END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Charles Gaba's blog

Press release from MNsure, Minnesota's ACA exchange:

MNsure update on first week of open enrollment

ST. PAUL—MNsure CEO, Allison O’Toole, issued the following statement recapping the first full week of open enrollment:

“The first seven days of this year’s open enrollment period have gone smoothly. We are off to a strong start and doing a steady business of enrolling Minnesotans in health care coverage. Market disruptions last year— including a large jump in premiums, a major carrier pulling out of the market, the first year of enrollment caps as well as other factors—drove large numbers of consumers to our doors in the first few days of last year’s enrollment period. This year, we are seeing a much steadier flow of traffic to the website that is more in line with what we would expect. Call wait times have been consistently low throughout this first week.”

This year, MNsure renewed more people into coverage than ever before. Open enrollment figures will be released next Wednesday at MNsure’s public board meeting.

Over the past week or so I've seen or been sent several screen shots along these lines:

My plan went from $1500/mo to $2500/mo. $30,000/yr before copays and deductibles. Very affordable stuff.... pic.twitter.com/uurZFVDw7T

— Mark Gallagher (@MJGRealtor) November 1, 2017

If you click on the image to see the full-size version, the key part is this:

Your new premium:

(sigh) OK, I wasn't planning on doing week-by-week estimates/projections given how batcrap insane this Open Enrollment Period is (not just in terms of the sabotage efforts and repeal lunacy, but also due to the time window being slashed in half for most states). In the end, however, my inner data geek got the better of me, so here we are.

Today is November 7th. The 2018 Open Enrollment Period's first week ends at midnight tonight. Here's what we know so far:

UPDATE: A couple more state numbers have come in this afternoon:

This may seem a bit anticlimactic after yesterday's "200,000 on Day One!" HealthCare.Gov leak, but every data point helps.

I've received official numbers from the Massachusetts Health Connector through Day Five (November 5th).

Unlike most states, the Massachuetts exchange also handles premium billing/payments themselves, so they have a more elaborate enrollment reporting system. However, I've confirmed the following breakout:

  • 628: Current enrollees, plans selected
  • 3,860: Current enrollees, plans selected/paid
  • 445: Returning* enrollees, plans selected
  • 215: Returning enrollees, plans selected/paid
  • 1,375: New enrollees, plans selected
  • 472: New enrollees, plans selected/paid

Total: 6,995 total plans selected, of which 4,547 are fully enrolled (i.e., 1st premium paid).

*"Returning enrollees" means someone who's already in the MA exchange system because they were previously enrolled in an exchange policy in the past but isn't currently enrolled in one. For instance, they might have been enrolled from 2015-2016, but then left the exchange for 2017 and is returning for 2018.

For awhile now I've been noting that making predictions about how many people will actually enroll in ACA exchange plans for 2018 is extremely difficult to do for a variety of reasons. On the one hand, Donald Trump has been desperately trying to sabotage the law any way he can, including everything from slashing outreach funding by 90% and cutting the enrollment period in half to cutting off Cost Sharing Reduction reimbursement payments...while at the same time Congressional Republicans have been desperately trying to repeal the law outright. All of this has caused a tremendous amount of confusion, as well as causing average unsubsidized premiums to shoot up around 30% on average nationally.

As both the largest-population state in the country and the largest state-based exchange under the ACA, Covered California provides an important guideline for me when it comes to attempting to track national enrollment data. They hold over 12% of the total U.S. population and enrolled 12.7% of all ACA exchange enrollments for 2017, coming in second only to Florida's 14.4%.

Today I confirmed that on Day One of the 2018 Open Enrollment Period, CoveredCA signed up 5,979 people...around 25% more than they did on Nov. 1st last year.

Over at the Obamacare: What's Next? Facebook group, John Bruder raised an odd premium situation he ran across in Hawaii.

According to our CSR Load Load spreadsheet, Hawaii is supposed to be one of the 20-odd states using the full "Silver Switcharoo" strategy. It also has a single Rating Area, and only has two carriers (Kaiser and HMSA) participating in the individual market (on or off-exchange) anyway, making it a pretty easy state to run a full apples-to-apples year over year comparison.

Kaiser is offering a total of 11 plans on the ACA exchange (3 Bronze, 3 Silver, 3 Gold and 2 Platinum), while HMSA lists 10 (2 Bronze, 3 Silver, 3 Gold and 2 Platinum). I couldn't run a perfect comparison to 2017 since each carrier changed a couple of their offerings, but it's pretty darned close.

*(OK, Maine is a lock...except that GOP Gov. LePage is apparently still being an utter jackass about implementing it, while Virginia is still kind of iffy...see below...)

UPDATE 11/8/17: Maine voters approve Medicaid expansion

Maine voters on Tuesday decided to expand Medicaid to cover more low-income adults, becoming the first state to do so through a referendum.

Support for the ballot measure was up by more than 18 points with 64 percent of precincts reporting about 10 p.m. when it was called by NBC affiliate WCSH and The Associated Press.

The results in Maine, one of 19 states that rejected Medicaid expansion under the Affordable Care Act, comes as other Republican-led states like Utah and Idaho eye similar ballot measures.

