Digging Deeper into the Final Enrollment Numbers: Who Signed Up and What They Picked

By Molly Warren

On May 1, the U.S. Department of Health and Human Services (HHS) released the official enrollment report . Simultaneously, the Centers for Medicare and Medicaid Services (CMS) also released its March 2014 Medicaid and Children Health Insurance Program (CHIP) enrollment numbers. The final tally: eight million Americans signed up for marketplace coverage and nearly five million more enrolled in Medicaid or CHIP during open enrollment period.

The biggest takeaway from the reports is the remarkable surge at the end of open enrollment. We expected an increase in enrollment near the deadline (based on Massachusetts’ experience with health reform) but did not anticipate this magnitude! Nearly as many consumers picked a marketplace plan in March and during the April grace period as during the first five months of open enrollment.

Marketplace Cumulative Trends

While there is no deadline to enroll in Medicaid or CHIP, we still saw a surge in Medicaid and CHIP enrollment during the last month of open enrollment: 1.8 million individuals enrolled in March compared to 3 million over the previous five months.

Marketplace enrollment report

The final report includes lots of great information on marketplace enrollment, and is broken down by marketplace type, state, various demographic information on enrollees, eligibility for financial help, and plan selection. And, for the first time, HHS released information on race and ethnicity and prior insurance coverage status of enrollees. Here are a few of the top breakdowns:

  • Marketplace type: 5.4 million Americans signed up for marketplace coverage through the federally facilitated marketplace (FFM) and 2.6 million through state-based marketplaces (SBMs). Both types of marketplaces saw an increase in signups during the end of open enrollment compared with previous months, but it was more pronounced in the FFM: FFM enrollment increased by more than 100 percent in March and April, while SBM enrollment increased by about 60 percent.
  • Age: Six percent of marketplace enrollees are under 18, 28 percent are 18-34 years old, and 66 percent are 35 and over. Fifty-two percent of young adults who selected a plan through the marketplace did so in March and April.
  • Gender: Forty-six percent of marketplace enrollees are male and 54 percent are female.
  • Financial help: Eighty-five percent of marketplace enrollees selected a plan with financial help. This underlines our consumer research with Perry Undem that found affordability and the availability of financial help are critical to maximize enrollment.
  • Plan type: Of marketplace enrollees, 20 percent selected a bronze plan, 65 percent selected a silver plan, nine percent selected a gold plan, five percent selected a platinum plan, and two percent selected a catastrophic plan. The type of plan a consumer selected varied depending on whether they were eligible to receive financial help. Of consumers receiving financial help, 76 percent selected silver plans. This indicates individuals receiving financial help are willing to pay slightly more for more comprehensive coverage. In contrast, however, consumers not getting financial help selected bronze plans more often than silver plans.
  • Race and ethnicity: Of consumers who reported race and ethnicity to the FFM, 63 percent were white, 17 percent were African American, 11 percent were Latino, and 8 percent were Asian. Over 30 percent of consumers did not report race, so the breakdown does not necessarily represent the true distribution of enrollees’ race and ethnicity.
  • Prior insurance status: Consumers applying for financial help through the FFMs were asked about their current insurance status. Of those that responded to this question, 13 percent answered they had coverage and 87 percent said that they were uninsured. HHS indicated that these results likely underestimate the true prior coverage rate; two SBMs separately reported prior-insurance rates of 25 and 30 percent.

Medicaid enrollment report

The new Medicaid and CHIP numbers released were monthly enrollment totals for March and an update on February’s numbers (CMS updates the prior month’s numbers as more accurate information comes in from the states). In addition to the enrollment totals and state-by-state enrollment breakdown, the report also included the number of consumer applications and determinations made by state agencies, which is not captured in the marketplace enrollment reports.

Overall Medicaid and CHIP enrollment grew to 63.4 million in March, which is an increase of 4.8 million or 8.2 percent compared to average monthly enrollment prior to open enrollment. Some states’ Medicaid and CHIP programs grew by much more than that—Oregon, West Virginia, Vermont, and Kentucky all saw more than 30 percent growth. Not surprisingly, states that expanded Medicaid had greater program growth rates than states that did not expand: 12.3 percent and 2.6 percent, respectively.

Although the initial open enrollment period is over, Medicaid enrollment continues year round, and consumers with certain life events will be eligible for Special Enrollment Periods throughout the year! Next open enrollment begins on November 15!

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