Early 2019 Effectuated Enrollment Snapshot

Early 2019 Effectuated Enrollment Snapshot

This report provides effectuated enrollment, premium, and advance payments of the premium tax credit (APTC) data, for the Federally-facilitated and State-based Exchanges (“the Exchanges”) for February 2019 and for the 2018 plan year.

As of March 15, 2019, 10.6 million consumers had effectuated coverage through the Exchanges for February 2019, meaning that they selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2019. This number represents approximately 92 percent of consumers who made plan selections during the 2019 Open Enrollment Period (11.4 million).[1] Total effectuated enrollment for February 2019 declined less than one percent from February 2018.[2]

The average total monthly premium for Exchange enrollees in February 2019 was $594.17, a decrease of one percent from the February 2018 average premium of $597.20. Approximately 9.3 million, or 87 percent of Exchange enrollees in February 2019 received APTC, consistent with the percentage of enrollees who received APTC in February 2018. The average monthly amount of APTC per enrollee receiving APTC also fell by approximately one percent from February 2018, to $514.01.

The numbers reported today may be revised in future months as additional data on new effectuations, terminations, and cancellations become available. Later this year, CMS intends to publish effectuated enrollment data for the first six months of 2019, which will include updated February 2019 enrollment data.

Background Information

The primary sources for the effectuated enrollment snapshot are payment and enrollment data. Effectuated enrollment for February 2019 is the total number of individuals who had an active policy in February 2019 and who paid their premium, if applicable, (thus effectuating their coverage) as of March 15, 2019. These data include effectuated enrollment from both the Federally-facilitated and State-based Exchanges.

APTC enrollment is the total number of individuals who had an active policy in February 2019, who paid their premium, if applicable, (thus effectuating their coverage), and who received an APTC. APTC is generally available if a consumer's household income is between 100 and 400 percent of the federal poverty level, and certain other criteria are met. A consumer was defined as receiving an APTC if the applied APTC amount was greater than $0; otherwise, a consumer was classified as not receiving APTC.

CSR enrollment is the total number of individuals who had an active policy in February 2019, who paid their premium, if applicable, (thus effectuating their coverage), and received cost-sharing reductions (CSRs). A consumer is generally eligible for CSR if the individual is eligible for APTC, has a household income between 100 percent and 250 percent of the federal poverty level, and is enrolled in a health plan from the silver plan category. American Indians and Alaskan Natives are eligible for CSRs under different criteria.

To see a breakdown of the data by state, click here: https://www.cms.gov/sites/default/files/2019-08/08-12-2019%20TABLE%20Early-2019-2018-Average-Effectuated-Enrollment.pdf

This communication was printed, published, or produced and disseminated at U.S. taxpayer expense.