Health Insurance Marketplace: March Enrollment Report. For the period: October 1, 2013 - March 1, 2014. Anticipated Enrollment Growth in March

03/11/2014

Based on the experience of private employers, the Federal Employees Health Benefits Program (FEHBP), Medicare Part D, Massachusetts’ Commonwealth Care, and the Children’s Health Insurance Program (CHIP), several factors drive enrollment rates, particularly in the early months of program operation,5 including:

  • “Action-forcing” events — such as the end date of an open enrollment period or the start date for benefits — often result in a spike in enrollment activity.
  • The length of a program’s pre-benefit period (i.e., the period between sign-up/enrollment and the receipt of benefits) also affects rates of initial enrollment: Shorter pre-benefit periods (e.g., 1 month) tend to generate higher initial enrollment rates than longer pre-benefit periods, during which the consumer may perceive little advantage to signing up or enrolling early.

Medicare Part D, which had a six-month open enrollment period, experienced faster initial rates of enrollment compared to Massachusetts Commonwealth Care, which allowed continuous enrollment throughout the year. However, initial take-up rates were slower for the State Children’s Health Insurance Program (CHIP), with only 60 percent of eligible children participating in CHIP in 2003, fully five years after states began implementing their CHIP programs in 1998.

Additionally, Medicare Part D and other programs such as employer sponsored insurance and the Federal Employees Health Benefits Program (FEHBP) have experienced a surge of enrollment as their respective open enrollment periods came to an end. For example, more than 1 million beneficiaries enrolled during the last week of the Medicare Part D initial open enrollment period.6 Additionally, data from FEHB show that nearly a quarter (22 percent) of the employees who changed their enrollment during the 2012 open enrollment season made their selection in the last two days before the season’s deadline. Based on this experience, a similar enrollment surge is expected in March as the close of the initial open enrollment period approaches for the Marketplace.

February Enrollment Growth

There was continued growth in total Marketplace plan selections in February, compared to the October-January period:

  • Marketplace Total (SBMs and FFM) – there was a 29 percent increase in plan selections in February
    • the 3,299,500 cumulative number in October-January rose by 942,800 in February to a cumulative five month total of 4,242,300
  • SBMs – there was a 19 percent increase in plan selections in February
    • the 1,359,900 cumulative number for October-January rose by 261,300 in February to a cumulative five month total of 1,621,200
  • FFM – there was a 35 percent increase in plan selections in February
    • the 1,939,600 cumulative number in October-January rose by nearly 681,500 in February to a cumulative five month total of nearly 2,621,100

The following are highlights of Marketplace enrollment-related information for the first five months of the initial open enrollment period (see Appendix C and the Addendum to the March Marketplace Enrollment Report for specific state-level data).

Cumulative Highlights for the period: October 1, 2013 – March 1, 2014

Marketplace Eligibility Determinations and Plan Selection

  • Number of Eligible Persons who have Selected a Plan through the SBMs and FFM: 4.2 million
  • Number of Persons who have had a Medicaid/CHIP Determination or Assessment through the Marketplaces: 4.4 million (does not include individuals applying through State Medicaid/CHIP agencies.)

Marketplace Plan Selection by Gender

  • 45 percent7 of the persons who have selected a Marketplace plan are male
  • 55 percent of the persons who have selected a Marketplace plan are female

Marketplace Plan Selection by Age

  • 25 percent of the persons who have selected a Marketplace plan are between the ages of 18 and 34
    • The percent of young adults who selected a Marketplace plan was 3 percentage points higher in January and February than it was from October through December (27 percent versus 24 percent)
  • 31 percent of the persons who have selected a Marketplace plan are between the ages of 0 and 34

Marketplace Plan Selection by Metal Level

  • 18 percent of the persons who have selected a Marketplace plan have selected a Bronze plan
  • 63 percent of the persons who have selected a Marketplace plan have selected a Silver plan
  • 11 percent of the persons who have selected a Marketplace plan have selected a Gold plan
  • 6 percent of the persons who have selected a Marketplace plan have selected a Platinum plan
  • 1 percent of the persons who have selected a Marketplace plan have selected a Catastrophic plan

