Better Understanding Re-Enrollees in the Health Insurance Marketplace

By Molly Warren

Enrolling uninsured Americans has been and will continue to be important for the success of the health insurance marketplaces. However, as more Americans enroll and fewer remain uninsured, making sure those who are enrolled are retaining their coverage throughout the year and actively re-enrolling during open enrollment becomes more important. Let’s take a look at what we know about the re-enrollee population, the variation across the country, and their behavior during the third open enrollment period (OE3).

Proportion of Re-Enrollees

Overall, 12.7 million Americans selected a 2016 plan on the health insurance marketplace during the OE3. Out of those 12.7 million plan selections, 4.9 million (39 percent) were new enrollees and 7.8 million (61 percent) were re-enrollees. Compared to the previous open enrollment period, there was higher total enrollment, but the ratio of new to returning enrollees remained virtually identical.

This ratio of new consumers to re-enrollees varied quite a bit from state to state, however. A handful of states (Colorado, Louisiana, Tennessee, and Texas) has close to a 50/50 split, with 48 percent new consumers and 52 percent re-enrollees. Vermont, on the other end of the spectrum, had just 6 percent new consumers and 94 percent re-enrollees. One notable divergence is between states using the HealthCare.gov enrollment platform and those with a state-based marketplace (SBM). Most HealthCare.gov states had much higher proportions of new consumers than SBMs — overall, HealthCare.gov states had 42 percent new consumers and 58 percent re-enrollees, while SBMs had 28 percent new consumers and 72 percent re-enrollees.

Figure1

Active Re-Enrollment

Within the re-enrollee population, one of the important delineations is whether consumers are shopping and comparing their coverage options each year (actively re-enrolling) or are being re-enrolled in the same or a similar plan by the marketplace without taking action (auto re-enrolling). Unlike employer or public coverage options, an individual’s cost for purchasing marketplace coverage with financial help — as 83 percent of marketplace enrollees do — is tied to specific plan rate changes as well as the amount of financial help they will get (which depends on both on individual circumstances like income and family size, as well as changes in the local benchmark plan). This financial help calculation protects consumers from plan rate increases on average, but may play out differently in individual circumstances. Here at Enroll America, we encourage consumers to update their information each year, find out what financial help they are eligible for, and reassess what plans are the best match for them for the coming year.

In OE3, out of the 7.8 million re-enrollees across the country, 4.6 million (59 percent) actively re-enrolled and 2.8 million were auto-enrolled. Like the new and re-enrollee differences, the ratio of active to auto enrollments varies geographically, and again the difference between HealthCare.gov states and SBM states is quite stark. Re-enrollees in states that use the HealthCare.gov enrollment platform were much more likely to actively re-enroll than their SBM counterparts — with about 71 percent of HealthCare.gov re-enrollees actively re-enrolling compared with 37 percent of SBMs re-enrollees (with a known re-enrollment type).

Figure2

HealthCare.gov States vs. State-Based Marketplaces

There are many potential reasons for the differences in HealthCare.gov states and SBMs in their ratios of new enrollees to re-enrollees, and active re-enrollees to auto re-enrollees. There are population differences — SBMs generally have had and continue to have lower uninsured rates, which means there are proportionally fewer residents to newly enroll (a good problem to have, indeed!), and the populations are generally wealthier, which means they may be less price sensitive (and so potentially less likely to actively re-enroll). There are also underlying policies that likely had some impact; for example, HealthCare.gov states were more likely to allow non-ACA-compliant transitional plans beyond 2013, and consumers in those states transitioned over to the marketplace in 2015 or 2016 instead of in 2014 in the SBMs. There is also variation in consumer notices and marketing by states, as well as changes in issuers, their offerings, and their rates by market that could be affecting the proportion of new to returning enrollees as well as the proportion of active to auto re-enrollees.

Demographic Variation

The last piece of data available on re-enrollees is additional information on demographic variation and re-enrollment behavior of consumers who re-enrolled via HealthCare.gov in OE3. This data shows that consumers getting financial help and those who are Latino and white are 4-6 percent more likely to actively enroll than the overall re-enrollee population. On the flip side, African-Americans and young adults are about 7 percent less likely to actively re-enroll than the overall re-enrollee population. However, it is important to note that more than a third of enrollees opt not to self-report their race/ethnicity, so this does not reflect the complete picture of all HealthCare.gov re-enrollees.

We also know that of HealthCare.gov re-enrollees who actively re-enrolled, 61 percent switched to a different plan than they had in 2015. Most of those who switched plans (65 percent), changed issuers while only about one-third (31 percent) changed metal level.

Figure3
As more consumers gain coverage through the marketplace, it becomes increasingly important to better understand this population, their behavior, and needs in order to ensure that the enrollment community provides the resources and supports consumers need to find and keep affordable coverage. Stay tuned for further analysis of the re-enrollee population from Enroll America’s surveys and strategies for encouraging consumers to stay covered year-round and actively engage during open enrollment.

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