Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period. Single Risk Pool in Each State

05/01/2014

To increase stability and comparability in health plan rating, the Affordable Care Act requires a single risk pool in each state, encompassing both plans that were purchased inside of the Marketplace (“Marketplace plans”) and Affordable Care Act-compliant plans that were purchased outside of the Marketplace. Risk-adjustment occurs across all plans in each state’s single risk pool. The Department will have more complete data on the size of the single risk pool in each state as issuers report their enrollment for medical loss ratio, rate review, and risk adjustment purposes over the course of the next year.

Enrollment Growth at the End of the Open Enrollment Period

There was continued growth in total Marketplace plan selections after March 1st (including SEP activity through 4-19-14), compared to the October-February period:

  • Marketplace Total (SBMs and FFM) – there was an 89 percent increase in plan selections after March 1st (including SEP activity through 4-19-14)
    • the 4.2 million cumulative number in October-February rose by nearly 3.8 million after March 1st to a cumulative total of more than 8 million (including SEP activity through 4-19-14)
  • SBMs – there was a 59 percent increase in plan selections after March 1st (including SEP activity through 4-19-14)
    • the 1.6 million cumulative number for October-February rose by more than 0.9 million after March 1st to a cumulative total of nearly 2.6 million (including SEP activity through 4-19-14)
  • FFM – there was a 108 percent increase in plan selections after March 1st (including SEP activity through 4-19-14)
    • the 2.6 million cumulative number in October-February rose by 2.8 million after March 1st to a cumulative total of 5.4 million (including SEP activity through 4-19-14)

The following are highlights of Marketplace enrollment-related information for the initial open enrollment period, including additional SEP activity through 4-19-14 (see Appendix E and the Addendum to the Marketplace Summary Enrollment Report for specific state-level data).

Cumulative Highlights for the period: October 1, 2013 – March 31, 2014 (including Additional Special Enrollment Period Activity through 4-19-14)

Marketplace Eligibility Determinations and Plan Selection

  • Number of Eligible Persons who have Selected a Plan through the SBMs and FFM: 8 million
  • Number of Persons who have had a Medicaid/CHIP Determination or Assessment through the Marketplaces: 6.7 million (does not include individuals applying through State Medicaid/CHIP agencies.)

Marketplace Plan Selection by Gender

  • 46 percent19 of the persons who have selected a Marketplace plan are male
  • 54 percent of the persons who have selected a Marketplace plan are female

Marketplace Plan Selection by Age

  • 28 percent of the persons who have selected a Marketplace plan are between the ages of 18 and 34
    • The percentage of young adults among persons who selected a Marketplace plan after March 1st (31 percent) was 4 percentage points higher than it was in January and February, and 7 percentage points higher than it was from October through December (27 percent and 24 percent, respectively)
  • 34 percent of the persons who have selected a Marketplace plan are between the ages of 0 and 34

Marketplace Plan Selection by Metal Level

  • 20 percent of the persons who have selected a Marketplace plan have selected a Bronze plan
  • 65 percent of the persons who have selected a Marketplace plan have selected a Silver plan
  • 9 percent of the persons who have selected a Marketplace plan have selected a Gold plan
  • 5 percent of the persons who have selected a Marketplace plan have selected a Platinum plan
  • 2 percent of the persons who have selected a Marketplace plan have selected a Catastrophic plan

Marketplace Plan Selection by Financial Assistance Status

  • 85 percent of the persons who have selected a Marketplace plan have selected a Marketplace Plan with Financial Assistance20

FFM Marketplace Plan Selection by Gender and Age

  • 29 percent of the males who have selected a Marketplace plan through the FFM are between 18 and 34
  • 28 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

  • FFM Marketplace Plan Selection by Gender and Metal Level
  • 67 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

  • 76 percent of the persons who have selected a Marketplace plan with Financial Assistance through the FFM have selected a Silver plan
  • 95 percent of the persons selecting a Silver plan in the FFM will be receiving Federal financial assistance in paying their premiums
  • 25 percent of the persons who have selected a Marketplace plan without Financial Assistance through the FFM have selected a Silver plan
  • 33 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

  • 68 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Silver plan
  • 17 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Bronze plan
  • 7 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Gold plan
  • 4 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Platinum plan
  • 5 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 83 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 fifth 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 3-31-14

(Including Additional SEP Activity through 4-19-14)

Over 8 million people have selected a Marketplace plan since October 1st, including 5.4 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 3-31-14

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 SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). SEP activity includes plan selections by those who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace

Source: Centers for Medicare & Medicaid Services, as of 4-29-2014.


