ASPE Issue BRIEF Inc HEALTH INSURANCE MARKETPLACE: MARCH ENROLLMENT REPORT For the period: October 1, 2013 – March 1, 2014 March 11, 2014 This is the fifth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace (Marketplace hereafter). 1 This brief includes data for states that are implementing their own Marketplaces (also known as State-Based Marketplaces or SBMs), and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services (including those run in partnership with states, also known as the Federally-facilitated Marketplace or FFM). This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status) and the plans that they have selected (by metal level); as well as additional data on the characteristics of people who have selected plans in the FFM and the plans they have selected. (Detailed state-level tables can be found in Appendix C, and in the Addendum to the March Marketplace Enrollment Report). 2 Cumulative enrollment-related activity during the first five months (10-1-13 to 3-1-14) of the initial open enrollment period is reported for several metrics, including: the number of visits to the Marketplace websites, the number of calls to the Marketplace call centers, the number of persons who have been determined or assessed eligible by the Marketplaces for Medicaid or the Children’s Health Insurance Program (CHIP), 3 and the number of persons who have selected a plan through the Marketplace. This report features cumulative data for the five-month period because some people apply, shop, and select a plan across monthly reporting periods. 1 The previous Marketplace enrollment reports can be accessed at http://www.aspe.hhs.gov/health/reports/2012/ACAResearch/index.cfm. 2 The Addendum to the March Enrollment Report is available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014Mar_enrollAddendum.pdf. 3 Data related to Medicaid and CHIP eligibility in this report are based on applications submitted through the Marketplaces. October through January data based on applications submitted through state Medicaid/CHIP agencies were released by the Centers for Medicare & Medicaid Services in a separate report, “Medicaid & CHIP: January 2014 Monthly Applications and Eligibility Determinations Report, February 28, 2014,” which can be accessed at http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/January-2014-EnrollmentReport.pdf. Comparable February 2014 enrollment data based on applications submitted through state Medicaid/CHIP agencies will be released in a subsequent report. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation http://aspe.hhs.gov ASPE Issue Brief Page 2 The cumulative number of individuals that have selected a Marketplace plan between 10-1-13 and 3-1-14 (including those who have paid a premium and those who have not yet paid a premium) is more than 4.2 million. Figure 1 and Table 1 show that, consistent with expectations, 4 the proportion of young adults (ages 18 to 34) who have selected a Marketplace plan through the SBMs and FFM has remained strong. Young adults continued to account for 27 percent of the Marketplace plan selections during the fifth month, which was consistent with their share of plan selections during the fourth month (27 percent) and 3 percentage points higher than their share of plan selections during the first three months (24 percent). Meanwhile, the proportion of older adults (ages 35 and over) selecting a Marketplace plan has continued to decrease (from 70 percent during the first three months to 67 percent during the fifth month). Figure 1 Trends in the Age Distribution of Individuals Who Have Selected a Marketplace Plan, 10-1-13 to 3-1-14 The proportion of young adults (ages 18-34) selecting a Marketplace plan (27%) remained constant during the fifth month of the initial open enrollment period, while the proportion of older adults (35 & over) selecting a Marketplace plan continued to decrease 100% 90% 80% 70% 60% 70% 68% 67% 24% 27% 27% 50% 40% 30% 20% 10% 6% 5% 6% Marketplace Plan Selections During the First Three Months 10-1-13 to 12-28-13 0% Marketplace Plan Selections During the Fourth Month 12-29-13 to 2-1-14 Marketplace Plan Selections During the Fifth Month 2-2-14 to 3-1-14 Ages 0-17 Ages 18-34 Ages 35 & over Notes: Represents cumulative monthly data on the number of unique individuals who have been determined eligible to enroll in a Marketplace plan through the SBMs and FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). The percent distribution excludes plan selections where the age is unknown. During the first 3 months, 2.2 million individuals selected a plan; during the 4th month, 1.1 million selected a plan; and during the 5th month, 0.9 million selected a plan, for a total of 4.2 million Marketplace plan selections for 10-1-13 to 3-1-14. Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. 4 The general expectation is that people who are older and sicker are more likely to select coverage earlier in the initial enrollment period, while “younger and healthier people will tend to wait until towards the end of the open enrollment period (which concludes March 31, 2014).” “The Numbers Behind “Young Invincibles” and the Affordable Care Act,” Larry Levitt, Gary Claxton and Anthony Damico, Kaiser Family Foundation, December 17, 2013, available at http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-theaffordable-care-act/. