Health Insurance Marketplace Open Enrollment Snapshot - Week 13

Health Insurance Marketplace Open Enrollment Snapshot - Week 13
January 24, 2016 – February 1, 2016

On January 31, Open Enrollment for 2016 coverage ended, with about 12.7 million plan selections through the Health Insurance Marketplaces. Of the 12.7 million consumers enrolling in Marketplace coverage, over 9.6 million came through the HealthCare.gov platform and 3.1 million selected a plan through State-based Marketplaces. It is also worth noting that nearly 400,000 people signed up for New York’s new Basic Health Program, along with about 33,000 people who signed up for Minnesota’s Basic Health Program, during this Open Enrollment. Basic Health Programs are state based programs supported by the Affordable Care Act that provide health insurance coverage to low income individuals who would generally otherwise be eligible for qualified health plans. In fact, about 160,000 of the roughly 300,000 New York Basic Health Program re-enrollees for 2016 were enrolled in Qualified Health Plans last year and were included in last year’s Marketplace total plan selections.¹

The Week 13 Open Enrollment Snapshot extends through 11:59pm EST on Monday, February 1, instead of through the January 31 deadline, to better capture consumers who may have been in line. This is the final snapshot for 2016 Open Enrollment.

“Open Enrollment for 2016 is over and we are happy to report it was a success,” said U.S. Department of Health and Human Services Secretary Sylvia Burwell. “The Health Insurance Marketplace is changing people’s lives for the better. Across the country, about 12.7 million Americans selected affordable, quality health plans for 2016 coverage, exceeding our goals. That includes over 4 million new consumers in the HealthCare.gov states who signed-up for coverage this year. The Marketplace is growing and getting stronger and the ACA has become a crucial part of healthcare in America.”

Of the 9.6 million consumers who got coverage through the HealthCare.gov platform, about 4.0 million are new consumers, which means about 42 percent of all plan selections were from new consumers. This does not include other new plan selections from State-based Marketplaces which will increase the total number of new consumers for 2016. In addition to the 4 million new HealthCare.gov consumers, about 3.9 million were returning Marketplace consumers who actively selected a plan and about 1.7 million were automatically enrolled by the Marketplace.

It is important to keep in mind that, because of improvements we made to further automate transactions with insurers, this year’s plan selection totals take into account any consumer initiated or insurer initiated cancellations that occurred during Open Enrollment. Last year’s totals only accounted for consumer-initiated cancellations, which means that this year’s totals have accounted for a larger number of cancellations during, rather than after, Open Enrollment. Because of these changes, there will likely be a smaller difference this year between plan selection totals at the end of Open Enrollment and subsequent effectuated enrollment snapshots.

The weekly Open Enrollment snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity to date could fluctuate as plan changes or cancellations occur, such as in response to life changes like starting a new job or getting married.

A more detailed report that looks at plan selections across all states for the entire Open Enrollment period will be released by HHS at a later time.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot

* Applications submitted could not be validated this week.

HealthCare.gov State-by-State Snapshot

The Week 13 Snapshot provides cumulative individual plan selections for the states using the HealthCare.gov platform. States with the fastest rate of growth between Week 12 and Week 13 are Nevada (12%), Texas (11%) and Hawaii (10%). [Those states with the largest rate of growth increase between OE3 and OE2 are Oregon (31%), Utah (25%), Iowa (22%), South Dakota (22%) and Nevada (20%).]  

Individual plan selections for the states using the HealthCare.gov platform include:

HealthCare.gov Local Market Snapshot

The Week 13 snapshot includes a look at plan section by Designated Market Areas (DMAs) which are local media markets. These data provides another level of detail to better understand total plan selections within local communities. Some DMAs include one or more counties in a state that is not using the HealthCare.gov platform in 2016. Plan selections for those DMAs only include data for the portions of these areas that are using the HealthCare.gov platform, so the cumulative totals in the snapshot do not represent plan selections for the entire DMA. In addition, some DMAs cross into multiple states that use the HealthCare.gov platform and those totals are cumulative for all HealthCare.gov states in that DMA. Because some communities do not fall into a DMA, cumulative plan selections for local markets will not total to the national cumulative plan selection number.

The ten markets showing the fastest rate of growth between Week 12 and Week 13 include Yuma, Arizona (21 percent), Corpus Christi, Texas (17 percent), Harlingen, Texas (16 percent), Laredo, Texas (16 percent), El Paso, Texas (14 percent), Odessa-Midland, Texas (14 percent), San Antonio, Texas (14 percent), Abilene-Sweetwater, Texas (13 percent), Las Vegas, Nevada (13 percent) and Lubbock, Texas (12 percent). Eight of the ten markets showing the strongest growth are in Texas.

Glossary

Plan Selections:  The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected a plan. Each week’s plan selections reflect the total number of plan selections for the week and cumulatively from the beginning of Open Enrollment to the end of the reporting period, net of any cancellations from a consumer or cancellations from an insurer during that time.

Because of further automation in communication with insurers, the number of net plan selections reported this year account for insurer-initiated plan cancellations that occur before the end of Open Enrollment for reasons such as non-payment of premiums. This change will result in a larger number of cancellations being accounted for during Open Enrollment than last year. Last year, these cancellations were reflected only in reports on effectuated enrollment after the end of Open Enrollment. As a result, there may also be a smaller difference this year between plan selections at the end of Open Enrollment and subsequent effectuated enrollment, although some difference will remain because plan cancellations related to non-payment of premium will frequently occur after the end of Open Enrollment.

Plan selections include those consumers who are automatically re-enrolled into their current plan or another plan with similar benefits, which occurs at the end of December.

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not include totals for effectuated enrollments.

Basic Health Program: Under the Affordable Care Act, the Basic Health Program is a tool states can choose to use that provides alternative coverage to people with incomes below 200 percent of the federal poverty level, who would otherwise be eligible to buy Qualified Health Plans through their Marketplaces. Plans selected under the Basic Health Program are very similar to Marketplace coverage. It is health insurance that is bought through a state Marketplace, contains all ten categories of essential health benefits, and provides financial assistance to consumers.

Marketplace: Generally, references to the Health Insurance Marketplace in this report refer to 38 states that use the HealthCare.gov platform. The states using the HealthCare.gov platform are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 38 states that use the HealthCare.gov platform for the 2016 benefit year, including the Federally-facilitated Marketplace, State Partnership Marketplaces and State-based Marketplaces.

Local Markets: Cumulative plan selections for local markets are based on Designated Market Areas (DMAs) which are media markets. Some DMAs include one or more counties in a state that is not using the HealthCare.gov platform in 2016. Plan selections for those DMAs only include data for the portions of these areas that are using the HealthCare.gov platform, so the cumulative totals in the snapshot do not represent plan selections for the entire DMA.

Applications Submitted:  This includes a consumer who is on a completed and submitted application or who, through the automatic re-enrollment process, which occurs at the end of December, had an application submitted to a Marketplace using the HealthCare.gov platform. If determined eligible for Marketplace coverage, a new consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

Call Center Volume:  The total number of calls received by the Federally-facilitated Marketplace call center over the course of the week covered by the snapshot or from the start of Open Enrollment. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative:  The total number of calls received by the Federally-facilitated Marketplace call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

HealthCare.gov or CuidadodeSalud.gov  Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadodeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.

¹This sentence was updated on 02/11/2016 to clarify the 2015 enrollment status of New York Basic Health Program enrollees.