ICYMI: Effectuated Enrollment Snapshot Released with New Special Enrollment Period (SEP) Data

By Anmol Gupta

On June 30, CMS released its effectuated Marketplace enrollment snapshot, which also includes data on individuals who made plan selections through a Special Enrollment Period (SEP) in 2015.

In case you missed it, — here are the toplines from the report:

  • Effectuated enrollment remains high: As of March 31, 2016, 11.1 million of the 12.7 million Americans who selected a plan during the third open enrollment period (OE3) had successfully paid their premiums and had an active health insurance policy in place. Overall, the number of individuals with effectuated coverage has increased by almost a million compared to this time last year, and the effectuation rate is very similar to last year’s, with approximately 87 percent of plan selections made during open enrollment eventually becoming effectuated enrollments.
  • A majority of individuals continue to receive financial help: About 9.4 million consumers are getting advanced premium tax credits (APTCs) to help make their monthly premiums more affordable (the average APTC amount was $291 per month). Additionally, almost 60 percent of consumers with effectuated enrollment are receiving cost-sharing reductions to reduce their out-of-pocket spending on health care.
  • First-ever data on SEP enrollment: Of the 1.6 million individuals that enrolled through a SEP in 2015, the majority were granted access to a SEP because they had lost minimum essential coverage (e.g. coverage through an employer).

Distribution of Qualifying SEPs

Source: CMS, June 2016

These results are encouraging, but we know that there is more that can be done to ensure individuals have twelve months of continuous coverage. We continue to work with the broader enrollment community using specific strategies — such as messagingsurveying, and supporting consumer-friendly protections — to ensure individuals have the information they need when they need it most to get covered and stay covered.

And periodic reports, like this, help us evaluate enrollment and retention efforts across the country. While these reports will now be released semiannually, as opposed to quarterly, we’re hopeful that the movement towards increased data transparency will carry on so that we can continue to work with our partners to help Americans get covered and stay covered.

To read CMS’s full report, click here.

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