The Centers for Medicare & Medicaid Services (CMS) collects data on health insurance coverage at the time of application only from individuals seeking financial assistance for coverage through the Federally-facilitated Marketplace (FFM). CMS is not currently collecting data on whether individuals who have selected Marketplace plans through the State-based Marketplaces had health coverage at the time of application, although we anticipate that such information may become available in the future.
Only individuals applying for financial assistance are required to report whether they currently have health insurance coverage and the source of that coverage. Information on coverage is necessary to determine eligibility for the advanced premium tax credit, cost-sharing reductions, and Medicaid/CHIP. Individuals who do not apply for financial assistance are not asked about current coverage.
This means that the data collected about health coverage at the time of application does not capture the full population of persons who use the FFM. There are also questions about the appropriate interpretation of the data for those individuals for whom information is available, as described below. The use of this information on health insurance coverage at the time of application should therefore be limited.
The coverage question on the Marketplace application form is designed to capture whether an individual currently has health insurance, and not whether an individual may have been covered prior to the time of application. Applicants for financial assistance through the Marketplace are asked: “Are you enrolled in health coverage now from the following?”58 Responses to the coverage question do not capture, for example, whether an individual without coverage only very recently became uninsured or whether someone with insurance is applying to the Marketplace to prevent an impending loss of coverage.
As noted above, those who elect not to apply for financial assistance through the Marketplace do not encounter questions about insurance status. We are unable to report the prevalence of health insurance coverage at the time of application among the approximately 5 percent of enrollees who did not apply for financial assistance, as well as among those who enrolled in any off-Marketplace, Affordable Care Act-compliant plans.
Health Insurance Coverage at the Time of Application among FFM Enrollees
Of the 5.45 million people who selected a Marketplace plan through the FFM during the period October 1, 2013–March 31, 2014 (including Special Enrollment Period (SEP) activity through April 19, 2014), 5.18 million (95 percent) applied for financial assistance and were required to answer a question about their health insurance coverage.59 Of these 5.18 million who applied for financial assistance and selected in a plan, 695,011 (13 percent) indicated that they had coverage at the time of application.
Health Insurance Coverage at the Time of Application among SBM Enrollees
CMS is requesting information from SBMs on coverage at the time of application. These data will be available at a later date. In terms of publicly available information, at least two State-based Marketplaces have publicly released information on previous health insurance coverage at the time of application among persons who selected Marketplace plans. NY State of Health has reported that about 30 percent of its combined 960,000 enrollees in Marketplace plans and in Medicaid/CHIP through April 15, 2014 had insurance coverage at the time of application60—twice the level of health insurance coverage at the time of application among persons who applied for financial assistance and selected Marketplace plans through the FFM. Preliminary data from Kynect, Kentucky’s Marketplace, showed that as of March, 25 percent of the persons who selected Marketplace plans had insurance before signing up.61
Landscape Data on Previously Uninsured
Estimates of the share of previously uninsured vary widely among surveys, and results may be sensitive to the period in which the survey was fielded, as well as the population of individuals included. A Gallup-Healthways Well-Being Index poll of nonelderly adults fielded March 4–April 14, 2014 found that half of those who bought coverage through the Marketplace had health insurance coverage at the time of application.62 Gallup reports that 4.2 percent of respondents reported obtaining Marketplace coverage, including 2.1 percent who bought it as a replacement for a previous policy and 1.9 percent who did not previously have a policy. In a separate survey, the RAND Corporation estimated that 2.5 million (61 percent) of the 3.9 million individuals enrolled in the Marketplace in March had previous coverage.63
The management consultancy McKinsey & Company has surveyed individuals who purchased new policies for 2014 through the nongroup market, including plans both in and outside the Marketplace. The coverage status of individuals purchasing plans outside the Marketplace may differ from the coverage status of those purchasing coverage on the Marketplace, so McKinsey’s results may not be comparable to the other surveys or to the application data cited above. McKinsey found that 73 percent of respondents in February 2014 who reported purchasing new nongroup coverage had health insurance coverage at the time of application, a change from 89 percent in their previous survey, conducted over the period November 2013 to January 2014.64
58 The list of possible answers for the question relating to health insurance coverage at the time of application includes an option marked “Other.” At this time, we are unable to verify whether answers of “Other” are counted toward the number of individuals with health insurance coverage at the time of application in the CMS application data.
59 Not all those who apply for financial assistance are determined eligible for it.
60 NY State of Health, “More Than 960,000 New Yorkers Enrolled on NY State of Health,” press release, April 15, 2014. Available at: http://www.healthbenefitexchange.ny.gov/news/more-960000-new-yorkers-enr...
61 “More Than 321,000 Now Enrolled Through Kynect as March 31 Deadline Approaches,” press release from the office of Gov. Steve Beshear, March 21, 2014. Available at: http://migration.kentucky.gov/newsroom/governor/20140321kynect.htm
62 Gallup presentation, “An Inside Look at Gallup’s Healthcare and ACA Data,” April 16, 2014. Video available at: http://thrive.gallup.com/2014/04/is-affordable-care-act-working.html.
63 Katherine Carman and Christine Eibner, “Changes in Health Insurance Enrollment Since 2013: Evidence from the RAND Health Reform Opinion Study,” RAND Corporation, April 2014. Available at: http://www.rand.org/pubs/research_reports/RR656.html.
64 Amit Bhardwaj, Erica Coe, Jenny Cordina, and Mahi Rayasam, “Individual Market Enrollment: Updated View,” McKinsey Center for U.S. Health System Reform, March 2014. Available at: http://healthcare.mckinsey.com/individual-market-enrollment-updated-view.