SBMs

The Centers for Medicare & Medicaid Services (CMS) has published two 2025 ACA Open Enrollment Period "snapshot reports," both of which had above-the-fold numbers which make it look as though enrollment numbers are lagging significantly behind last year's record-breaking totals:

The Centers for Medicare & Medicaid Services (CMS) is committed to creating a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase high-quality, affordable health care coverage. CMS reports that nearly 988,000 consumers who do not currently have health care coverage through the individual market Marketplace have signed up for plan year 2025 coverage.

OMG! Last year over 1.6 milllion new enrollees had signed up as of the first snapshot report...over 66% more!

Earlier this afternoon, the Centers for Medicare & Medicaid Services (CMS) published the second 2025 Open Enrollment Period "National Snapshot" report...and as I noted two weeks ago, at first glance healthcare data junkies might panic at the seemingly low topline numbers:

The Centers for Medicare & Medicaid Services (CMS) is committed to creating a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase high-quality, affordable health care coverage. CMS reports that nearly 988,000 consumers who do not currently have health care coverage through the individual market Marketplace have signed up for plan year 2025 coverage. 

OMG! Last year over 1.6 milllion new enrollees had signed up as of the first snapshot report...over 66% more!

Earlier this afternoon, the Centers for Medicare & Medicaid Services (CMS) published the first 2025 Open Enrollment Period "National Snapshot" report...and I admit my initial takeaway was PANIC OMG HAIR ON FIRE!!

Over 496,000 New Consumers Selected Affordable Health Coverage in ACA Marketplace

The Centers for Medicare & Medicaid Services (CMS) is committed to creating a robust Marketplace Open Enrollment process for consumers so they can effortlessly purchase high-quality, affordable health care coverage. CMS reports that 496,000 consumers who do not currently have health care coverage through the individual-market Marketplace have signed up for plan year 2025 coverage.

OMG! Last year nearly 920,000 new enrollees had signed up as of the first snapshot report...over 85% more!

Via Pennie:

Pennie Has Issued a New Request for Proposal (RFP) for an Enrollment Assister Contract to Expand Support Across Pennsylvania Communities  

Pennie is seeking an organization to build grassroots awareness and provide direct enrollment assistance to Pennsylvanians seeking health coverage. Proposals due at 1 pm on June 27th.   

Harrisburg, PA – May 2024 – Pennie, PA’s official health insurance marketplace, has issued a Request for Proposal for Assister Services.  The awardee will collaboratively drive statewide activities to increase awareness of the financial help and health coverage available through Pennie, and work directly with community organizations to provide local, in-person enrollment assistance.  

The primary goals of this project are to:  

As I noted in my deep dive into "Gold or Better Enrollment" last week, there are three main reasons why nearly 63% of all ACA exchange enrollees nationally have healthcare policies with 80% or higher Actuarial Values this year:

• The enhanced federal subsidies provided by the Inflation Reduction Act (set to expire at the end of 2025);

• Some states (but not most yet, unfortunately) fully embracing robust Premium Alignment w/maximized Silver Loading policies; and

• About half the states which operate their own full ACA exchange offering supplemental financial subsidies to either reduce premiums, reduce cost sharing or both.

The last bullet includes California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont and Washington State. In addition, both Minnesota and New York have large numbers of enrollees in their respective Basic Health Plan programs (New York just expanded theirs), which may or may not be considered "state-based subsidies" depending on your perspective.

Via the Augusta Free Press:

Friday is the last day for Virginia residents to apply for health care coverage that starts on January 1, 2024.

Any healthcare coveragesecured after December 15 and before Open Enrollment ends on January 15 will begin on February 1, 2024.

The Virginia Insurance Marketplace reminds Virginians to apply now for 2024. 

After the Open Enrollment period ends January 15, Virginians experiencing a Qualifying Life Event such as having a baby or losing health insurance coverage may be eligible to enroll during a Special Enrollment Period. 

Virginia’s Insurance Marketplace replaced HealthCare.gov for all Virginians and launched on November 1, 2023. Marketplace provides a wealth of resources for residents to find affordable health care coverage. Hundreds of thousands of Virginians have accessed the Marketplace this Open Enrollment Period to find coverage that meets their needs.  

I included so much data wonkery in my last Open Enrollment Period data breakout that I decided to split one more item onto its own entry.

As I noted in the prior entry, QHP enrollment is running ahead of last year so far in 45 states so far, with it running more than 50% higher in over a dozen of them and more than twice as high in Mississippi.

Another way of looking at this is to compare the confirmed current QHP enrollment in every state as of the most recent data (12/02/23 for HC.gov states; 11/25/23 for SBM states) against the final total QHP enrollment as of the end of the 2023 Open Enrollment Period.

This is obviously isn't a fair comparison since there's still a full 40 days left for people to enroll and because auto-renewals still have to be added to the federal exchange states. However, it's still interesting to take a look.

For the SBM states, I've included their auto-renewals as reported in either the CMS snapshot report or, in a few cases, even more recent combined enrollment data from the SBMs themselves.

A week or so ago, when the Centers for Medicare & Medicaid Services (CMS) issued their first official "snapshot report" of the 2024 Open Enrollment Period, I noted that unlike most states which have seen dramatically higher initial enrollment numbers, Virginia saw a dramatic drop in initial 2-week enrollment:

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.

10/11/23: SEE IMPORTANT UPDATES BELOW!

In August I noted that Amy Lotven of Inside Health Policy had reported that Virginia's brand-new state-based ACA health insurance exchange had been officially approved by the Centers for Medicare & Medicaid Services:

Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.

Last month I noted that Amy Lotven of Inside Health Policy had reported that Virginia's brand-new state-based ACA health insurance exchange had been officially approved by the Centers for Medicare & Medicaid Services:

Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.

Virginia’s Health Benefit Exchange (VHBE) was enacted in 2020 by former Gov. Ralph Northam (D) and has been operating as a state-based exchange reliant on the federal platform (SBE-FP) since plan year 2021. The state paused the transition activity in 2021 after the enhanced premium tax credits were enacted but restarted it the following year.