Health Insurance Marketplace 2015 Open Enrollment Period: December Enrollment Report. Appendix C: Technical Notes

12/30/2014

We believe that the information contained in this issue brief provides the most systematic summary of enrollment-related activity in the Marketplaces through 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 platforms. However, data for certain metrics may not be available (including in states that changed their Marketplace platform between the 2014 and 2015 coverage years) due to information system issues. It is also important to note that the data that are included in this report may differ slightly from comparable data that are included in the weekly enrollment updates that are published by CMS (also known as the Weekly Enrollment Snapshots) because that data may be based on different time periods and/or reporting dates than those that are used in this report.

The following section provides additional information about the metrics used in this enrollment report, in addition to the information that is included elsewhere in the footnotes of the tables in this report.

Additional Information About the Metrics Used in this Marketplace Summary Enrollment Report

Reporting of Data on Activity Relating to the 2015 Marketplace Coverage Year – Except where otherwise noted, this report includes enrollment-related data on activity related to the 2015 Marketplace coverage year. The data that are being reported for 11-15-14 to 12-15-14 do not include activity associated with individuals who may have applied for and/or qualified for a Special Enrollment Period for 2014 Marketplace coverage.

Reporting Period – This report includes data that are currently available on enrollment-related activity for the first month of the 2015 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. The following table shows how the reporting periods for the data in this report compare with those for the most recent Weekly Enrollment Snapshot.

Appendix Table C1

Marketplace Type Reporting Period
December Monthly Enrollment Report Week 6 Weekly Enrollment Snapshot
States Using the HealthCare.gov Marketplace Platform (37 states) 11-15-14 to 12-15-14* 11-15-14 to 12-26-14
States Using Their Own Marketplace Platform (14 states)
California 11-15-14 to 12-14-14 Not included
Other 13 States (including DC) 11-15-14 to 12-13-14 Not included

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


2015 Marketplace Plan Selections – Represents cumulative data on the number of unique individuals who have selected a 2015 Marketplace plan for enrollment through the Marketplaces (with or without the first premium payment having been received directly by the Marketplaces or the issuer) during the reference period. This is also known as pre-effectuated enrollment. These data represent the number of individuals with active plan selections for a Marketplace medical plan as of the reporting date (excluding cancellations and terminations), and do not include stand-alone dental plan selections. These data also do not include any 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). This table only reflects data for the individual market Marketplaces.

We are using the term “active Marketplace plan selections” to signify that the total number of Individuals Who Have Selected a Marketplace Plan that is reported in the monthlyMarketplace enrollment reports excludes data for plan selections that have been cancelled or terminated. For example, if an individual selected a Marketplace plan during the first week of the open enrollment period, but selected a different plan during the third week of the open enrollment period, the active plan selections total would only include data for the most recent plan selection. This is consistent with the way that the Marketplace plan selection data were reported in the previous monthly enrollment reports for the 2014 Open Enrollment period.

Definitions of “New” and “Reenrolling” Consumers – The monthly enrollment reports for the 2015 Open Enrollment period distinguish plan selections by new consumers from plan selections by those who are reenrolling in Marketplace coverage:

  • “New Consumers” are those individuals who selected a 2015 Marketplace plan (with or without the first premium payment having been received directly by the Marketplaces or the issuer) and did not have a Marketplace plan selection as of November 2014. These data do not include: cancellations and terminations; standalone dental plan selections; 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).
    Additionally, some states are generally classifying all of their plan selections as new consumers for operational enrollment and reporting purposes due to changes in Marketplace platform (e.g., Idaho switched to using its own Marketplace platform in 2015, while Nevada and Oregon switched to using the HealthCare.gov platform in 2015), or changes in system vendors (Maryland and Massachusetts).
  • “Consumers Reenrolling in Marketplace Coverage” are those individuals who had Marketplace plan selection as of November 2014, and have either actively submitted a 2015 application and selected a 2015 Marketplace medical plan, or in applicable states using their own Marketplace platforms (Connecticut, Idaho, Kentucky, Vermont, and Washington), are being automatically reenrolled in Marketplace coverage – with or without the first premium payment having been received directly by the Marketplaces or the issuer. These data do not include: cancellations and terminations; standalone dental plan selections; 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). This category is consistent with the “consumers renewing coverage” category that is included in the HHS Weekly Enrollment Snapshots. Consumers Reenrolling in Marketplace Coverage includes the following two categories:
    • Consumers who are Actively Reenrolling in Marketplace Coverage – People who had a Marketplace plan selection as of November 2014, and return to the Marketplace to select a new plan or actively renew their existing plan; and
    • Consumers who are being Automatically Reenrolled into Marketplace Coverage (also known as “Automatic Reenrollees”) – People who had a Marketplace plan selection as of November 2014, and retain coverage without returning to the Marketplace and selecting a plan.

