Rich Daly | December 22, 2015
TOTAL 2015 ENROLLMENTS DECLINED 6 PERCENT TO 9.3 MILLION IN THE LATEST QUARTERLY REPORT.
Dec. 22—The federally operated health insurance marketplaces are well on their way to meeting their 2016 enrollment goal, but many of those enrollees may pay more than necessary.
Of the 8.3 million sign-ups that the federal government-run marketplaces garnered in 38 states by Dec. 19, “over 2 million” were automatically re-enrolled, a senior official from the U.S. Department of Health and Human Services (HHS) told reporters. Automatically re-enrolling for 2016 coverage—and not shopping around for lower-cost options—could cost enrollees $4.5 billion in potential savings, according to an HHS report issued shortly before the start of open enrollment. That report was part of a nationwide push to get more enrollees to shop around for 2016 coverage, instead of auto-enrolling in the same or similar coverage.
The latest HHS enrollment report did not provide the exact number of auto-enrollments, but indicated the latest total included most of the auto-enrollments that are expected to occur during the current open enrollment period, which lasts through January.
The extent of the financial hit that auto-enrollees could take was further detailed in a recently released Robert Wood Johnson Foundation (RWJF) national data set on all plans offered in the health insurance marketplaces in 2015 and 2016. The average lowest-cost premium for the popular Silver-level plans in each Affordable Care Act marketplace will increase by 12 percent to $253, while the average overall Silver-level premium will increase by 11 percent to $296. Meanwhile, average family plan Silver-level deductibles will increase by 11 percent to $8,003, and average individual-coverage Silver plan deductibles will increase by 18 percent to $4,219.
The impact of those increased costs was illustrated in a new RWJF analysis that found 10 percent of individual market enrollees with incomes from 200 to 500 percent of the federal poverty level will spend more than 21 percent of their income on healthcare costs in 2016.
In addition to the rising premium and out-of-pocket costs that non-shoppers could face, customer advocates have warned that a lack of shopping could leave them in plans that don’t meet their medical needs or that have dropped their preferred providers.
Another potential financial risk for automatic re-enrollers could arise if their incomes have changed and they don’t provide the insurance marketplace with updated information. In that scenario, consumers may receive too large a premium tax credit and have to repay the Internal Revenue Service for the excess subsidy.
The latest totals do not include “the millions more” who were enrolled for coverage in the 12 state-based marketplaces, Kevin Counihan, CEO of Healthcare.gov, said in a call with reporters.
Some Improvements
Federal officials emphasized their success bringing in some new consumers to the federal marketplace. Through Dec. 19, 29 percent of plan selections were by new customers, with 71 percent made by returning or auto-re-enrolling customers.
Officials also reported comparatively improved performance this year among the so-called young invincibles, or enrollees ages 18 to 34. The average age of marketplace shoppers qualifying for coverage to begin Jan. 1 was younger than the average age of those beginning coverage Jan. 1, 2015. There were nearly twice as many consumers under age 35, or about 2.1 million more, compared with last year. Those younger individuals comprised 35 percent of the federal marketplace plan enrollment, compared with 33 percent before the deadline for 2015 coverage.
“And that’s good because a younger risk pool is a healthier risk pool, and that’s good for everyone’s premiums,” Counihan said.
Although federal officials emphasized the increasing tax penalty faced by most Americans who lack ACA-compliant health insurance coverage, they downplayed the role of the penalty in the latest enrollment results.
“There are probably many reasons behind the increase in enrollment and the enthusiasm that we are seeing,” Meena Seshamani, MD, director of the Office of Health Reform at HHS, said during the call. “The penalty going up may be one, but also there are many more people who are in the marketplace and so there are people who may have a family member, a work colleague, a neighbor who may be getting marketplace coverage and so it becomes more familiar to them.”
Current Enrollments
HHS officials also announced that current enrollments in all federal and state marketplaces declined 6 percent to 9.3 million in the third quarter of 2015.
HHS attributed much of the decrease to reductions in federal financial assistance for enrollees who failed to adequately document their income when applying for subsidies. In the second quarter of 2015, HHS cut subsidies to about 734,000 households because of a lack of required documentation.
Such cuts dropped to 186,000 households in the third quarter, so the administration expected a smaller enrollment drop-off in the final quarter of the year.
HHS continued to project that 9.1 million enrollees would have ACA marketplace coverage through the end of 2015.
Source: HFMA
https://www.hfma.org/Content.aspx?id=45135