Health Insurance Marketplace 2015 Open Enrollment Period: December Enrollment Report

For the period: November 15, 2014 – December 15, 2014¹

The Health Insurance Marketplace (“the Marketplace”) plays a critical role in achieving one of the Affordable Care Act’s goals of reducing the number of uninsured Americans by creating a market for affordable, high-quality health insurance for individual and small group consumers. This report provides preliminary data for enrollment-related activity in the individual Marketplace during the first month of the 2015 Open Enrollment period for all 50 states and the District of Columbia.

Section I of the report focuses on the 37 states that are using the HealthCare.gov platform for 2015 (also known as “HealthCare.gov states”) for the first month of the 2015 Open Enrollment (generally for the period 11-15-2014 to 12-15-2014).¹ The 37 HealthCare.gov states include 35 states that are states that used the HealthCare.gov platform in both 2014 and 2015 and Oregon and Nevada, which are new to the HealthCare.gov platform in 2015. These 37 states accounted for 68 percent of total Marketplace plan selections in 2014.² The data available for these states includes Marketplace plan selections for new consumers and consumers reenrolling in Marketplace coverage – including consumers who are actively reenrolling in Marketplace coverage (people who return to the Marketplace to select a new plan or actively renew their existing plan), but not consumers who are being automatically reenrolled into coverage (“automatic reenrollees” – people who retain coverage without returning to the Marketplace and selecting a plan). The reporting period for HealthCare.gov states in this report (through 12-15-14) differs from the reporting period (through 12-26-14) in the most recent weekly enrollment snapshot published by the Centers for Medicare & Medicaid Services (CMS).³

The most recent Weekly Enrollment Snapshot included a summary of enrollment activity in the 37 HealthCare.gov states showing that from November 15th to December 26th, nearly 6.5 million consumers selected a 2015 Marketplace plan or were automatically reenrolled in those states. As noted above, this report includes data for the HealthCare.gov states through 12-15-14, as well as for other states that are using their own Marketplace platforms (as discussed below). However, neither the most recent Weekly Enrollment Snapshot, nor this report fully capture the total number of plan selections for coverage beginning January 1st (see Appendix Table C1 for additional information on how the data in this report compare with the data in the most recent Weekly Enrollment Snapshot). This report also includes data relating to completed applications, eligibility determinations, and website visits, and call center activity for the HealthCare.gov states; as well as data on the overall distribution of Marketplace plan selections in these states by gender, age, metal level, financial assistance status, race/ethnicity, and rural status.

Section II of the report focuses on the 14 states (including the District of Columbia) that are operating their own Marketplace platform for 2015 (see page 10). Most of the 14 states include activity for the period 11-15-2014 to 12-13-2014 (however data for California are through 12-14-14). These 14 states accounted for 32 percent of Marketplace plan selections in 2014. The data available for these states includes new consumers, consumers who are actively reenrolling in Marketplace coverage (except for two states, New York and California), and automatic reenrollees in 5 states (Connecticut, Idaho, Kentucky, Vermont, and Washington).

Because complete data are not yet available, this report does not provide a comprehensive estimate of the total number of Marketplace plan selections, including both new consumers and consumers reenrolling in Marketplace coverage, for all states for coverage beginning on January 1, 2015. (Please see Appendix Table C2 for additional information on the Marketplace plan selection data that are available for various states).

¹ Most of the data in this report are for the 11-15-14 to 12-15-14 reporting period with the following exceptions: Marketplace plan selection data for most of the 14 states that are using their own Marketplace platforms are for 11-15-14 to 12-13-14 (with the exception of California, which is reporting data for 11-15-14 to 12-14-14); and data on website visits and call center volume for states that are using the HealthCare.gov platform are for 11-15-14 to 12-20-14.

² For more information about data on Marketplace plan selections for the 2014 coverage year, please see the Marketplace Summary Enrollment Report, which can be accessed at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/i….