The categories of Marketplace plan selection data for the first month of the 2015 Open Enrollment period that are included in this report vary by Marketplace type and state:

Appendix Table C2

Enrollment Type States Using Their Own Marketplace Platforms (14 states including DC) States Using the HealthCare.gov Platform (37 states)
New Consumers Includ d in this report Included in this report
Consumers Who Are Actively Reenrolling in Marketplace Coverage Included in this report for the following 12 states: CO, CT, DC, HI, ID, KY, MD, MA, MN, RI, VT, and WA* [Not included for CA and NY] Included in this report**
Consumers Who Are Being Automatically Reenrolled into Marketplace Coverage Included in this report for the following five states: CT, ID, KY, VT, and WA Not included in this report

* Some states that are using their own Marketplace platforms are generally classifying all of their plan selections as new consumers for operational enrollment and reporting purposes due to changes in Marketplace platform (e.g., ID, which switched to using its own Marketplace platform in 2015), or changes in eligibility and enrollment system vendors (MD and MA).

** Some HealthCare.gov states are generally classifying all of their plan selections as new consumers for operational enrollment and reporting purposes due to changes in Marketplace platform (e.g., NV and OR, which switched to using the HealthCare.gov platform in 2015).


Categories for Reporting State-Level Marketplace Data – The Health Insurance Marketplace includes the Marketplaces established in each of the states (and the District of Columbia) and run by the state or the federal government. This report addresses the individual market Marketplaces that are using their own Marketplace platforms for the 2015 coverage year, as well as the individual market Marketplaces that are using the HealthCare.gov Marketplace platform for eligibility and enrollment for the 2015 coverage year (data for the small group Marketplace, also known as SHOP, is not included in this report).

Marketplace enrollment-for the 2015 Open Enrollment period, will be reported based on the following two major categories:

  • State-Based Marketplaces (SBMs) Using Their Own Marketplace Platform – 14 states (including DC):

California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, and Washington.

  • States Using the HealthCare.gov Platform – 37 states, including:
    • State-Based Marketplaces Using the HealthCare.gov Platform – 3 states

Nevada, New Mexico, and Oregon (Note: one of these states (New Mexico) also used the HealthCare.Gov platform during the 2014 Open Enrollment period; however, Nevada and Oregon switched to using the HealthCare.gov platform for the 2015 Open Enrollment period).

  • Federally-Facilitated Marketplaces – 34 states

Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. (Note: all of these states also used the HealthCare.Gov platform during the 2014 Open Enrollment period).

Notes on Changes in Marketplace Platforms – The following states changed their Marketplace eligibility and enrollment platform between the 2014 and 2015 coverage years:

  • Nevada and Oregon switched from using their own Marketplace eligibility and enrollment platforms in 2014 to using the HealthCare.gov platform for eligibility and enrollment for 2015 (as a consequence, all people who select 2015 Marketplace plans in NV and OR are treated as new consumers for operational enrollment and reporting purposes because the system cannot identify or automatically reenroll persons who previously had 2014 Marketplace coverage in these states); and
  • Idaho switched from using the HealthCare.gov platform for 2014 to using its own Marketplace platform for 2015.

Additionally, Maryland and Massachusetts are continuing to use their own Marketplace platforms, but have implemented new eligibility and enrollment systems for the 2015 Open Enrollment period, and as a result, the Marketplaces in these states are unable to distinguish between new consumers and consumers reenrolling in Marketplace coverage for plan year 2015. Individuals who have 2014 Marketplace coverage in these states will need to return to the Marketplace to reenroll in coverage for 2015.

Idaho, Nevada, Oregon, Maryland and Massachusetts are generally classifying all of their plan selections as new consumers for operational enrollment and reporting purposes due to their changes in Marketplace platform (e.g., ID, NV and OR) or eligibility and enrollment system vendors (MD and MA).

Data on Total Number of Completed Applications and Total Individuals Applying for Coverage in Completed Applications – We are showing data on the number of completed applications and the total number of individuals applying for coverage in the completed applications in this report.

Data on Characteristics of Marketplace Plan Selections by Metal Level – The subtotals for each metal tier type do not sum to the total number of Plan Selections with Available Data on Metal Level due to a small number of individuals (0.1%) who have multiple 2015 Marketplace plan selections in the system that will be resolved through data cleanup processes (including some people who may have records in multiple states). Data for standalone dental plan selections are shown separately.