Enrollment Growth by Age - Table 3 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 period after March 1st (including SEP activity through 4-19-14) is compared to the five month period. The cumulative number of young adults selecting a Marketplace plan has doubled – increasing by 109 percent (nearly 1.2 million) since March 1st (from nearly 1.1 million to 2.2 million). By comparison, there was an 82 percent increase in Marketplace plan selections for all other age groups during the same time period (from nearly 3.2 million to over 5.7 million).

Table 3

 

Trend In the Cumulative Number of Marketplace Plan Selections By Age Group (based on data reported as of 4-29-14) Cumulative Total, First Five Months 10-1-13 to 3-1-14 Cumulative Total, 10-1-13 to 3-31-14 (Including Additional SEP Activity through 4-19-14) % Change
MARKETPLACE TOTAL
Ages 18 to 34 1,075,990 2,248,943 109%
All Other Age Groups Combined 3,158,690 5,756,759 82%
Subtotal With Available Data on Age 4,234,680 8,005,702 89%
Unknown Age 7,645 14,061 84%
Marketplace Total 4,242,325 8,019,763 89%
SBM TOTAL
Ages 18 to 34 411,645 710,591 73%
All Other Age Groups Combined 1,209,594 1,848,940 53%
Subtotal With Available Data on Age 1,621,239 2,559,531 58%
Unknown Age 0 14,054 n/a
Marketplace Total 1,621,239 2,573,585 59%
FFM TOTAL
Ages 18 to 34 664,345 1,538,352 132%
All Other Age Groups Combined 1,949,096 3,907,819 100%
Subtotal With Available Data on Age 2,613,441 5,446,171 108%
Unknown Age 7,645 n/a* n/a
Marketplace Total 2,621,086 5,446,178 108%

Notes: Represents cumulative data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). Special Enrollment Period (SEP) activity includes plan selections that were made between 4-1-14 and 4-19-14 by those who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace. The 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.

* Data for cells with less than ten Marketplace plan selections have been suppressed in this table, but are included in the totals.

Source: Centers for Medicare & Medicaid Services, as of 4-29-2014.


Marketplace Plan Selections by Age – The proportion of Marketplace plan selections by persons between the ages of 18 and 34 has been increasing (Table 4). Persons between the ages of 18 and 34 account for more than a quarter (28 percent) of all Marketplace plan selections (SBMs and FFM) for the initial open enrollment period, including SEP activity through 4-19-14 (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: 28 percent between the ages of 18 and 34 (10-1-13 to 3-31-14, including SEP activity through 4-19-14).
  • FFM: 28 percent between the ages of 18 and 34 (10-1-13 to 3-31-14, including SEP activity through 4-19-14).

Table 4

Comparison of the Age Distribution of Marketplace Plan Selections (SBM & FFM) For the Initial Open Enrollment Period: 10-1-13 to 3-31-14 (Including SEP Activity through 4-19-14) (based on data reported as of 4-29-14) Percent of Total Individuals Who Have Selected a Marketplace Plan (1)
Age < 18 6%
Age 18-25 11%
Age 26-34 17%
Age 35-44 17%
Age 45-54 23%
Age 55-64 25%
Age ≥65 21 0%
Total 100%
Ages 18 to 34 28%
Ages 0 to 34 34%

(1) Represents the age distribution based on Represents cumulative data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). Special Enrollment Period (SEP) activity includes plan selections that were made between 4-1-14 and 4-19-14 by those who qualified for an SEP because they were “in line” on 3-31-14, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplace. The 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 4-29-2014.


19 Based on the total number of plan selections for which the applicable data are available (excluding unknown). Some percentages may not add to 100% due to rounding.

20 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).

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

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