The Week 4 HealthCare.Gov Snapshot Report from CMS should be released at any time, covering enrollment in 38 states from Nov. 10th - Nov. 23th.

As a reminder, here's what the Week 3 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around ~120,000 of the difference. Secondly, Nevada split off from HC.gov this year, which accounts for around ~19,000 of the gap the first 3 weeks. In addition, a small portion of the difference is likely due to Idaho and Maine expanding Medicaid; exchange enrollees earning between 100-138% FPL should be tranferred over to Medicaid instead.


IMPORTANT: As I've noted before, Covered California has arranged to expand and enhance their ACA premium subsidies beyond the official ACA formula starting with the 2020 Open Enrollment Period. Back in October, I posted a detailed analysis, complete with tables and graphs to explain just how much hundreds of thousands of Californians could save under the new, beefed-up subsidy structure.

However, Anthony Wright of Health Access California just called my attention to the fact that I made a major mistake in my analysis which impacted every one of the examples: I was basing them on the draft enhanced subsidy formula from back in May instead of the final version, which is considerably more generous at the upper end of the sliding scale than the draft version was!

In short:

  • The ACA formula caps premiums (for the benchmark Silver plan) at between 2 - 9.8% of household income but only if you earn between 100 - 400% of the Federal Poverty Level.
  • The draft California formula is a bit more generous from 100 - 400% FPL and also caps premiums between 9.9 - 25% of income between 400 - 600% FPL.
  • The final California formula is more generous yet: It's pretty much the same up to 400% FPL, but caps premiums between 9.8 - 18% of income between 400 - 600% FPL.

I've therefore gone back and re-calculated and re-written the entire blog post below with the updated, corrected subsidy formula. My apologies for the error!


There's two important points for CA residents to keep in mind starting this Open Enrollment Period:

  • First: The individual mandate penalty has been reinstated for CA residents. If you don't have qualifying coverage or receive an exemption, you'll have to pay a financial penalty when you file your taxes in 2021, and...
  • Second: California has expanded and enhanced financial subsidies for ACA exchange enrollees:

Until now, only CoveredCA enrollees earning 138-400% of the Federal Poverty Line were eligible for ACA financial assistance. Starting in 2020, however, enrollees earning 400-600% FPL may be eligible as well (around $50K - $75K/year if you're single, or $100K - $150K for a family of four). In addition, those earning 200-400% FPL will see their ACA subsidies enhanced a bit.

New York

Smart idea via the NY State of Health ACA exchange:

Increased Visits to Food Pantries During Holiday Season Provide Opportunity to Reach Uninsured New Yorkers

ALBANY, N.Y. (November 25, 2019) – NY State of Health, the state's official health plan Marketplace, today announced its partnership with food pantries for the third holiday season to educate consumers about enrolling in high quality, affordable health insurance. Food pantries across New York will have certified enrollment assistors on-site throughout November and December to answer questions about health coverage options and how to enroll in a health plan. This year, the Marketplace is also offering eligible New Yorkers the option to receive information on the Supplemental Nutrition Assistance Program (SNAP) during the enrollment process.

Washington State

Back in late October, a few days before the launch of the 2020 Open Enrollment Period, I issued a warning to ACA exchange enrollees who may have been benefiting from the "Silver Loading" premium pricing strategy for in 2018 and/or 2019 that the enhanced subsidies they've been taking advantage of for two years are likely going to be reversed for 2020:

What happens next year if the benchmark Silver plan drops by 4%...but the Bronze, Gold, and the OTHER Silver plans stay flat?

Over at the Washington Post, reporter Yasmeen Abutaleb has a disturbing-sounding story which immediately caught my eye and raised major internal alarms within the healthcare wonk/advocate community:

Critics say ‘junk plans’ are being pushed on ACA exchanges

The Trump administration has encouraged consumers to use private brokers, who often make more money if they sell the less robust plans.

The Trump administration is encouraging consumers on the Obamacare individual market to seek help from private brokers, who are permitted to sell short-term health plans that critics deride as “junk” because they don’t protect people with preexisting conditions, or cover costly services such as hospital care, in many cases.

