Maryland

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

A couple of weeks ago the final approved rates for Maryland's individual market were released; when plugging these into my table, my estimate of the statewide weighted average was 24.8%.

Thanks to the heads up from Louise Norris, however, I now have hard numbers from the Maryland Dept. of Insurance. I was close, but the actual weighted average is slightly higher. In addition, they've provided the small group averages as well:

The Maryland Insurance Administration Approves Premium Rates for 2017 Small Group and Individual Markets
Open Enrollment Begins Nov. 1 in the individual market; Consumers Encouraged to Shop Rates

Every once in awhile I remember what I actually do for a living (I'm a website developer, for those who don't know). That's actually a major reason I started this project in the first place...the techical meltdown of HealthCare.Gov and many of the state-based exchange sites in October 2013 fascinated me, leading me to start trying to assess just how many people were actually enrolling in the plans using the messy websites, and it spread from there.

Since then, of course, most of the exchange sites have been vastly improved. HealthCare.Gov is literally​ 100,000x better than it was in 2013 (while also now being considered among the most secure major consumer websites in the world), and has completely overhauled and streamlined their user interface and workflow process (cutting the number of screens for creating an account from around 80 down to 16). They've also added some nifty features like their Expected Total Cost, Network and Formulary tools.

Thanks to "M E" in the comments for the heads up regarding Maryland's approved rate hikes:

The cost of health insurance plans offered under the Affordable Care Act will jump 20 percent or more next year under rates to be announced Friday by Maryland regulators.

His remarks came as the Maryland Insurance Administration approved double-digit rate increases for the four companies that sell health plans through the state exchange, an online marketplace set up under the law for people who cannot buy coverage through their employer.

...CareFirst, which holds 68 percent of the market, received an average hike of 31.4 percent on its PPO plan and 23.7 percent on its HMO — the highest increases of any insurer.

...Rates in Maryland also have been typically lower than those nationally under the Affordable Care Act, so there could be some normalizing going on, said John Holahan, a fellow in the Urban Institute's Health Policy Center.

"Maryland rates have been lower than the rest of the nation so it seems some catching up should be expected," said Holahan.

Maryland was one of the first states I ran a weighted average rate request on back in May. At the time, it looked like around a 15.0% average request for the individual market state-wide:

However, as with Arizona and Tennessee, the largest carrier in the state has since submitted revised rate requests:

BALTIMORE – Commissioner Al Redmer, Jr. will be conducting a second public hearing on Monday, August 15th from 11 am – 1 pm at the Maryland Insurance Administration located at 200 St. Paul Place, 24th floor Hearing Room, Baltimore, MD 21202 to receive public input on a revised filing made by CareFirst. On July 26, CareFirst refiled its 2017 proposed rates for the individual market and requested a 27.8% rate increase for HMO plans and a 36.6% rate increase for PPO plans. CareFirst previously requested a 12.0% and 15.3% rate increase, respectively.

Interesting. When I last checked in on the Maryland exchange, their effectuated QHP enrollment was down about 14% since the end of open enrollment (from 162,177 QHP selections to 139,379 effectuated enrllees as of the end of April).

However, they just posted the following market share breakdown, which shows that they currently have 148,403 Marylanders enrolled in exchange policies, a net drop of just 8.5%. Apparently they've added more people during the off season via SEPs than they've lost due to attrition since April.

Last year, Maryland's individual market saw rate hike requests average roughly 20% overall. For 2017, it doesn't look quite as bad on a percentage basis (although obviously the actual dollar increase is still on top of last year's):

Health insurers seek rate increases in Maryland as United Healthcare quits market

...United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.

Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market.

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

Maryland's ACA exchange saw a dramatic 35% year over year enrollment increase during the 2016 Open Enrollment Period, totalling 162,177 QHP selections.

I was just informed by the MD Health Benefit Exchange that as of April, their effectuated individual enrollments are down to 139,379 people. That's a drop of just over 14%. This is completely in line with my numbers for 8 other states.