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 3 Table 1 Trends in the Distribution of Marketplace Plan Selections By Age Group (based on data reported as of 3-7-14) MARKETPLACE TOTAL Ages 0-17 Ages 18-34 Ages 35 & over Subtotal With Available Data on Age Unknown Age Total, All Ages SBM SUBTOTAL Ages 0-17 Ages 18-34 Ages 35 & over Subtotal With Available Data on Age Unknown Age Total, All Ages FFM SUBTOTAL Ages 0-17 Ages 18-34 Ages 35 & over Subtotal With Available Data on Age Unknown Age Total, All Ages Cumulative Total, First Three Months 10-1-13 to 12-28-13 Number % of Total Change, Fourth Month Only 12-29-13 to 2-1-14 Number % of Total Change, Fifth Month Only 2/2/14 to 3-1-14 Number % of Total Cumulative Total, First Five Months 10-1-13 to 3-1-14 Number % of Total 126,735 489,460 1,442,012 6% 24% 70% 60,192 318,055 796,138 5% 27% 68% 64,329 268,475 669,284 6% 27% 67% 251,256 1,075,990 2,907,434 6% 25% 69% 2,058,207 95,214 2,153,421 100% n/a n/a 1,174,385 -28,314 1,146,071 100% n/a n/a 1,002,088 -59,255 942,833 100% n/a n/a 4,234,680 7,645 4,242,325 100% n/a n/a 61,049 212,909 595,016 7% 25% 68% 21,516 114,187 293,725 5% 27% 68% 18,287 84,549 220,001 6% 26% 68% 100,852 411,645 1,108,742 6% 25% 68% 868,974 88,017 956,991 100% n/a n/a 429,428 -26,515 402,913 100% n/a n/a 322,837 -61,502 261,335 100% n/a n/a 1,621,239 0 1,621,239 100% n/a n/a 65,686 276,551 846,996 6% 23% 71% 38,676 203,868 502,413 5% 27% 67% 46,042 183,926 449,283 7% 27% 66% 150,404 664,345 1,798,692 6% 25% 69% 1,189,233 7,197 1,196,430 100% n/a n/a 744,957 -1,799 743,158 100% n/a n/a 679,251 2,247 681,498 100% n/a n/a 2,613,441 7,645 2,621,086 100% n/a n/a Note: These percentages are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age. (Source: Centers for Medicare & Medicaid Services, as of 3-7-2014.) ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 4 There was a 29 percent increase in the cumulative number of individuals who have selected a Marketplace plan during the month of February. While the total number of new Marketplace plan selections was slightly lower in February when compared with the previous month of January (942,000 versus 1,146,000, respectively), the rate of Marketplace plan selections is expected to increase as the March 31, 2014 end of the initial open enrollment period approaches. Anticipated Enrollment Growth in March Based on the experience of private employers, the Federal Employees Health Benefits Program (FEHBP), Medicare Part D, Massachusetts’ Commonwealth Care, and the Children’s Health Insurance Program (CHIP), several factors drive enrollment rates, particularly in the early months of program operation, 5 including: • “Action-forcing” events — such as the end date of an open enrollment period or the start date for benefits — often result in a spike in enrollment activity. • The length of a program’s pre-benefit period (i.e., the period between sign-up/enrollment and the receipt of benefits) also affects rates of initial enrollment: Shorter pre-benefit periods (e.g., 1 month) tend to generate higher initial enrollment rates than longer prebenefit periods, during which the consumer may perceive little advantage to signing up or enrolling early. Medicare Part D, which had a six-month open enrollment period, experienced faster initial rates of enrollment compared to Massachusetts Commonwealth Care, which allowed continuous enrollment throughout the year. However, initial take-up rates were slower for the State Children’s Health Insurance Program (CHIP), with only 60 percent of eligible children participating in CHIP in 2003, fully five years after states began implementing their CHIP programs in 1998. Additionally, Medicare Part D and other programs such as employer sponsored insurance and the Federal Employees Health Benefits Program (FEHBP) have experienced a surge of enrollment as their respective open enrollment periods came to an end. For example, more than 1 million beneficiaries enrolled during the last week of the Medicare Part D initial open enrollment period. 6 Additionally, data from FEHB show that nearly a quarter (22 percent) of the employees who changed their enrollment during the 2012 open enrollment season made their selection in the last two days before the season’s deadline. Based on this experience, a similar enrollment surge is expected in March as the close of the initial open enrollment period approaches for the Marketplace. 5 For additional information, please refer to Appendix C of the November Marketplace Enrollment Report, which can be accessed at http://www.aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/rpt_enrollment.pdf. 6 Centers for Medicare & Medicaid Services, “Enrollment Activity on May 15th,” Press Release, May 16, 2006. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 5 February Enrollment Growth There was continued growth in total Marketplace plan selections in February, compared to the OctoberJanuary period: • Marketplace Total (SBMs and FFM) – there was a 29 percent increase in plan selections in February o • SBMs – there was a 19 percent increase in plan selections in February o • the 3,299,500 cumulative number in October-January rose by 942,800 in February to a cumulative five month total of 4,242,300 the 1,359,900 cumulative number for October-January rose by 261,300 in February to a cumulative five month total of 1,621,200 FFM – there was a 35 percent increase in plan selections in February o the 1,939,600 cumulative number in October-January rose by nearly 681,500 in February to a cumulative five month total of nearly 2,621,100 The following are highlights of Marketplace enrollment-related information for the first five months of the initial open enrollment period (see Appendix C and the Addendum