Individual Market

Fantastic news via the New Jersey Dept. of Banking & Insurance:

NJDOBI Adopts Regulations to Require Comprehensive Abortion Coverage in Department Regulated Health Insurance Markets

TRENTON – As part of the Murphy Administration’s efforts to protect access to reproductive health care, the New Jersey Department of Banking and Insurance today announced the adoption of rules to require comprehensive abortion coverage as a part of all health benefits plans regulated by the department. This requirement, which was in place as of January 1, 2023 in the individual and small employer health insurance markets, will now be in effect for the fully-insured large employer health insurance market upon plan issuance or renewal.

Mark Farrah Associates is an electronic publisher of business information and analytics for the U.S. healthcare industry; they aggregate industry data and market metrics for their own database products that they sell on a subscription basis.

They typically release state-level breakout estimates of the total U.S. individual market once or twice a year. They haven't done so in 2023 as of yet, but today they did release this overview analysis:

Wax On Wax Off

It's been nearly a year since I've checked in on what the off-exchange individual health insurance market looks like. In October 2021, Mark Farrah Associates estimated the total indy market (including both on- and off-exchange enrollees) at around 15.9 million people nationally as of June 2021. Of that, they figured roughly 75.4% of it was on-exchange vs. 24.6% off-exchange.

However, as I noted at the time, there were a couple of important caveats with Mark Farrah's estimates, two of which they mentioned but one of which they didn't:

It is important to note that Mark Farrah Associates (MFA) applied enrollment figures for select carriers not required to report health enrollment on a quarterly basis and made other adjustments based on market analysis. Furthermore, individual enrollment includes short term plan enrollees and may include Medicaid programs, such as CHIP, as some states include subsidized lines in the individual segment. These factors may have resulted in moderate understatement or overstatement of enrollment.

Wax On Wax Off

Back in September, the Centers for Medicare & Medicaid Services (CMS) issued several reports which touted the success of the 2021 COVID Special Enrollment Period. Thanks in part to enrollment being re-opened but mostly to the dramatically expanded financial aid provided by the American Rescue Plan (ARP), over 2.8 million additional Americans signed up for 2021 healthcare coverage via the ACA exchanges nationally.

This came on top of the 12.0 million who had already enrolled during the official 2021 Open Enrollment Period from November 1st, 2020 - January 31st, 2021. All told, that's 14.8 million Americans who selected Qualified Health Plans (QHPs) via the exchanges through mid-August.

Thanks to David Snow for the heads up!

A couple of weeks ago, both Louise Norris and I crunched the South Carolina data and came up with different estimates of the weighted average requested 2016 rate hikes for the ACA-compliant individual market. She used a worst-case scenario and estimated it to be around 16.8%; I took a slightly more optimistic approach and came up with 15.2%.

Well, the South Carolina Dept. of Insurance just released their approved 2016 rates, and they ended up pretty much splitting the difference.

As you can see, even though there are only 5 carriers operating on the ACA exchange and another 5 offering policies off-exchange only, the overall average is still 15.9% either way: