factors below (the subtotals are accurate; the new/returning breakout for 2023 are estimates but should be pretty close):

As you can see, the initial enrollment numbers are dramatically higher across the board:

  • HC.gov is 47% higher (54% more new enrollees, 46% more returning enrollees)
  • SBMs are 27% higher (19% more new enrollees, 29% more returning enrollees)
  • Overall: 45% higher (50% more new enrollees, 44% more returning enrollees)

In any event, here you go:

The Centers for Medicare & Medicaid Services (CMS) reports that nearly 4.6 million Americans have signed up for 2024 individual market health insurance coverage through the Marketplaces since the start of the 2024 Marketplace Open Enrollment Period (OEP) on November 1. This includes 4.1 million plan selections in the 32 states using the HealthCare.gov platform for the 2024 plan year, through November 18, 2023 (Week 3), and 502,000 plan selections in the 17 states* and the District of Columbia with State-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through November 11, 2023 (Week 2).

Total nationwide plan selections include 920,000 consumers (20% of total) who are new to the Marketplaces for 2024, and 3.7 million consumers (80% of total) who have active 2023 coverage and returned to their respective Marketplaces to renew or select a new plan for 2024. 

*(this is a typo in the press release...it's 18 states +DC)

Here's the state-by-state breakout compared to the same point in time a year ago. Again, I've adjusted for the missing extra day (multiplying HC.gov states by 18/19ths and SBM states by 11/12ths). I've also included relevant notes for specific states which have special circumstances or alterations this year:

It's also important to note that New York's ACA exchange, NY State of Health, didn't launch their OEP until 11/16 (several days after the SBM data ends) either year, so there's no enrollment data included. CMS's proposed 2025 NBPP rule would nip this in the bud by requiring all SBMs to start their OEPs no later than 11/01 going forward.

Overall, 2024 OEP enrollment is running 44.9% higher y/y when the date and platform shifts are accounted for.

The first big takeaway at the individual state level is that some states are massively outperforming last year so far while others are lagging way behind...and there's only reasonable explanations for some of this:

  • Mississippi, Tennessee and Ohio (all federal exchange states) are each running more than 100% higher than last year so far...with Mississippi having enrolled 126% more people in exchange plans than they did a year ago.

  • 11 other states are each running more than 50% higher than the same point last year: LA, IN, SC, OK, WV, GA, DC, MO, AR, AZ & KS.

  • At the opposite end of the spectrum, Virginia is running a whopping 64% behind their 2023 OEP enrollment at this point, almost certainly due to the state moving off of the federal exchange onto their own platform; since current enrollees have to actively log into a whole new account and go through a different interface to enroll for 2024, there's no doubt a lot of confusion at the moment. Hopefully this will straighten itself out by the time OEP ends, however.

  • Both of the Dakotas as well as New Jersey are running slightly behind last year so far, and 6 states (HI, OR, WY, AK, NV & NM) are running less than 10% ahead y/y.

Next, let's look at the breakout between platform type (federal vs. state-based exchange) as well as Medicaid expansion status:

  • Federal exchange states (HC.gov) are running 47% ahead of last year at the same point, while state-based exchange states (SBMs) are only up 27% y/y. Again, the reason this gap is larger than the nominal gap shown in the summary above is because I forgot to account for Virginia's move in the summary.
  • Medicaid expansion states are running a whopping 50% higher y/y so far, while non-expansion states are running 36% higher.
  • If you further break this out by platform type, expansion states on the federal exchange are running 43% higher while non-expansion states on the federal exchange are up 49% so far.

Some or all of these y/y changes could easily change as we move into the next phase of the Open Enrollment Period, of course.

Finally, we get to the "4.7 million" figure I mention in the headline above. All of the above data only adds up to 4.58 million QHP selections so far, but in addition to those, I've confirmed some additional enrollments from a handful of state-based exchanges which have posted interim enrollment reports which include additional data past the dates in CMS's press release:

  • Colorado reported over 36,500 enrollees thru 11/14
  • Maine reported 58,254 enrollees thru 11/14 (includes auto-renewals)
  • New Mexico reports 46,234 enrollees thru 11/20 (includes auto-renewals)

Add all of these into the mix and you get a grand total of 4,700,124 confirmed QHP enrollees so far.

This also doesn't include the likely ~1.3 million people enrolled in Basic Health Plan programs in Minnesota and New York, although those haven't been reported yet.

Put them all together and here's what it looks like visually, overlaid on top of the 2023 OEP enrollment progress. Eyeballing the graph below, it looks like we've likely broken 5.5 million QHP selections as of today (11/21):