Standalone Dental Plan Selections – Individuals who are shopping for health insurance coverage in the Marketplace have the choice of selecting:

  • A medical Marketplace plan with integrated dental coverage,
  • A medical Marketplace plan without integrated dental coverage, or
  • A medical Marketplace plan and a separate standalone dental plan (it is not possible to select a standalone dental plan without also selecting a medical plan).

Individuals who have selected both a medical Marketplace plan and a standalone dental plan are only counted once in the total Marketplace plan selections metric. However, we report data on total standalone dental plan selections separately for the 37 states that are using the HealthCare.gov platform, including combined data for both the “High” and “Low” standalone dental plan metal tier types (see Appendix Table A).

Data on Additional Characteristics of Marketplace Plan Selections – This report also includes data on the characteristics of persons who have selected a Marketplace plan in the 37 states that are using the HealthCare.gov platform by Race/Ethnicity and Rural Status. In some cases, the data for certain characteristics of Marketplace plan selections are not yet available. For this reason, for each metric, we have calculated the comparable percentages based on the number of plan selections with known data for that metric.

  • Race/Ethnicity – The application for Marketplace coverage in the states using the HealthCare.gov platform contains questions on race and on ethnicity, which are both marked as optional. The share of unknown race/ethnicity in Marketplace plan selection data for HealthCare.gov states is higher than in federal survey data,11 but lower than that reported in administrative data sources in the healthcare industry.12 Thus, while this information is provided for transparency purposes, its quality is low and its use should be limited. For example, it is also important to note that the racial/ethnic makeup of the persons with unknown race and ethnicity who selected a Marketplace plan in the HealthCare.gov states may differ substantially from that among those who reported race and ethnicity. For example, if racial and ethnic minorities are more likely to skip the optional questions, they would be disproportionately under-reported in the overall totals.13
  • Rural Status – The proportion of Marketplace plan selections in rural areas was derived by aggregating data for Marketplace plan selections with valid ZIP Code information based on the HHS Office of Rural Health Policy’s (ORHP) most current list of Rural Designated ZIPs, which has been updated using the 2010 Census data.

Number of Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace – Marketplace Medicaid & CHIP eligibility determination and assessment data in this report cannot be added to eligibility determination data in the most recent monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment report (available on www.Medicaid.gov), which covers data through October 2014. Some of the individuals assessed or determined eligible for Medicaid or CHIP by the Marketplace and reported in this report may also be reported in the monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Report when the state has made an eligibility determination based on the information provided by the Marketplace. Total Medicaid & CHIP enrollment is reported in the monthly Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Report, and is a point-in-time count of total enrollment in the Medicaid and CHIP programs at the end of the monthly reporting period.

Effectuated Enrollment – Data on effectuated enrollment for the 2015 Open Enrollment period are not yet available.

Additional Data Validation – CMS has been taking steps to enhance the processes for generating and validating Marketplace data. As such, some of the numbers in this report could be updated in future reports.


11 The main Census surveys have missing data on 3 to 5 percent of respondents, and the National Health Interview Survey has missing information for about 5 percent of respondents. (Source: ASPE correspondence with U.S. Census and the National Center for Health Statistics regarding the American Community Survey, the Current Population Survey, and the National Health Interview Survey; February 2014.)

12 For example, a study of administrative data from the Department of Veterans Affairs found that race/ethnicity information was missing from files for 36 percent of patients. Additionally, as of 2008, commercial plans that collected race and ethnicity data only had information for about 40 percent of their members. The health insurance company Aetna, which began collecting data on race and ethnicity for all its members in 2002 via enrollment forms, currently has information on race/ethnicity for about 35 percent of its membership. (Sources: Nancy R. Kressin, Bei-Hung Chang, Ann Hendricks, and Lewis E. Kazis, “Agreement between administrative data and patients’ self-reports of race/ethnicity,” American Journal of Public Health, vol. 93, no. 10 (2003), p. 1734-1739); José J. Escarce, Rita Carreón, German Veselovskiy, and Elisa H. Lawson, “Collection of race and ethnicity data by health plans has grown substantially, but opportunities remain to expand efforts,” Health Affairs, vol. 30, no. 10 (2011); and Aetna, “Aetna’s Commitment,” accessed April 25, 2014. Available at: http://www.aetna.com/about-aetna-insurance/initiatives/racial-ethnic-equ....

13 For additional information on the methodology that was used to analyze the characteristics of individuals who selected a Marketplace plan in the HealthCare.gov states by race/ethnicity, please refer to Appendix C in the 2014 Marketplace Summary Enrollment Report, which can be accessed at http://www.aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr201....

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