Marketplace Plan Selection by Financial Assistance

  • 83 percent of the persons who have selected a Marketplace plan have selected a Marketplace Plan with Financial Assistance8

FFM Marketplace Plan Selection by Gender and Age

  • 26 percent of the males who have selected a Marketplace plan through the FFM are between 18 and 34
  • 25 percent of the females who have selected a Marketplace plan through the FFM are between 18 and 34

FFM Marketplace Plan Selection by Gender and Metal Level

  • 69 percent of the females who have selected a Marketplace plan through the FFM have selected a Silver plan
  • 65 percent of the males who have selected a Marketplace plan through the FFM have selected a Silver plan

FFM Marketplace Plan Selection by Financial Assistance Status and Metal Level

  • 74 percent of the persons who have selected a Marketplace plan with Financial Assistance through the FFM have selected a Silver plan
  • 94 percent of the persons selecting a Silver plan in the FFM will be receiving Federal financial assistance in paying their premiums
  • 26 percent of the persons who have selected a Marketplace plan without Financial Assistance through the FFM have selected a Silver plan
  • 30 percent of the persons who have selected a Marketplace plan without Financial Assistance through the FFM have selected a Bronze plan

FFM Marketplace Plan Selection by Metal Level and Age

  • 66 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Silver plan
  • 15 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Bronze plan
  • 10 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Gold plan
  • 5 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Platinum plan
  • 4 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Catastrophic plan
    • Young adults account for 91 percent of all catastrophic plan selections through the FFM

Monthly Data on Marketplace Plan Selection – As shown in Figure 2, the cumulative number of persons who have selected a Marketplace plan has increased considerably since the end of the fourth month of the initial open enrollment period.

Figure 2

Trends in the Cumulative Number of Individuals Who Have Selected a Marketplace Plan, 10-1-13 to 3-1-1

Over 4.2 million people have selected a Marketplace plan since October 1st, including 2.6 million who have selected a plan through the FFM

Figure 2: Trends in the Cumulative Number of Individuals Who Have Selected a Marketplace Plan, 10-1-13 to 3-1-1

Notes: Represents cumulative monthly sums of data on the number of unique individuals who have been determined eligible to enroll in a plan through the FFM, and have selected a plan (with or without the first premium payment having been received by the issuer).

Source: Centers for Medicare & Medicaid Services, as of 3-7-2014.


Additionally, Table 2 shows that the cumulative number of young adults (ages 18 to 34) selecting a Marketplace plan grew faster than for other age groups when the five month period is compared to the four month period. The cumulative number of young adults selecting a Marketplace plan has increased by 33 percent (268,475) since February 1st (from 807,515 to 1,075,990). By comparison, there was a 30 percent increase in Marketplace plan selections for all other age groups during the same time period (from 2.4 million to nearly 3.2 million).

Table 2

Trend In the Cumulative Number of Marketplace Plan Selections By Age Group
(based on data reported as of 3-7-14)
Cumulative Total,
First Four Months 10-1-13 to 2-1-14
Cumulative Total, First Five Months 10-1-13 to 3-1-14 % Change
MARKETPLACE TOTAL
Ages 18 to 34 807,515 1,075,990 33%
All Other Age Groups Combined 2,425,077 3,158,690 30%
Subtotal With Available Data on Age 3,232,592 4,234,680 31%
Unknown Age 66,900 7,645 -89%
Marketplace Total 3,299,492 4,242,325 29%
SBM TOTAL
Ages 18 to 34 327,096 411,645 26%
All Other Age Groups Combined 971,306 1,209,594 25%
Subtotal With Available Data on Age 1,298,402 1,621,239 25%
Unknown Age 61,502 0 -100%
Marketplace Total 1,359,904 1,621,239 19%
FFM TOTAL
Ages 18 to 34 480,419 664,345 38%
All Other Age Groups Combined 1,453,771 1,949,096 34%
Subtotal With Available Data on Age 1,934,190 2,613,441 35%
Unknown Age 5,398 7,645 42%
Marketplace Total 1,939,588 2,621,086 35%

Notes: These percentages for Ages 18 to 34 and All Other Age Groups Combined are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age. The number of Marketplace plan selections with unknown age decreased significantly for the SBMs in comparison to the previous reporting period due to an increase in the completeness of data reporting for this metric.

