In Early ACA Enrollments, One-Third Are New Customers

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By Sara Hansard

Nov. 12 — More than 543,000 people selected plans in the federal Affordable Care Act health insurance marketplace in the first week of open enrollment for 2016, and 34 percent were new consumers, the Department of Health and Human Services reported Nov. 12.

From Nov. 1, when the third ACA open enrollment began, through Nov. 7, close to 1.2 million applications were submitted for coverage in the HealthCare.gov marketplace used by 38 states, the HHS's Centers for Medicare & Medicaid Services said in a fact sheet. More than 1.1 million users shopped for coverage, it said. No information is yet available on how many people selected plans in the state-run marketplaces.

HHS Secretary Sylvia Mathews Burwell has predicted that between 11 million and 14.1 million people will select marketplace plans in the open enrollment period from Nov. 1 through Jan. 31, 2016, and about 10 million of those people will have paid premiums and have coverage at the end of 2016—an increase of about 1 million from 2015. Between 2.8 million and 3.9 million currently uninsured people are likely to gain coverage of the 10.5 million uninsured people who qualify for coverage, Burwell said in October.

Outpacing 2015 Enrollment

About 462,000 people signed up for 2015 coverage in the first week the federal enrollment system was open for business in 37 states. Unlike in 2015, Hawaii is using HealthCare.gov for 2016 after it had technical problems with its state-run marketplace. HHS officials had said earlier they expected the Sunday opening for the 2016 open enrollment to be somewhat slower than the Saturday opening for 2015 because fewer people typically shop for health insurance on Sundays.

“It’s a solid start and I’m pleased with the consumer engagement we’ve seen over this last week,” Burwell said in a Nov. 12 blog posting. “Our partners were ready to work, and people were ready to sign up. We know we have 11 more weeks to go and a lot of hard work still to do.”

The HHS has added a new feature for HealthCare.gov that allows some consumers to search health plans by a preferred doctor or health-care facility. In addition, it has added a search tool that allows people to get an estimate of their total out-of-pocket costs, including deductibles, copayments and coinsurance.

Affordability a Key Issue for 2016

Burwell has also said it will be harder to reach the remaining uninsured this year, and she has identified affordability as a key issue to be addressed through ads and other communications that stress the availability of federal premium tax credits to help moderate- and low-income people pay for coverage.

Average monthly premiums for 2016 ACA plans on which premium subsidies are based are increasing 7.2 percent to $240 from $224 in 2015 before subsidies are deducted, according to an HHS report released Oct. 30. However, most marketplace enrollees receive subsidies, and eight in 10 returning HealthCare.gov consumers will be able to buy a plan with premiums of less than $100 per month after tax credits, the agency said.

Because of further automation between HealthCare.gov and health insurers, the number of plan selections reported this year account for plan cancellations by issuers that occur before the end of open enrollment for reasons such as not paying premiums, the CMS said in the fact sheet. That change “will result in a larger number of cancellations being accounted for during Open Enrollment than last year,” when cancellations were reflected only in reports after the end of open enrollment, it said.

Dec. 15 Enrollment for Jan. 1 Coverage

In order to have coverage as of Jan. 1, people must enroll by Dec. 15, and current enrollees who don't take action will be automatically re-enrolled at the end of December, the CMS said. Agency officials are encouraging enrollees to visit HealthCare.gov to ensure they're getting the best deal, because premium prices for their current plans may change in 2016, and plans on which subsidies are based may change.

HealthCare.gov had 741,112 people contact its call center, and the average waiting time to get through was four minutes and 38 seconds, the CMS said. The first year the ACA marketplaces opened, the federal website as well as a number of state-run marketplace websites were largely dysfunctional for the first several months, and people were often unable to get through.

The CMS said it will release weekly open enrollment figures, which it calls snapshots, for HealthCare.gov. The snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov websites, including the Spanish-language version, CuidadoDeSalud.gov. The figures don't include effectuated enrollment, which takes into account enrollees who have paid premiums for their coverage.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com