³ The Centers for Medicare & Medicaid Services has released a weekly snapshot for Open Enrollment Week 6: December 20 - December 26, 2014 which states that nearly 6.5 million consumers have selected 2015 Marketplace plans in the states that are using the HealthCare.gov platform through 12-26-14, including data for automatic reenrollments. The weekly Open Enrollment snapshots provide preliminary point-in-time estimates for weekly data that could fluctuate based on consumers changing or canceling plans or having a change in status such as a new job or marriage; data revisions may mean that the weekly totals from the snapshots may not sum to the cumulative numbers. The weekly snapshots can be accessed at http://www.hhs.gov/healthcare/facts/blog/index.html.

Section I. Data for the 37 States Using the Healthcare.gov Platform

• The Marketplaces in HealthCare.gov States are Succeeding in Reaching People Who Do Not Currently have Marketplace Coverage.

  3.4 million individuals have already selected 2015 Marketplace plans as of 12-15-14 in HealthCare.gov states, including new consumers, and consumers who are reenrolling in Marketplace coverage (see Table 1). Of that total, 52 percent (1.8 million) are plan selections by new consumers who did not have a Marketplace plan selection as of November 2014, and 48 percent (1.6 million) are plan selections from consumers who are reenrolling in Marketplace coverage (excluding automatic reenrollees).

Table 1

Notes: Numbers may not add to totals due to rounding

(1) Total 2015 Marketplace Plan Selections represents cumulative data on the number of unique individuals who have selected a 2015 Marketplace medical plan for enrollment through the individual market Marketplaces (with or without the first premium payment having been received directly by the Marketplaces or the issuer). This is also known as pre-effectuated enrollment. These data do not include: cancellations and terminations; a count of the number of individuals who have selected a standalone dental plan; or individuals who may have selected a 2014 Marketplace plan during the reporting period, as a result of having been granted a Special Enrollment Period (SEP).

(2) Consumers reenrolling in Marketplace coverage includes data for consumers who are actively reenrolling in Marketplace coverage, but does not include data for automatic reenrollees.

Source: Centers for Medicare & Medicaid Services, as of 12-23-14.

• Interest in the Marketplaces in HealthCare.gov States is High – During the first month of the 2015 Open Enrollment period:
  • 14.7 million visits were made to the HealthCare.gov and CuidadoDeSalud.gov websites;
  • 6.8 million calls were made to the Marketplace call center for the HealthCare.gov states;
  • 3.4 million completed applications for 2015 coverage were submitted; and
  • 5.0 million people were included in these completed applications.
• Two-Thirds of the Consumers Who Submitted Applications to the Marketplaces in the HealthCare.gov States Have Already Selected Marketplace Plans – Most of the people who applied for coverage through the Marketplace during the first month of the 2015 Open Enrollment period in the HealthCare.gov states have already received an eligibility determination and/or selected a plan (see Appendix Table B2):
  • 97 percent of applicants have received an eligibility determination.⁴
  • Two-thirds (68 percent) of those applying have already selected a 2015 Marketplace plan; and
  • 9 percent of applicants have been determined or assessed eligible for Medicaid/CHIP.
• People Responded to the December 15th Deadline for Marketplace Coverage Beginning on January 1, 2015 in HealthCare.gov States
  • ​2.0 million people selected a 2015 Marketplace plan in the 37 HealthCare.gov states between 12-7-14 and 12-15-14 (59 percent of the 3.4 million people who selected a plan during the first month of the 2015 Open Enrollment period) (see Figure 1); and
  • Nearly 1.0 million people selected a 2015 Marketplace plan on 12-13-14, 12-14-14 or 12-15-14, which is 28 percent of the total number of people selecting a plan during the first month of the open enrollment period.

Figure 1

Trends in the Cumulative Number of Individuals Who Selected a Marketplace Plan in States Using the HealthCare.gov Platform, 11-15-14 to 12-15-14

3.4 million people selected 2015 Marketplace plans in HealthCare.gov states during the first month of the open enrollment period, including 28% during the last 3 days

Notes: Represents the cumulative number of unique individuals who have been determined eligible to enroll in a plan through the states using the HealthCare.gov platform, and have actively selected a plan (with or without the first premium payment having been received bythe issuer). Number of states using the HealthCare.gov platform: 37 states during the 2015 coverage year.

