BOOM: Old n' Busted: 21.5M QHPs. New Hotness: 23.6M and counting!

A week or so ago I expressed surprise and disappointment over an incredibly misleading headline from KFF, declaring "Obamacare sign-ups lag after Trump election and legal challenges." In fact, as I noted on December 23rd, I noted, 2025 ACA Open Enrollment was actually running over 16% ahead of roughly the same point a year earlier:

Across 38 states, a total of around 19.5 million people have selected Qualified Health Plans (QHPs) via either the federal or state-based exchanges as of anywhere from 12/05 - 12/18. Collectively, this is roughly 16.6% higher than the same/nearly the same dates a year ago.

It's important to remember that Georgia moved from the federal exchange to its own state-based marketplace this year, which is why ~1.2 million enrollees have been subtracted from the 2024 HC.gov total. Note that the HC.gov numbers are rounded off to the nearest 100K, per CMS's press releases both years.

Sure enough cut to this morning via the Centers for Medicare & Medicaid Services (CMS):

Nearly 24 Million Consumers Have Selected Affordable Health Coverage in ACA Marketplace, With Time Left to Enroll

The Centers for Medicare & Medicaid Services (CMS) is committed to a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase quality, affordable health care coverage. CMS reports that 23.6 million consumers selected plan year 2025 coverage through the Marketplaces since the start of the 2025 Marketplace Open Enrollment Period, including 3.2 million new consumers. That represents 11.6 million more enrollees compared to the 2021 Open Enrollment Period.

During last year’s record-setting Open Enrollment Period, 21.4 million people selected coverage through the Marketplaces, driving the uninsured rate to a historic low, where it remains today. Over 20.4 million consumers had active 2024 coverage and selected a plan for 2025 coverage or were automatically re-enrolled. Building on the historic success of last year and thanks to President Biden’s leadership, we are on track for a record high number of plan selections for this year’s Open Enrollment.

As always, the details are important; I'll dig in below the press release itself.

“Nearly 24 million people, a record number, have signed up for Marketplace coverage — and the Open Enrollment Period is not over yet. The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” said Health and Human Services (HHS) Secretary Xavier Becerra. “Every American should have access to quality, affordable health care — and thanks to the ACA, they do. The Affordable Care Act now stands along with Medicare, Medicaid, and Social Security as one of the most consequential social programs in the history of our nation.”

The Secretary added: “You can still sign up on HealthCare.gov for quality coverage that costs $10 or less a month after financial assistance.”

“We can’t lose sight of what’s behind our tremendous, record-setting progress: Millions of individuals and families who now have a critical connection to the lifeline of health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “To the millions more who may still need coverage: Don’t delay. Help is still available, including tax credits that have made coverage more accessible by reducing the barrier posed by high costs.”

For 2025, consumers continue to have greater plan choices and, thanks to the Biden-Harris Administration and the Inflation Reduction Act of 2022, many people who were previously ineligible for financial assistance now have access to lower premiums after tax credits. Four out of five HealthCare.gov consumers can find a plan for $10 or less per month through expanded tax credits. Consumers are reminded that these enhanced tax credits will remain available through 2025. For more information on the range of updates CMS has implemented to improve the Health Insurance Marketplace® for 2025 — including web and navigation enhancements and more — consult the “What’s New for 2025 Open Enrollment” fact sheet.

Marketplace Open Enrollment on HealthCare.gov runs through January 15. Consumers who enroll by midnight local time on January 15 (no later than 5 a.m. ET on January 16) can get coverage that starts February 1, 2025. State-based Marketplace enrollment deadlines vary. State-specific deadlines and other information are available in the State-based Marketplace Open Enrollment Fact Sheet.

Individuals can enroll or re-enroll in health insurance coverage for 2025 by visiting HealthCare.gov (or CuidadoDeSalud.gov), or by calling 1-800-318-2596 to fill out an application. Individuals who want assistance signing up for coverage may go to “Find Local Help” on HealthCare.gov to find a Navigator, Certified Application Counselor, or agent or broker. Additionally, if someone learns they are no longer eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage, they can visit HealthCare.gov to see if they are eligible to enroll in a low-cost, quality health plan. They can also contact the Marketplace Call Center for support in finding a plan that fits their needs.