Advocates of Medicaid expansion in Maine successfully petitioned the state to include a question on this year’s ballot following several failed legislative efforts to expand the program.

The Washington HealthPlan Finder is the 2nd state exchange to release their initial enrollment data from opening day:

  • We had a very good first day of Open Enrollment
  • Over 32,000 unique visitors and 886,000 page views
  • At peak we had 3,534 concurrent users when on 11/1 last year our peak was of 2,699 concurrent users
  • 2,108 QHP plans selected by customers who either did not have a 2018 enrollment or switched away from the plan they were auto-enrolled into
  • Over 800 new downloads of the WAHBE mobile app
  • No significant system issue was encountered

In addition, unlike the federal exchange and most state exchanges, instead of waiting until after the initial wave of erollments are out of the way, Washington auto-renews existing enrollees right up front, but then changes their policies as people log in and switch to a different policy (or cancels the renewals if people don't pay up or inform them that they're not renewing):

(sigh) A couple of weeks ago, I reported that it appeared that Illinois was joining the ranks of states which were going the full "Silver Switcharoo" route for the 2018 Open Enrollment Period, based on an article by Kristen Schorsch in Crain's Chicago Business:

Even before President Donald Trump announced plans last week to nix Obamacare subsidies, the Illinois Department of Insurance raced over the summer to get insurers on board with a strategy to minimize the financial pain of such a move.

...Trump on Oct. 12 ordered the federal government to stop paying the cost-sharing subsidies provided to insurers to defray the cost of covering low-income people. But the Rauner administration has found a way to make the federal government pick up the tab anyway.

Believe it or not, the original core focus of ACASignups.net was...wait for it...to track how many people are Signing Up for the ACA. Hard to believe, I realize.

Anyway, I have my first hard data point of the batcrap insane 2018 Open Enrollment Period, and it's a surprisingly positive one:

Enrollments in health insurance through the state’s health exchange was robust on the first day of open enrollment Wednesday, with more people signing up for insurance than last year, officials said Thursday.

Advocates and others had expressed concern that consumers would be confused by political wrangling and policy changes to the Affordable Care Act from the administration of Pres. Donald Trump that led to last-minute rate increases and a severe decrease in marketing dollars for the program.

But exchange officials reported that enrollments under the law, known as Obamacare, were up 70 percent to more than 1,800 compared with 1,055 on the first day a year ago. About 150,000 people signed up for private insurance on the exchange in the state last year and more enrolled directly through insurers.

Until today, I operated under the assumption that my home state of Michigan was among the 18 states which took the "Silver Load" approach to dealing with the Cost Sharing Reduction (CSR) cut-off by the Trump administration. Reviewing the SERFF rate filings of the various carriers participating in the individual market, it looked like most of them were loading the CSR cost onto both on and off-exchange Silver plans. I didn't check every single carrier, but that seemed to be the trend, so I filed the state under "Silver Load".

HOWEVER, earlier today, commenter "Cayo" chimed in to say:

I'm signing up for a plan off the exchange with Priority Health in Michigan. ON-Exchange, the plan is $365 a month, but off exchange (directly from their website), the price is $300 per month. I don't qualify for a subsidy, but it's still cheaper than my 2017 plan with BCBSM. That was the Multi-State Plan in Region 7 with Dental and Vision.

MAJOR UPDATE / MEA CULPA: 

Hey there, I called again and I was able to talk to a more knowledgeable agent who found out what the issue was and was able to enroll me in a plan!

Apparently, the Marketplace renewed automatically my application based on my 2016 income, which was enough to receive a tax credit in 2017, but is no longer enough to receive one in 2018.

Luckily, my income has increased since then, so I reported the change and was able to get a credit applied to the premiums

Still need to send copy of my green card for verification, but I can use the tax credit immediately

So I'm not sure why the person I talked to earlier today told me the rules had changed

Sorry for the confusion

OOF. OK, this pretty much torpedoes the entire basis of this blog entry. I'm going to leave it up in the interest of letting documented immigrants know that they ARE eligible to enroll AND for tax credits, but it sounds like the original concern may be unwarranted after all.

No one has been promoting the Silver Switcharoo option (in states which allow it) louder or more emphatically than I have for the past few weeks.

To summarize (again), this is where someone whose household income is too high for them to qualify for ACA tax credits (400% of the Federal Poverty Line) chooses an ACA-compliant off-exchange Silver plan instead, which is either identical or nearly identical to the same on-exchange policy in every way except that the additional CSR load hasn't been tacked onto it.

Here's a perfect example found by Louise Norris...ironically, this is via Priority Health here in Michigan, which (until today) I thought was a "Silver Load" state, not "Silver Switcharoo". I'll have to do some more research to be sure, but it sounds like at least one MI carrier (Priority) is going full Switch:

#1: The 2018 Open Enrollment Period is only half as long as usual in most states!

  • In the other 11 states (+DC), the deadline to enroll for 2018 coverage is later...but the final dates range from Dec. 22nd (CT) to as late as Jan. 31 (CA, DC & NY).

#2: BOTH types of Tax Credits/Subsidies ARE STILL AVAILABLE for those who qualify!

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