Source: Centers for Medicare & Medicaid Services, as of 12-23-14

⁴ The number of applicants who have received an eligibility determination includes both those who have been determined eligible to enroll in a plan through the Marketplaces, and those who have been determined or assessed eligible for Medicaid/CHIP by the Marketplaces.

Characteristics of 2015 Marketplace Plan Selections

In the HealthCare.gov states, the socio-demographic characteristics of people who selected 2015 Marketplace plans during the first month of the 2015 Open Enrollment period are generally similar to those of people who selected Marketplace plans during the early months of the 2014 Open Enrollment period (see Table 2).⁵

• Young People: The 2014 Open Enrollment period showed that the proportion of young people (ages 0 to 34) selecting plans increased over time as the period progressed. For example, the proportion of 0 to 34 year olds who selected a Marketplace plan during the early months of the 2014 Open Enrollment period (29 percent for 10-1-13 to 12-28-13)⁶ grew to 35 percent by the end of the open enrollment period. For the 2015 Open Enrollment period, the information to date suggests a slightly higher rate of plan selections by this age group at this early point than for 2014 (33 percent versus 29 percent in the early months of the 2014 Open Enrollment period). However, it is important to note that because it is early in the open enrollment period, the age distribution of the 2015 plan selections could change. This is especially the case because the data for automatic reenrollees have not yet been incorporated into the analysis.
• Race/Ethnicity: The self-reported Marketplace data on race/ethnicity should be used with caution due to the high proportion of plan selections with unknown race/ethnicity (nearly a third both in 2014 and thus far in 2015). The proportions of plan selections by race/ethnicity in the early months of the 2014 Open Enrollment Period⁷ are similar to those for the first month of 2015 with the following exceptions: the proportion of Latino plan selections is slightly higher than in 2014 (8 percent in 2015 compared with 7 percent in 2014), and for African-Americans the share is slightly lower in 2015 (11 percent in 2015 compared to 14 percent in 2014).
• Financial Assistance: Similarly, the proportion of people who selected Marketplace plans with financial assistance (including premium tax credits and/or cost-sharing subsidies) grew during the 2014 Open Enrollment Period. For example, the proportion selecting plans with financial assistance grew from 80 percent during the early months of the 2014 Open Enrollment period (10-1-13 to 12-28-13) to 86 percent by the end of the open enrollment period. For the 2015 Open Enrollment period, the proportion who selected a plan with financial assistance is 87 percent to date compared with 80 percent in the early months of the 2014 Open Enrollment period.
• Gender: For the 2015 Open Enrollment period, the proportion of males who have selected a Marketplace plan is 44 percent to date compared to 45 percent in the early months of the 2014 Open Enrollment period (10-1-13 to 12-28-13). As this pattern suggests, the same holds true for women (56 percent vs. 55 percent).
• Rural Status: Approximately one-fifth (18 percent) of the people who selected a 2015 Marketplace plan in the HealthCare.gov states between 11-15-14 and 12-15-14 live in rural ZIP Codes.

Table 2

(1) Represents cumulative data on the number of unique individuals who have selected a 2015 Marketplace medical plan for enrollment through the individual market Marketplaces (with or without the first premium payment having been received directly by the Marketplaces or the issuer). This is also known as pre-effectuated enrollment. These data do not include: cancellations and terminations; a count of the number of individuals who have selected a standalone dental plan; or individuals who may have selected a 2014 Marketplace plan during the reporting period, as a result of having been granted a Special Enrollment Period (SEP). See Appendix C for additional technical notes.

(2) During the 2014 Marketplace coverage year, there were a total of 36 states using the HealthCare.gov platform, including one state (Idaho) that switched from using the HealthCare.gov platform in 2014 to using its own Marketplace platform in 2015.

(3) During the 2015 Marketplace coverage year, there were a total of 37 states using the HealthCare.gov platform, including 35 states that are states that used the HealthCare.gov platform in both 2014 and 2015, and two states which are new to the HealthCare.gov platform in 2015 (Oregon and Nevada).

