June 30, 2015 Effectuated Enrollment Snapshot

June 30, 2015 Effectuated Enrollment Snapshot

On June 30, 2015, about 9.9 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of June.¹ These numbers are consistent with HHS’s effectuated enrollment target of 9.1 million for the end of 2015.

Of the approximately 9.9 million consumers nationwide with effectuated Marketplace enrollments at the end of June 2015, about 84 percent, or more than 8.3 million consumers, were receiving an advanced premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $270 per month.²  

There were 7.2 million consumers with effectuated enrollments at the end of June 2015 through the 37 Federally-Facilitated Marketplaces (including State Partnership Marketplaces) and supported State-based Marketplaces (collectively known as HealthCare.gov states) and 2.7 million through the remaining State-based Marketplaces.³

“Consumers from coast-to-coast are continuing to show how important health coverage is to their families,” said HHS Secretary Sylvia Burwell. “Millions of Americans are benefiting from the peace of mind that comes with having quality coverage at a price they can afford as they access coverage through the Affordable Care Act’s Marketplace.”

CMS releases Marketplace state-by-state effectuated enrollment snapshots on a quarterly basis, detailing how many consumers have an effectuated enrollment, how many are benefiting from APTC and/or cost-sharing reductions (CSR), and the distribution of effectuated enrollment by qualified health plan metal level. The first Marketplace enrollment snapshot for 2015 was released on June 2 and covered effectuated enrollment through March 31, showing that 10.2 million consumers had effectuated coverage. Today’s snapshot also provides an update through June 30 on the number of individuals with citizenship, immigration status, or household income data matching issues.

The Marketplace effectuated enrollment snapshot provides point-in-time estimates. CMS expects enrollment numbers will change over time as consumers find other coverage or experience changes in life circumstances such as employment status or marriage, which may cause consumers to change, newly enroll in, or terminate their plans.⁴

The following tables are included in the June 2015 Marketplace Effectuated Enrollment Snapshot:

Table 1: June 30, 2015 Total Effectuated Enrollment and Financial Assistance by State
Table 2: June 30, 2015 Average Advance Payment of Tax Credits by State
Table 3: June 30, 2015 Total Effectuated Enrollment Data by Metal Level by State

June 2015: Total Effectuated Enrollment and Financial Assistance

Of the approximately 9.9 million consumers who had effectuated Marketplace enrollments at the end of June 2015, about 84 percent or about 8.3 million consumers were receiving APTC to make their premiums more affordable.⁵ In addition, 56 percent or about 5.6 million consumers were benefiting from CSRs to lower the amount they pay out-of-pocket for deductibles, coinsurance, and copayments. This financial assistance generally is available if a consumer’s household income is between 100 percent and 250 percent of the federal poverty level, the consumer is otherwise eligible for APTC, and the individual chooses a health plan from the silver plan category.

The ten states with the highest rate of consumers who received financial assistance through APTC were: Mississippi (95.4%), Wyoming (92.2%), North Carolina (91.6%), Florida (91.3%), Alabama (90.9%), Louisiana (90.7%), Georgia (90.0%), Arkansas (90.0%), Wisconsin (89.6%), and Alaska (88.8%). The states with the lowest rate of consumers who received APTC are: District of Columbia (10.2%), Minnesota (54.8%), Colorado (55.3%), Hawaii (61.4%), New Hampshire (62.8%), Vermont (64.2%), Utah (65.6%), Kentucky (69.8%), Maryland (70.7%), and New York (71.4%).  

Nine of the ten states with the highest rate of consumers receiving financial assistance (all but Arkansas) had not expanded Medicaid programs under the Affordable Care Act as of June 30.⁶ As such, residents in those states with household incomes from 100 to 133 percent of the federal poverty level who are otherwise eligible can qualify for coverage through the Marketplace with tax credits. In states that do not decide to expand Medicaid, APTC eligibility ranges from 100 percent to 400 percent of the federal poverty level.

Table 1: June 30, 2015 Total Effectuated Enrollment and Financial Assistance by State 

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.
**Validated APTC and CSR enrollment data for Rhode Island was not available at the time of publication. We will update this report with validated data as soon as it is available.

June 2015: Average APTC by State

Consumers with household incomes between 100 percent and 400 percent of the FPL may qualify for APTC, which helps make their coverage more affordable throughout the year by lowering their share of monthly premium costs. Consumers who qualify for APTC may choose how much of the APTC to apply to their premiums each month, up to the maximum amount for which they are eligible.

The overall average APTC Marketplace consumers received was $270 per month at the end of June 2015. Because the amount of APTC an enrollee may receive depends on household income and the cost of the second lowest cost silver plan available to the enrollee, the average APTC ranged from $534 per month in Alaska to $159 per month in Arizona. Of the 7.0 million consumers in the 34 states with Federally-facilitated Marketplaces, nearly 6.0 million or 86 percent received APTC which averaged $271.

Table 2: June 30, 2015 Average Advance Payment of Tax Credits by State

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.
**Validated APTC and CSR enrollment data for Rhode Island was not available at the time of publication. We will update this report with validated data as soon as it is available.

June 2015: Total Effectuated Enrollment by Metal Level

There are generally four “metal levels” of coverage available through the Marketplace, plus catastrophic plans. Plans in each category can be expected to pay different amounts of the total costs of an average person’s care. This takes into account the plans’ deductibles, copayments, coinsurance, and out-of-pocket maximums. The actual percentage a consumer pays in total or per service will depend on the services used during the year.