Source: Centers for Medicare & Medicaid Services, as of 3-7-2014.


 

  • Marketplace Plan Selections by Age – The proportion of Marketplace plan selections by persons between the ages of 18 and 34 has been increasing. Persons between the ages of 18 and 34 account for nearly a quarter (25 percent) of all Marketplace plan selections (SBMs and FFM) for the first five months of the initial open enrollment period (compared to 24 percent during the first three months of the initial open enrollment, and 27 percent during the months of January and February).
    • SBMs: 25 percent between the ages of 18 and 34 (10-1-13 to 3-1-14).
    • FFM: 25 percent between the ages of 18 and 34 (10-1-13 to 3-1-14).

Table 3 shows the age distribution of the Marketplace plan selections (SBMs and FFM) during the first five months of the initial open enrollment period.

Table 3

Comparison of the Age Distribution of Marketplace Plan Selections (SBM & FFM) For the Five Month period: 10-1-13 to 3-1-14
(based on data reported as of 3-7-14)
Percent of Total Individuals Who Have Selected a Marketplace Plan (1)
Age < 18 6%
Age 18-25 10%
Age 26-34 16%
Age 35-44 16%
Age 45-54 23%
Age 55-64 30%
Age ≥659 0%
Total 100%
Ages 18 to 34 25%

(1) These percentages are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age. Additionally, these percentages have been rounded, and may not add to totals due to rounding errors. (Source: Centers for Medicare & Medicaid Services, as of 3-7-2014.)


Consumer Shopping – Marketplace plan selection is expected to continue to grow. Consumer interest in gaining health coverage continues to be strong among Americans who currently lack insurance – a recent Gallup survey found that 55 percent of uninsured adults say that they are likely to get health insurance in 2014, and the majority of those who intend to get insurance plan to use the Marketplace.10 Similarly, a recent McKinsey & Company survey found that most (65 percent) of the respondents who said that they intend to enroll in coverage are persons who were previously uninsured.11

Recent national surveys indicate that the number of Americans with health insurance coverage is growing. For example, Gallup has found that the percentage of uninsured Americans has decreased by 1 percentage point during the first quarter of 2014 (16 percent uninsured, compared to 17.1 percent in the fourth quarter of 2013).12 Similarly, McKinsey & Company’s February survey of consumers eligible to purchase individual coverage during open enrollment (either on or off the Marketplace) found that 27 percent of those surveyed who enrolled in health coverage in 2014 report they were previously uninsured (compared with 11 percent in earlier McKinsey surveys), and 10 percent of all respondents who self-identified as being previously uninsured said that they had enrolled in a product (compared with 3 percent in January).13


5 For additional information, please refer to Appendix C of the November Marketplace Enrollment Report, which can be accessed at http://www.aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/rpt_en....

6 Centers for Medicare & Medicaid Services, “Enrollment Activity on May 15th,” Press Release, May 16, 2006

7 Based on the total number of plan selections for which the applicable data are available (excluding unknown).

8 Represents individuals who have selected a Marketplace plan, and qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR).

9 There are nearly 400,000 uninsured persons over the age of 65; some persons over 65 have selected Marketplace plans.

10 “Majority of Uninsured Say They Will Get Insurance,” Frank Newport, Gallup daily tracking poll, March 7, 2014, accessed at
http://www.gallup.com/poll/167786/majority-uninsured-say-insurance.aspx?....

11 McKinsey Center for U.S. Health System Reform, “Individual market enrollment: Updated view,” March 2014, accessed at healthcare.mckinsey.com/reform.

12 “U.S. Uninsured Rate Drops so Far in First Quarter of 2014,” Jenna Levy, Gallup Gallup-Healthways Well-Being Index survey, February 12, 2014, accessed at http://www.gallup.com/poll/167393/uninsured-rate-drops-far-first-quarter...

13 McKinsey Center for U.S. Health System Reform, “Individual market enrollment: Updated view,” March 2014, accessed at healthcare.mckinsey.com/reform.

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