(4) Most of the data for the early months of the 2014 Open Enrollment period are for 10-1-13 to 12-28-13. However, the race/ethnicity data are for 10-1-13 to 2-1-14 (the earliest period for which these data are available).

(5) Data for the HealthCare.gov states for the first month of the 2015 Open Enrollment Period only include plan selections for individuals who are new consumers or who have actively reenrolled in Marketplace coverage during the reference period. These data do not include automatic reenrollments.

(6) Percentages shown in this table are based on the total number of active Marketplace plan selections for which the applicable data are available, excluding plan selections with unknown data for a given metric (e.g., age, gender, race/ethnicity, etc.) Additional information on the number of plan selections with missing data for each metric can be found in Appendix Table A.

Source: Centers for Medicare & Medicaid Services, as of 12-23-14.

⁵ The number and composition of the HealthCare.gov states has changed slightly between the 2014 coverage year, when there were 36 HealthCare.gov states, and the 2015 coverage year, when 37 states are using the HealthCare.gov Marketplace platform

⁶ For additional information on Marketplace plan selection data for 10-1-13 to 12-28-13, please see the “Health Insurance Marketplace: January 2014 Enrollment Report,” which can be accessed at http://www.aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan201...

⁷ Data on the race/ethnicity distribution of Marketplace plan selections during the early months of the 2014 Open Enrollment Period are for 10-1-13 to 2-1-14, the earliest period for which these data are available.

Other Data on Marketplace Enrollment-Related Activity in the HealthCare.gov States

Interest in the Marketplaces in HealthCare.gov states has been high during the first month of the 2015 Open Enrollment period, with 14.7 million visits on the Marketplace websites, 6.8 million calls to the Marketplace call center, and 3.4 million completed applications in the HealthCare.gov states (see Table 3).

Table 3

Notes:

(1) Most of the data in this table are for the 11-15-14 to 12-15-14 reporting period with the following exceptions: the data on website visits and call center volume are for 11-15-14 to 12-20-14.

(2) Visits on the Marketplace Websites includes 14,161,103 unique visitors on HealthCare.gov and 496,917 unique visitors on CuidadoDeSalud.gov between 11-15-14 and 12-20-14. Visitors to the Marketplace Websites is the sum of monthly data and has been deduplicated to the extent possible.

(3) Total Calls to the Marketplace call centers includes 501,614 calls with Spanish-speaking representatives and 6,326,090 other calls between 11-15-14 and 12-20-14.

(4) Total 2015 Marketplace Plan Selections represents cumulative data on the number of unique individuals who have selected a 2015 Marketplace medical plan for enrollment through the individual market Marketplaces (with or without the first premium payment having been received directly by the Marketplaces or the issuer). This is also known as pre-effectuated enrollment. These data do not include: cancellations and terminations; a count of the number of individuals who have selected a standalone dental plan; or individuals who may have selected a 2014 Marketplace plan during the reporting period, as a result of having been granted a Special Enrollment Period (SEP). See Appendix C for technical notes.

Source: Centers for Medicare & Medicaid Services, as of 12-23-2014.

Section II. Data for the 14 States Using Their Own Marketplace Platforms

Initial data indicate that over 600,000 individuals have selected 2015 Marketplace plans in the 14 states (including DC) that are using their own Marketplace platforms for the 2015 coverage year. This includes:

• 161,752 Marketplace plan selections in two states reporting only data for new consumers (California and New York);
• 153,011 Marketplace plan selections in seven states reporting data on new consumers and consumers actively reenrolling in Marketplace coverage (Colorado, District of Columbia, Hawaii, Maryland, Massachusetts, Minnesota, and Rhode Island); and
• 318,075 Marketplace plan selections in five states reporting data on new enrollees, consumers actively reenrolling in Marketplace coverage, and automatic reenrollees (Connecticut, Idaho, Kentucky, Vermont, and Washington).

