Today I want to address the question of Actuarial Value (AV)...that is, what percent of medical expenses (in aggregate) a given healthcare policy actually pays for. As a quick reminder, ACA policies are generally broken into four AV categories, labeled by metal levels: Bronze, Silver, Gold and Platinum, which generally cover roughly 60%, 70%, 80% or 90% of enrollees in-network medical expenses per year (there's a fifth category in front of Bronze called Catastrophic plans, but these have limited eligibility and hardly anyone enrolls in them anyway).
There's still likely up to perhaps ~25,000 or so Qualified Health Plan (QHP) enrollments to be added to the 2024 Open Enrollment Period (OEP) tally from the states which haven't reported their final, post-1/16 enrollments (in fact, CA & NY technically haven't ended theirs yet, but I decided to throw this together today for the hell of it.
The table below charts the first eleven years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota & New York, the only states where BHP programs have been implemented to date (Oregon is scheduled to launch theirs this summer, I believe).
The Centers for Medicare & Medicaid Services (CMS) reports that 21.3 million consumers have signed up for 2024 individual market health insurance coverage through the Marketplaces since the start of the 2024 Marketplace Open Enrollment Period (OEP) on November 1. This includes 16.4 million Marketplace plan selections in the 32 states using the HealthCare.gov platform for the 2024 plan year through the end of the OEP on January 16, 2024 (Week 11+), and 4.9 million plan selections in the 18 states and the District of Columbia with State-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through January 13, 2024 (Week 11) or the end of their OEP[1]. Total nationwide plan selections include 5 million consumers (24% of total) who are new to the Marketplaces for 2024, and 16.3 million consumers (76% of total) who have active 2023 coverage and returned to their respective Marketplaces to renew or select a new plan for 2024.
Historic 21.3 Million People Choose ACA Marketplace Coverage
Marketplace enrollment climbs nearly 5 million higher than previous year
The Biden-Harris Administration announced 21.3 million people selected an Affordable Care Act Health Insurance Marketplace plan during the 2024 Open Enrollment Period. Total plan selections include more than five million people — about a fourth — who are new to the Marketplaces and 16 million people who renewed their coverage. Notably, open enrollment continues in four states and Washington, D.C., through January 31.
Statement by President Joe Biden on the Record-Breaking 2024 Open Enrollment Period Under the Affordable Care Act
Today, we broke another record when it comes to lowering costs and ensuring Americans have access to quality, affordable healthcare: 21.3 million Americans have signed up for health coverage through Affordable Care Act marketplaces. That means 9 million more people have gained coverage under the law - and peace of mind - since I took office. It’s no accident. My actions to protect the Affordable Care Act and lower premiums continue to make a big difference. And the American people have made it clear: they don’t want the Affordable Care Act weakened and repealed – they want it strengthened and protected.
...we could now be looking at anywhere from 21.4 - 22.7 million QHPs, for a grand total of somewhere between 22.7 - 24.0M QHPs+BHPs combined by the time the dust settles in every state on January 1st. I'll stick with 23M for the moment just in case...
A week later, the Centers for Medicare & Medicaid Services (CMS) posted their final pre-deadline Open Enrollment Snapshot Report, which confirmed that over 20.3 million people had selected Qualified Health Plans (QHPs) through December 23rd.
As promised, here's my full state-by-state breakout of the latest 2024 ACA Open Enrollment Period "Snapshot" report as we head into the final week of enrollment in most states.
Here's an overview of the year over year comparison. I had to adjust for the missing day (thru 12/23 instead of 12/24 last year). I've also had to adjust for the fact that Virginia moved from the federal exchange to its own platform this year:
Under the Biden-Harris Administration, Over 20 Million Selected Affordable Health Coverage in ACA Marketplace Since Start of Open Enrollment Period, a Record High
As January 16 coverage deadline approaches, Biden-Harris Administration continues to encourage Americans to sign up for quality, affordable health care coverage
Under the Biden-Harris Administration, the U.S. Department of Health and Human Services announced today that over 20 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period launched on November 1 — a record number of enrollments.
CMS's press release states that they won't be posting the next detailed/state-by-state enrollment breakout until January 10th, so aside from a handful of minor SBM updates here and there, there hasn't been much to report on the enrollment front since then...until this:
Just 3 days ago, I posted a revised 2024 ACA Open Enrollment Period projection, in which I upgraded my prior projection from 18.5 million Americans signing up for either Qualified Health Plans (QHPs) or Basic Health Plans (BHPs) combined nationally to over 19 million doing so. That 18.5M projection was itself a drop from my original projection of 19M QHPs + BHPs combined from a month earlier.
I delved into the various reasons for both my original and revised projections, but the bottom line is that I figured it would end up being somewhere in the neighborhood of 19 - 19.5 million, give or take, likely broken out something like ~18 million QHPs plus another ~1.3 million BHPs in New York & Minnesota only.
I even included 20 million as an outside possibility.