So far, this is nothing new; I've been warning people about this since day one...it's the 2nd item on my "Seven Important Things to Remember" blog post from November 1st:

The Week 3 HealthCare.Gov Snapshot Report from CMS should be released later on this afternoon, covering enrollment in 38 states from Nov. 10th - Nov. 16th.

As a reminder, here's what the Week 2 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around half of the 244,000 difference. The other significant difference is that Nevada split off from HC.gov this year, which accounted for around 12,000 of the gap the first 2 weeks.

If you assume around 130,000 of the difference is due to the missing day, that still leaves 2020 Open Enrollment around 100,000 short of the same time period last year on HealthCare.Gov.


Connect for Health Colorado® Reports Coloradans are Shopping Around for 2020 Coverage

DENVER – Nearly 24,000 Coloradans have signed up for a health insurance plan through Connect for Health Colorado’s Marketplace between Nov. 1 and Nov. 15. for coverage starting Jan. 1, 2020.

More Coloradans buying their own health insurance are seeing lower premiums, largely due to the reinsurance program that passed this year. Reinsurance helps insurers with their most costly claims. However, given the complexities of how financial help available through the Marketplace is calculated, current customers should shop around to reduce monthly costs.

Heh. This is a pretty good layman-speak for #ReverseSilverLoading.

On average, those who qualify to automatically renew their plan would lower their premiums by 15 percent (compared to 2019) if they switch to the lowest-cost plan in their current level of coverage.


OK, this is a bit confusing. Over the past few years, more and more of the state-based exchanges have shifted from waiting until the end of Open Enrollment to officially report auto-renewals of existing enrollees...to going ahead and auto-renewing everyone up front, and then subtracting those current enrollees who actively cancel their renewals.

This has caused a bit of confusion, since the exchanges don't always make it clear who's being counted and when.

Case in point: Access Health CT, Connecticut's ACA exchange. Last year they reported 12,777 enrollees during the first two weeks of Open Enrollment...and also noted that there were another 85,000 existing enrollees who hadn't yet actively renewed their policies as of 11/18.

This year, their press release page states the following:

Qualified Health Plans (QHP):

  • Net Total QHP Enrollment: 96,810
  • 2020 OE Acquisition Summary: 3,947

Overall Volume

via KLAS-TV:

CARSON CITY, Nev. (KLAS) — Nearly 60,500 Nevadans have enrolled in a Qualified Health Plan for plan year 2020 since open enrollment began on Nov. 1.

The Silver State Health Insurance Exchange, which runs online insurance marketplace Nevada Health Link, announced these numbers just 15 days into the enrollment period.

Nevada Health Link migrated 65,563 Nevadans from HealthCare.gov onto the State Based Exchange platform at NevadaHealthLink.com.

“At exactly one-third of the way into open enrollment, we are enthusiastic about the level of engagement we’ve seen from consumers and brokers,” said Heather Korbulic, executive director of Silver State Health Insurance Exchange, in a press release. “While we still have work to do to reach the uninsured populations throughout our state, we remain optimistic that we will see enrollment numbers continue to rise throughout the duration of this enrollment period.”

The agency says this is the first year Nevada Health Link will no longer rely on HealthCare.gov after the transition began in 2018.

New York

Arrrrgh! Don't ask me why, but for some reason I forget about this weird policy of NY State of Health every year:

Press Release: NY State of Health Announces Annual Renewal Begins Saturday

  • 500,000 New York State Households Expected to Renew Their Health Plan for the 2020 Plan Year
  • Consumers Must Enroll or Renew by December 15 for Coverage Effective January 1

ALBANY, N.Y. (November 14, 2019) - NY State of Health, the state’s official health plan Marketplace, today announced that beginning November 16, the Marketplace will be open for individuals looking to renew or change their health plan for 2020. Open Enrollment for new customers seeking to enroll in a Qualified Health Plan began November 1 and runs through January 31, 2020.  New Yorkers must enroll by December 15 for coverage beginning January 1, 2020.