Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period. Appendix F: Methodology and Technical Notes


The data that are reported in this issue brief have been generated by the information systems of the Centers for Medicare & Medicaid Services, based on information reported to CMS by SBMs, and information collected by the FFM for states with Marketplaces supported by or fully run by HHS (including those run in partnership with states).

Unless otherwise noted, the data in this issue brief represent cumulative Marketplace enrollment-related activity for the 10-1-13 to 3-31-14 reporting period (including activity associated with individuals who qualified for a Special Enrollment Period (SEP) through 4-19-14), with information available as of 4-29-14.

We believe that the information contained in this issue brief provides the most systematic “snapshot” of enrollment-related activity in the Marketplaces to date because the data for the various metrics are counted using comparable definitions for data elements across states, and between the SBMs and FFM (see table below). It is important to note that the SBM enrollment-related data that are in this issue brief represent state data that have been reported to CMS as of April 29, 2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report.

While this issue brief includes some data for all states, data for certain metrics are not available for some states due to information system issues.

The following section provides highlights of major methodological changes since the last Marketplace Enrollment Report. For additional technical information about the metrics that are included in this report, please refer to the earlier Marketplace enrollment reports.65

Highlights of Major Methodological Changes Since the March Marketplace Enrollment Report

Reporting of Cumulative Data (Including SEP Activity) - This report includes 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) through 4-19-14.

This report includes cumulative data for 10-1-13 to 3-31-14, including SEP Activity through 4-19-14, because some people’s process of applying, shopping, and selecting a plan may span across multiple monthly reporting periods (for example, a person may have applied for a Marketplace plan in October and then selected a Marketplace plan in December). We believe that these cumulative data provide the best “snapshot” of Marketplace enrollment-related activity to date. Ongoing efforts are underway to eliminate duplication associated with counting people in more than one month. Additionally, some SBM data systems are still working to eliminate duplication in their cumulative counts, so all duplication has not yet been removed in this report.

Data on Total Number of Completed Applications and Total Individuals Applying for Coverage in Completed Applications – We are no longer showing data on the total number of completed applications and total number of individuals applying for coverage in completed applications because we believe that there is duplication in these metrics.

SBM Data – While all SBMs have provided updated data on call center activity, not all SBMs have provided updated data on website visits. For additional state-specific technical notes, please see the footnotes of the tables in Appendix E, and in the Addendum to the Marketplace Summary Enrollment Report.

FFM Data Application and Eligibility Metrics – The cumulative FFM data that are being reported for the eligibility-related metrics reflect additional efforts to eliminate duplication from these data.

Data on Characteristics of Marketplace Plan Selections by Metal Level – The SBM and FFM subtotals for each metal tier type do not sum to the total number of Plan Selections With Available Data on Metal Level due to instances where consumers enrolled in more than one plan type in their state (for example, some consumers may have enrolled in both a health plan and a standalone dental plan). As a result, the corresponding percentages also do not sum to 100 percent. This also affects the data for the Marketplace total. To the extent possible, duplication associated with standalone dental plan selection has been removed from the data shown for each metal tier type. Additionally, separate totals for standalone dental plan selections are shown separately where appropriate. Data distributions for States with very small numbers of Marketplace plan selections for a given metal level have been suppressed.

Standalone Dental Plan Selection – For the FFM, total standalone dental plan selections includes data for both the “High” and “Low” standalone dental plan metal tier types. For the SBMs, separate data are not yet available on standalone dental plan selections.

Data on Characteristics of FFM Marketplace Plan Selections By Health Insurance Coverage Status at the Time of Application, and Race / Ethnicity – For the first time, the Appendices of this report include FFM data on the race/ethnicity (Appendix C) and health insurance coverage status at the time of application (Appendix D) and of the persons who have selected a Marketplace plan through the FFM. While this information is provided for transparency purposes, its quality is low and its use should be limited. Please refer to Appendix C and Appendix D for additional information about the limitations of these data.

Data on Additional Characteristics of FFM Marketplace Plan Selections – This report also includes additional data on the characteristics of persons who have selected a Marketplace plan through the FFM (by Gender and Age; Gender and Metal Level; Financial Assistance Status and Metal Level; and Metal Level and Age). 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.

Data on Enrollment Activity Related to Individuals Who Qualified for a Special Enrollment Period (SEP) – This report includes data on Marketplace plan selections and other enrollment-related activity associated with individuals who qualified for a Special Enrollment Period (SEP) through 4-19-14. The data on SEP activity includes information for those who qualified for an SEP because they who were “in line” on 3-31-14, as well as those who experienced a qualifying life event66 or a complex situation related to applying for coverage in the Marketplace. 67 The data are not disaggregated based on the reason that a given individual qualified for an SEP.

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. 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 prior to March 31, 2014.

Medicaid and CHIP Eligibility Determination and Assessment Data – Marketplace Medicaid & CHIP eligibility determination and assessment data in this report cannot be added to eligibility determination data in the March 2014 Monthly Applications, Eligibility Determinations, and Enrollment report. In the Marketplaces, 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 March 2014 Monthly 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 March 2014 Monthly 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 March.

State Data Profiles – Key enrollment-related data from this report have been summarized in state-level data profiles, which can be accessed at

65 The previous Marketplace Enrollment Reports can be accessed at

66 There are nine types of life events that would potentially allow an individual to qualify for an SEP through the Marketplace.: 1) a change in marital status (marriage, divorce); 2) a change in dependents (birth, adoption, or undertaking placement of a child); 3) permanently moving to a state whose health plan options differ from their current choices; 4) gaining new status as a citizen or lawfully present individual in the USA; 5) experiencing a change in income; 6) experiencing an enrollment error on behalf of the Marketplace; 7) losing minimum essential health coverage due to job loss, divorce, loss of Medicaid or CHIP eligibility, expiration of COBRA coverage, or decertification of a health plan; 8) being already enrolled in a Marketplace plan, but experiencing a change in income or household status, affecting tax credit or cost-sharing reduction eligibility; and 9) aging off of their parent’s healthcare plan at 26 years of age.

67 Examples of other complicated cases that could qualify for an SEP relate to: exceptional circumstances, misinformation or misrepresentation, an enrollment error, system errors related to immigration status, display errors on, Medicaid/Marketplace transfers, error messages, unresolved casework, victims of domestic abuse, and other system errors. Additional information on Marketplace SEPs can be found at

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