A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.

In the past few days, this has become increasingly clear, as Centene's news from yesterday shows.

As Kevin Drum at Mother Jones notes (quoting Richard Mayhew of Balloon Juice):

As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.

In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.

Investor's Business Daily's Jed Graham picked up on some of my work for his post today, including the enrollment data for both Minnesota and Connecticut...but in addition to that extra data point (which I'll come back to in a moment), he also nabbed the latest number out of a third state, Oklahoma, from one of Adam Cancryn's updates on what I'm calling the UnitedHealthcare Disenrollment Odometer:

A couple of weeks ago, the Maryland ACA exchange provided me with their semi-official OE3 enrollment tally:

As of 2/1, total QHPs are 165,123 (49,377 new + 115,746 renewal-active and passive).

However, this number didn't include a few "overtime" days of enrollees, which padded the number a bit more...nor did it include the subtraction of unpaid QHP enrollees (ie, cancellations/purging of enrollees who didn't pay their January premiums in time, were transferred to Medicaid due to income changes and so forth).

A few days ago they issued a formal press release with the official final tally, which is, as expected, slightly lower than 165K...but not by much:

MORE THAN 162,000 MARYLANDERS ENROLLED IN HEALTH COVERAGE FOR 2016 THROUGH THE STATE MARKETPLACE

AMONG FASTEST GROWTH RATES IN U.S. SINCE 2015

I just received an update out of the Maryland Health Connection:

As of 2/1, total QHPs are 165,123 (49,377 new + 115,746 renewal-active and passive).

It's important to note that Maryland is still taking OE3 enrollees through Friday via their "In Line by Midnight" extension due to the lingering impact of the snowstorm a couple of weeks back, so MD's final official number will actually be slightly higher than this.

Even without the stragglers, however, Maryland kicked butt again this year, enrolling over 10% more people than the 150K that both they and I were expecting (and even more than my preliminary projection of 163K)...and a whopping 37% higher than 2015's total.

Hmmm...this was unexpected:

ALERT! If you started enrolling by 1/31 deadline but unable to finish due to recent snowstorm, you may finish by 2/5 pic.twitter.com/U9X3QhTIT9

— MD Health Connection (@MarylandConnect) January 29, 2016

I'm surprised by this for several reasons. The snowstorm was nearly a week ago, and there's still 3 days left for people to enroll as it is; are there still a lot of areas of Maryland coping with power outages/other disruptions which are making it unreasonable to expect people to get in under the wire?

Second, because CMS just stated pretty unequivocally that HealthCare.Gov will not be offering any official deadline extension (although, like the MD exchange, they did say that they'll have an "in line by midnight" exception). I assumed that if HC.gov was taking a "hard line stance" that the state exchanges would as well.

Maryland already exceeded my (and their) OE3 target of 150K QHPs a few weeks ago, so anything more is just gravy, but every bit helps counter the shortages I'm seeing in other states. Last week they reported 155,701 QHP selections as of 1/20/16.

Just now, they confirmed the latest numbers ahead of Sunday's final deadline:

As of 1/26, 156,695 QHP / 304,667 Medicaid / 25,784 Dental.

I've never really tracked dental plans, and I'll be writing about the latest Medicaid numbers later, but that's 156,695 QHPs as of 1/26, or 994 more in the past 6 days, or 166 per day.

This is actually a slowdown from MD's average from 12/28 - 1/20, when they reported a net gain of 5,408 over 23 days (235 per day). On the other hand, given how much Maryland has been kicking butt this year, perhaps they're just running out of people to, you know, enroll.

Anyway, MD is on track to add at least another 1,000, potentially up to 3,000 more for a final number close to 160K.

The final 2016 deadline to enroll in a qualifying healthcare plan for policies starting coverage as of March 1st officially ended as of MIDNIGHT on January 31st.

As usual however, there are a few caveats to this...but not as many as the past two years:

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