QHPs

As I noted in yesterday's analysis of the semi-final 2023 Open Enrollment Period report released by the Centers for Medicare & Medicaid Services, one of the most striking data points we're seeing this year is a significant drop in year over year on-exchange enrollment across a number of states operating their own ACA exchanges...even as enrollment continues to surge across states hosted on the federal exchange (HealthCare.Gov).

Overall, QHP enrollment in HC.gov states (Federally Facilitated Marketplaces, or FFMs) is up 19.6% vs. the same point last year, while QHP enrollment in state-based marketplace states (SBMs) is down 2.8% year over year:

Here's some further points of interest from my analysis of the semi-final 2023 ACA Open Enrollment report earlier today:

As I noted this morning, Florida has by far the highest percent of its total statewide population enrolled in on-exchange ACA policies, with over 3.15 million Floridians enrolled so far (likely around 3.24 million when the final weekly numbers are included). This is 14.2% of Florida's total 2022 population according to the U.S. Census Bureau, or 1 in 7 residents of the state.

What about the other states? The table below sorts total 2023 OEP enrollment as of either 1/07/23 for federal exchange states (HC.gov) or 12/31/22 for state-based marketplace states (SBM) by what percent of the total state population has signed up so far. For New York and Minnesota the percent of total population includes each states Basic Health Plan (BHP) enrollment as well, since everyone enrolled in those plans would normally be eligible for a QHP instead:

via the Centers for Medicare & Medicaid Services:

Nearly 16 Million People Have Signed Up for Affordable Health Coverage in ACA Marketplaces Since Start of Open Enrollment Period

• This record-breaking enrollment represents a 13% increase over last year, including over 3 million people new to the Marketplaces.
• Open enrollment continues through January 15

Today, the Biden-Harris Administration announced that about 15.9 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1. This represents activity through January 7, 2023 (Week 10) for the 33 Marketplaces using HealthCare.gov and through December 31, 2022 (Week 9) for the 18 State-based Marketplaces (SBMs) in 17 states and the District of Columbia that are using their own eligibility and enrollment platforms. Total plan selections include 3.1 million people (20% of total) who are new to the Marketplaces for 2023, and 12.8 million people (80% of total) who had active 2022 coverage and made a plan selection for 2023 coverage or were automatically re-enrolled. About 1.8 million more people have signed up for health insurance, or a 13% increase, from this time last year.

Yesterday I reported that the Centers for Medicare & Medicaid have issued a new 2023 Open Enrollment Period (OEP) report which raises the official Qualified Health Plan (QHP) enrollment tally for 2023 to nearly 5.5 million people nationally.

However, as I noted, the actual confirmed 2023 OEP tally is over a million higher than that thanks to the nearly 1.2 million Basic Health Plan (BHP) enrollees in New York and Minnesota, as well as some other more recent oddball enrollment data released by various state-based exchanges. All told, this brought the grand total up to over 6.8 million.

HOWEVER, it turns out the actual confirmed total is much higher than that as well, thanks to another ~2.9 million current exchange enrollees across the 18 state-based exchanges who have already been automatically re-enrolled in their current policies for another year (or, alternately, auto-mapped to a similar healthcare plan in cases where their current policy is being discontinued).

As I noted earlier today, the Centers for Medicare & Medicaid Services have released an updated 2023 ACA Open Enrollment Period data report, which runs through 12/03/22 for the 33 states hosted by the federal exchange and 11/26/22 for the 18 states which operate their own exchanges.

There were several major takeaways, including an overall 18% year over year enrollment increase so far, with new enrollments up 28%, active renewals for current enrollees up 17% and so forth.

However, there's another important factor to look at when comparing 2023 ACA enrollment to date vs. the same point in 2022 (actually one day less): Medicaid expansion.

The table below breaks out every state's 2023 enrollment vs. the same point in 2022, including which type of exchange they use as well as their ACA Medicaid Expansion status as of this writing:

via the Centers for Medicare & Medicaid Services:

• Plan selections represent an 18% increase over last year, including 1.2 million enrollees who are new to the Marketplace

ACA Marketplace National Enrollment Snapshot

Last week I noted that the Centers for Medicare & Medicaid Services (CMS) finally released their first 2023 Open Enrollment Period report, which included 3.0 million Qualified Health Plan (QHP) enrollees through 11/19/22 for the 33 states hosted by HealthCare.Gov plus another 387,000 QHP enrollees via the 18 state-based ACA exchanges.

In a footnote, the press release also noted that around 1.07 million New Yorkers have enrolled in NY's ACA-created Basic Health Plan (BHP) program, which is designed specifically for people who earn between 138% of the Federal Poverty Level (FPL) (the cut-off for ACA-expanded Medicaid eligibility) and 200% FPL.

Currently, there's only one other state which has a BHP program established for this population: Minnesota, whose MinnesotaCare program was around pre-ACA but which has been retooled & is now funded by the Affordable Care Act...although two more states, Kentucky and Oregon, are also expected to launch their own BHP program in the next year or so.

No one has been promoting the Silver Switcharoo option (in states which allow it) louder or more emphatically than I have for the past few weeks.

To summarize (again), this is where someone whose household income is too high for them to qualify for ACA tax credits (400% of the Federal Poverty Line) chooses an ACA-compliant off-exchange Silver plan instead, which is either identical or nearly identical to the same on-exchange policy in every way except that the additional CSR load hasn't been tacked onto it.

Here's a perfect example found by Louise Norris...ironically, this is via Priority Health here in Michigan, which (until today) I thought was a "Silver Load" state, not "Silver Switcharoo". I'll have to do some more research to be sure, but it sounds like at least one MI carrier (Priority) is going full Switch:

Shout-out to Dan Goldberg of Politico New York for the heads up:

NY State of Health Enrollment Tops 4 Million
Open Enrollment for Qualified Health Plans to Begin November 1, 2017

ALBANY, N.Y. (October 5, 2017) - NY State of Health, the state's official health plan Marketplace, today announced that more than 4 million people have signed up for health insurance through the Marketplace. Enrollment in the Essential Plan continues to grow, with more than 680,000 enrolled. The Marketplace is ready for its 5th Open Enrollment Period, which begins November 1, 2017 and has been extended to January 31, 2018, beyond the federal deadline of December 15, 2017, to allow New Yorkers sufficient time to enroll.