Data on consumers reenrolling in Marketplace coverage are not yet available for all 14 of these states, nor is a complete breakdown of new consumers versus consumers reenrolling in Marketplace coverage available. Several states could not separate out data for new consumers compared to consumers reenrolling in Marketplace coverage due to system vendor changes or other information technology system issues. Also, five states initiated automatic reenrollment prior to 12-14-2014 and these reenrollments are included in their plan selection data.

Section III. Methodological Overview

The data reported here have been obtained from the information systems of the Centers for Medicare & Medicaid Services (CMS), based on information collected for 37 states using the HealthCare.gov platform. We also obtained more limited data reported to CMS by the 14 states (including DC) that are using their own Marketplace platform. Data for the Small Business Health Options Program (SHOP) Marketplaces are not included in this report.

This report includes data that are currently available on enrollment-related activity for the first month of the open enrollment period – which generally corresponds with data from 11-15-14 to 12-15-14 for the 37 HealthCare.gov states, and from 11-15-14 to 12-13-14 for most of the states that are using their own Marketplace platforms for the 2015 coverage (see Table 4 below).

Table 4

*Data for call center and website visits are for 11-15-2014 – 12-20-2014

Data for certain metrics are not yet available for several of the states that are using their own Marketplace platforms. Additionally, some states (Connecticut, Idaho, Kentucky, Vermont, and Washington) initiated automatic reenrollments prior to 12-14-2014; automatic reenrollments are included in these states’ plan selection data. This report does not include complete data on the number of individuals with 2014 Marketplace coverage who have selected health insurance coverage through the Marketplace that can begin on January 1, 2015 because the automatic reenrollments were not completed during the one-month period this report examines. In addition, some states extended their deadline for plan selection for January 1 coverage or offered special enrollment periods to consumers experiencing longer than normal wait times or other challenges.^{8 9}

It is important to note that data for the 14 states that are using their own Marketplace platforms include new consumers but not all states are reporting reenrollments (California and New York are only reporting data for new consumers) and some states are not separately reporting data for new consumers and consumers who are reenrolling in Marketplace coverage. Most of the 14 states include activity through 12-13-14 (however data for California are through 12-14-14), ending prior to the surge associated with the deadlines for January 1st coverage.¹⁰ Please refer to Appendix C for additional technical notes.

This report also includes data on the characteristics of persons who have selected a Marketplace plan through the 37 states that are using the HealthCare.gov platform for 2014. In some cases, the data for certain characteristics of Marketplace plan selections are not yet available in selected states.

We believe that the information contained in this issue brief provides the most systematic summary of enrollment-related activity in the Marketplaces for the first month of the 2015 Open Enrollment period because the data for the various metrics are counted using comparable definitions for data elements across states and Marketplace types.

⁸ For example, in the HealthCare.gov states, the deadline for Marketplace coverage beginning on January 1st was 12-15-14. However, consumers in these states who experienced longer than normal wait times or other challenges as a result of increased website and call center activity near the December 15th deadline will be eligible for a Special Enrollment Period.

⁹ Dan Mangan, “More Extensions as Obamacare Deadline Looms,” accessed at http://www.cnbc.com/id/102269082#.

¹⁰ In the States that are using their own Marketplace platform, the deadline for Marketplace coverage beginning on January 1st varies. The deadline in the District of Columbia and Kentucky was December 15th, but some states have announced later deadlines. For example, the deadline in Maryland was December 18th; the deadline for Connecticut was December 19th; the deadline in New York and Idaho was December 20th; the deadline in California was December 21st; the deadline in Massachusetts and Washington was December 23rd; and the deadline in Hawaii, Minnesota, Rhode Island and Vermont is December 31st. Additionally, Connect for Health Colorado has offered to work with people who started the process before the December 15th deadline, but were not able to finish enrolling, to complete their application for January coverage.

Section Iv: Appendices

Appendix Table a

Marketplace Plan Selections by Gender, Age, Metal Level, Financial Assistance Status, Race/Ethnicity, and Rural  Status, in States Using the HealthCare.gov Platform, 11-15-14 to 12-15-14 (1)