Here's the top line numbers, including the comparable semi-final enrollment data from a year earlier:

Boom: With a week left to enroll in most states, total enrollment is indeed running 16% ahead of last year. More specifically, while new enrollment is down about 15% y/y, returning enrollees are up 23%.

It's also important to note that the seemingly massive gap between the HC.gov and SBM changes aren't nearly as dramatic as they appear--remember, Georgia moved from the former to the latter this year. When you account for that, it looks like this (CMS hasn't provided the state-level new vs. renewal breakout yet):

In other words, when you adjust for Georgia's move, there's not much difference between the FFM (up 16.8%) and SBM (up 14.1%) states this year.

When we break it out by state, it gets even more impressive:

Not only is 2025 Open Enrollment up 16% over the same point last year, it's actually already up over 10% versus the final 2024 OEP total nationally...with a week left for folks to enroll!

Other noteworthy data points:

• FLORIDA continues to blow away every other state in raw enrollees, with over 4.6 MILLION residents having signed up so far...a full 20% of their entire population, up another 600,000 vs. last year.

• Other major raw enrollment increases are being seen in Texas (also +600K), Georgia (+277K) and California (+162K), with MI, OH, NJ, TN & AL also boosting their enrollments by over 100K apiece so far.

• The only states to see a net decrease in Qualified Health Plan (QHP) enrollments are New York, North Carolina, Virginia, Oregon and DC.

However, North Carolina's drop is due to them expanding Medicaid a year ago (which siphoned off a chunk of their low-income exchange enrollees), while New York similarly expanded their Basic Health Plan (BHP) program last spring and Oregon launched theirs last summer, both of which, again, cannibalize a portion of residents who would otherwise be enrolled in exchange plans. DC's reduction, meanwhile, is nominal. The only state I'm scratching my head over is Virginia, which saw a 4.7% drop in enrollment without anything obvious happening to account for it.

• On a percentage change basis, LOUISIANA is leading the way with a 45% increase year over year, followed by West Virginia (+40%), New Jersey (+34%) and Rhode Island (+34%). Again, setting NY, NC & OR aside, only VA & DC are down vs. last year, while SD, AME & AK are up by less than 5% apiece.

It's important to remember that there's still a week or longer left for people to enroll in every state except Idaho!

Speaking of which, Idaho's final 2025 OEP total is up 13.1% vs. last year's final 2024 OEP tally.

As for other states, again, with anywhere from 7 - 23 days left for people to sign up (technically Rhode Island has even longer, but that's a special case), here's where things stand vs. last year's final OEP totals:

• Raw enrollment: Florida is up 421,000 vs. 2024 final
• Percent change: Louisiana is up 34% vs. 2024 final
• Federally-facilitated marketplace (HC.gov): Up 11.0% vs. 2024 final
• State-based marketplaces (SBMs): Up 8.0% vs. 2024 final

As for the remainder of this year's OEP, around ~550,000 more people signed up in the final weeks of the 2024 OEP (after the dates in this report). Assuming this year's trend continues, that would translate into perhaps another 630,000 signing up this year.

If so, that would bring the total up to around 24.2 million QHPs when the dust settles, give or take.

Oh yeah...I almost forgot: Speaking of the Basic Health Plan (BHP) programs in New York, Minnesota and Oregon, from the footnote in CMS's press release:

As of December 28, 2024, Oregon had 29,705 individuals enroll in a BHP, and New York had 1,625,174 individuals enroll in the EP Expansion under the state’s approved section 1332 waiver program. Minnesota’s BHP data was not available at the time of this report.

I don't know why CMS always says that about Minnesota, however, since they do have monthly Minnesotacare enrollment reports available, including for December (105,464).

Combined, that's 1,760,343 BHP enrollments across all three states.

Adding those to the QHPs brings the grand total up to 25,369,000 QHPs + BHPs combined, which will likely be more like 26.0 million combined when the dust settles.