Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period

For the period: October 1, 2013 – March 31, 2014

(Including Additional Special Enrollment Period Activity Reported through 4-19-14)

This is the sixth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace (Marketplace).¹ This brief includes data for states that are implementing their own Marketplaces (also known as State-Based Marketplaces or SBMs), and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services (including those run in partnership with states, also known as the Federally-facilitated Marketplace or FFM).

This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status) and the plans that they have selected (by metal level). Additionally, for the first time, Appendix C of this report includes self-reported race/ethnicity data on persons who have selected a Marketplace plan through the FFM. This report also includes data on other characteristics of people who have selected plans in the FFM and the plans they have selected. (Detailed state-level tables can be found in Appendix E, and in the Addendum to the Report).²

This report captures cumulative enrollment-related activity during the initial open enrollment period (10-1-13 to 3-31-14), including activity associated with individuals who qualified for a Special Enrollment Period (SEP) that was reported through 4-19-14. The data on SEP activity include information for those who qualified for an SEP because they were “in line” on 3-31-14,^{3 4} as well as those who qualified for an SEP for other reasons.⁵ Several metrics are reported, including: the number of visits to the Marketplace websites, the number of calls to the Marketplace call centers, the number of persons who have been determined or assessed eligible by the Marketplaces for Medicaid or the Children’s Health Insurance Program (CHIP),⁶ and the number of persons who have selected a plan through the Marketplace.

The cumulative number of individuals that have selected a Marketplace plan between 10-1-13 and 3-31-14, including additional SEP activity reported through April 19th is over 8 million (including those who have paid a premium and those who have not yet paid a premium).

Figure 1 and Table 1 show that, consistent with expectations,⁷ the proportion of young adults (ages 18 to 34) who have selected a Marketplace plan through the SBMs and FFM has remained strong. Young adults accounted for 31 percent of the Marketplace plan selections after March 1st, which was 4 percentage points higher than their share of plan selections between 12-29-13 and 3-1-14 (27 percent) and 7 percentage points higher than their share of plan selections between 10-1-13 and 12-28-13 (24 percent). Meanwhile, the proportion of older adults (ages 35 and over) selecting a Marketplace plan has continued to decrease (from 70 percent between 10-1-13 and 12-28-13 to 62 percent after March 1st).

Figure 1

Trends in the Age Distribution of Individuals Who Have Selected a Marketplace Plan, 10-1-13 to 3-31-14

(Including Additional SEP Activity through 4-19-14)

The proportion of young adults (ages 18-34) selecting a Marketplace plan increased by 4 percentage points after March 1st (from 27% to 31%), while the proportion of older adults (35 & over) selecting a plan continued to decrease

Notes: Represents cumulative monthly data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). The percent distribution excludes plan selections where the age is unknown. Between 10-1-13 and 12-28-13, 2.2 million individuals selected a plan; between 12-29-13 and 3-1-14, 2.1 million selected a plan; between 3-2-14 and 3-31-14 (including additional SEP activity through 4-19-14), 3.8 million selected a plan, for a total of 8 million Marketplace plan selections for 10-1-13 to 3-31-14 (including SEP activity through 4-19-14). SEP activity includes plan selections by those  who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace.

Table 1

Notes: Represents cumulative data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). Special Enrollment Period (SEP) activity includes plan selections that were made between 4-1-14 and 4-19-14 by those who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace.

Percentages in this table are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age.

Source: Centers for Medicare & Medicaid Services, as of 4-29-2014.

There was an 89 percent increase in the cumulative number of individuals who selected a Marketplace plan after March 1st (including SEP activity through 4-19-14).

The total number of new Marketplace plan selections was significantly higher after March 1st (including SEP activity through 4-19-14) when compared with comparable data for February (nearly 3.8 million versus 0.9 million, respectively), consistent with expectations that the rate of Marketplace plan selections would increase as the March 31, 2014 end of the initial open enrollment period approached.

¹ The previous Marketplace enrollment reports can be accessed at http://www.aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm.

² The Addendum to the Marketplace Summary Enrollment Report is available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollAddendum.pdf.

³ Those who had started the enrollment process on or before March 31st (i.e., those who were “in line”) were allowed to complete that process, even if their enrollment was not finalized before March 31. This accommodation was made so that people who had demonstrated a good faith effort to enroll during the Open Enrollment Period were not penalized if the Marketplace websites or call centers could not complete their enrollment by March 31st.

⁴ The SEP for individuals who were “in-line” on 3-31-14 ended on 4-15-14 for the FFM. Most SBMs followed the federal guidelines regarding individuals who started the process before 3/31 but could not finish, allowing applicants to complete the application and select a plan by April 15th. Other states, including Colorado, Nevada, Oregon, and Maryland allowed consumers additional time beyond April 15th to complete the enrollment process and obtain coverage in 2014. For example, Maryland’s SEP continued through April 18, 2014, while Oregon established an SEP which continues through April 30. Colorado’s SEP extends through May 30th, and Nevada will offer an SEP from April 1, 2014 – May 30, 2014 to individuals who have either successfully registered or attempted to register for an account on Nevadahealthlink.com prior to March 31, 2014.

⁵ This includes persons who had a qualifying life event that qualifies them for an SEP (such as a change in marital status, a change in dependents, or losing minimum essential health coverage), or a complex situation related to applying for coverage in the Marketplace. Additional information on Marketplace SEPs can be found at https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2.

⁶ Data related to Medicaid and CHIP eligibility in this report are based on applications submitted through the Marketplaces. October through March data based on applications submitted through state Medicaid/CHIP agencies were released by the Centers for Medicare & Medicaid Services in a separate report, “Medicaid & CHIP: March 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report,” May 1, 2014, which can be accessed at http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/March-2014-Enrollment-Report.pdf.

⁷ The general expectation is that people who are older and sicker are more likely to select coverage earlier in the initial enrollment period, while “younger and healthier people will tend to wait until towards the end of the open enrollment period.” “The Numbers Behind “Young Invincibles” and the Affordable Care Act,” Larry Levitt, Gary Claxton and Anthony Damico, Kaiser Family Foundation, December 17, 2013, available at http://kff.org/healthreform/ perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/.