• Catastrophic: The health plan pays less than 60% of the total average cost of care on average, with consumers paying the balance. These plans are only available to people who are under 30 years old at the beginning of the plan year, or those who have a hardship or affordability exemption.
• Bronze: The health plan pays 60% on average. Consumer pays about 40%.
• Silver: The health plan pays 70% on average. Consumer pays about 30%. Consumers eligible for CSRs can only receive them by enrolling in a silver plan. (Note, American Indians and Alaska Natives can receive CSRs through any metal-level plan.)
• Gold: The health plan pays 80% on average. Consumer pays about 20%.
• Platinum: The health plan pays 90% on average. Consumer pays about 10%.

Of the 9.9 million consumers with effectuated enrollment in Marketplace plans at the end of June 2015, 1% were enrolled in Catastrophic plans, 21% in Bronze plans, 68% in Silver plans, 7% in Gold plans, and 3% in Platinum plans.

Table 3: June 30, 2015 Total Effectuated Enrollment Data by Metal Level by State

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.

2015 Data Matching

In operating the Marketplaces, we are committed to providing access to coverage and financial assistance to individuals and families who are eligible while maintaining strong program integrity. Throughout 2014 and into 2015, the Marketplaces have worked to resolve consumers’ data matching issues, including for those individuals whose citizenship, immigration status, or household income application information did not match information in our trusted data sources. In 2014, the Marketplace extended the deadline for consumers to submit documentation verifying the information in their applications and conducted an extensive outreach campaign in coordination with local assisters, stakeholders, and insurance companies to contact consumers with data matching issues.

In 2015, the Marketplaces have moved to regular monthly action for consumers with unresolved data matching issues who have not provided adequate documentation within 95 days for citizenship or immigration status data matching issues and within 90 days for household income inconsistencies. Consumers who do not submit sufficient documentation to resolve their annual household income data matching issue will have a recalculation of their APTC and/or CSRs based on available tax data. Individuals who have not provided the necessary documentation for their citizenship or immigration status will have their enrollment through the Marketplace terminated. Those individuals whose enrollment through the Marketplace was terminated because of citizenship or immigration status data matching issues are not included in effectuated enrollment totals.

During the time period from April 1, 2015 to June 30, 2015, enrollment in coverage through the Federally-facilitated Marketplaces was terminated for about 306,000 consumers with citizenship or immigration status data matching issues who failed to produce sufficient documentation of their citizenship or immigration status. In addition, during the same time period, about 734,000 households with annual household income inconsistencies had their APTC and/or CSRs for 2015 coverage adjusted.

Overall, as of June 30, 2015 the Marketplace has ended 2015 coverage for approximately 423,000 consumers with 2015 coverage who failed to produce sufficient documentation on their citizenship or immigration status and has adjusted APTC and/or CSRs for about 967,000 households.

If a consumer believed they had the appropriate documentation but their enrollment through the Marketplace was terminated based on a citizenship/immigration status data matching issue, the individual is able to submit his or her documentation to the Marketplace to resolve the data matching issue and regain enrollment through the Marketplace through a Special Enrollment Period.   

NOTES:

¹Individuals effectuate their enrollment by paying their first month’s premium. This snapshot measures individuals who effectuated their enrollment and have an active policy on the date of the snapshot; it does not measure the rate at which consumers pay their first month’s premium. Active policies include those who have paid for the current month and individuals who may be in a grace period for non-payment. Grace periods can vary by state and issuer. For those individuals receiving APTC, issuers are required to give enrollees a three month grace period. 45 CFR §§ 155.430 and 156.270.

²This data is reported by insurance companies with plans in the Health Insurance Marketplaces as part of the interim payment process. Issuers report total effectuated enrollment counts, and the estimated APTC amounts owed to the issuer for those effectuated enrollments. After CMS validates these amounts, issuers are paid monthly based on these estimates. Each month, issuers are permitted to restate prior months’ enrollment and payment data to reflect enrollee cancellations, terminations, or other fluctuations in enrollment. The data in this snapshot represents issuer estimates of individuals with effectuated enrollment for June 2015 as of August 2015 interim payment process data submission.

³For 2015, there are 37 HealthCare.gov states; including, Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. New Mexico, Nevada, and Oregon are State-based Marketplaces using the HealthCare.gov platform for 2015. Thirteen states – California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington – plus the District of Columbia – have their own State-based Marketplaces and are using their own technology platform for 2015. Effectuated enrollment for the 34 states that are part of the Federally-facilitated Marketplaces on June 30, 2015 was 7.0 million, and 2.9 million for State-based Marketplaces, including those in New Mexico, Nevada, and Oregon which use the HealthCare.gov platform.

⁴As announced in the 2015 Special Enrollment Period Report, between February 23 and June 20, 2015, nearly 950,000 new consumers selected a plan through HealthCare.gov platform. Supporting these types of changes is an important function of the Health Insurance Marketplace.

⁵Consumers reconcile differences between their projected 2015 household income and their actual household income to determine the final premium tax credits they should receive. This reconciliation process ensures individuals receive the correct amount of tax credit, which will be reflected on their tax return: taxpayers may see a smaller refund or owe money back if they underestimated their household income, or they may get a bigger refund if they overestimated their household income.

⁶Alaska implemented Medicaid expansion on September 1, 2015.