to the March Marketplace Enrollment Report for specific state-level data). Cumulative Highlights for the period: October 1, 2013 – March 1, 2014 Marketplace Eligibility Determinations and Plan Selection • Number of Eligible Persons who have Selected a Plan through the SBMs and FFM: 4.2 million • Number of Persons who have had a Medicaid/CHIP Determination or Assessment through the Marketplaces: 4.4 million (does not include individuals applying through State Medicaid/CHIP agencies.) Marketplace Plan Selection by Gender • 45 percent 7 of the persons who have selected a Marketplace plan are male • 55 percent of the persons who have selected a Marketplace plan are female Marketplace Plan Selection by Age • 25 percent of the persons who have selected a Marketplace plan are between the ages of 18 and 34 o The percent of young adults who selected a Marketplace plan was 3 percentage points higher in January and February than it was from October through December (27 percent versus 24 percent) • 31 percent of the persons who have selected a Marketplace plan are between the ages of 0 and 34 Marketplace Plan Selection by Metal Level • 18 percent of the persons who have selected a Marketplace plan have selected a Bronze plan • 63 percent of the persons who have selected a Marketplace plan have selected a Silver plan • 11 percent of the persons who have selected a Marketplace plan have selected a Gold plan • 6 percent of the persons who have selected a Marketplace plan have selected a Platinum plan • 1 percent of the persons who have selected a Marketplace plan have selected a Catastrophic plan Marketplace Plan Selection by Financial Assistance 7 Based on the total number of plan selections for which the applicable data are available (excluding unknown). ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 6 • 83 percent of the persons who have selected a Marketplace plan have selected a Marketplace Plan with Financial Assistance 8 FFM Marketplace Plan Selection by Gender and Age • 26 percent of the males who have selected a Marketplace plan through the FFM are between 18 and 34 • 25 percent of the females who have selected a Marketplace plan through the FFM are between 18 and 34 FFM Marketplace Plan Selection by Gender and Metal Level • 69 percent of the females who have selected a Marketplace plan through the FFM have selected a Silver plan • 65 percent of the males who have selected a Marketplace plan through the FFM have selected a Silver plan FFM Marketplace Plan Selection by Financial Assistance Status and Metal Level • 74 percent of the persons who have selected a Marketplace plan with Financial Assistance through the FFM have selected a Silver plan • 94 percent of the persons selecting a Silver plan in the FFM will be receiving Federal financial assistance in paying their premiums 26 percent of the persons who have selected a Marketplace plan without Financial Assistance through the FFM have selected a Silver plan • • 30 percent of the persons who have selected a Marketplace plan without Financial Assistance through the FFM have selected a Bronze plan FFM Marketplace Plan Selection by Metal Level and Age • 66 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Silver plan • 15 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Bronze plan • 10 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Gold plan • 5 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Platinum plan • 4 percent of the young adults between the ages of 18 and 34 who selected a Marketplace plan through the FFM selected a Catastrophic plan o Young adults account for 91 percent of all catastrophic plan selections through the FFM 8 Represents individuals who have selected a Marketplace plan, and qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR). ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 7 Monthly Data on Marketplace Plan Selection – As shown in Figure 2, the cumulative number of persons who have selected a Marketplace plan has increased considerably since the end of the fourth month of the initial open enrollment period. Figure 2 Trends in the Cumulative Number of Individuals Who Have Selected a Marketplace Plan, 10-1-13 to 3-1-14 Over 4.2 million people have selected a Marketplace plan since October 1st, including 2.6 million who have selected a plan through the FFM 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 Week 1 (10-1-13) Week 5 (11-2-13) Week 9 (11-30-13) Week 13 (12-28-13) Week 18 (2-1-14) Week 22 (3-1-14) Marketplace Total Cumulative Number Who Have Selected a Marketplace Plan FFM Cumulative Number Who Have Selected a Marketplace Plan SBM Cumulative Number Who Have Selected a Marketplace Plan Notes: Represents cumulative monthly sums of data on the number of unique individuals who have been determined eligible to enroll in a plan through the FFM, and have selected a plan (with or without the first premium payment having been received by the issuer). Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 8 Additionally, Table 2 shows that the cumulative number of young adults (ages 18 to 34) selecting a Marketplace plan grew faster than for other age groups when the five month period is compared to the four month period. The cumulative number of young adults selecting a Marketplace plan has increased by 33 percent (268,475) since February 1st (from 807,515 to 1,075,990). By comparison, there was a 30 percent increase in Marketplace plan selections for all other age groups during the same time period (from 2.4 million to nearly 3.2 million). Table 2 Trend In the Cumulative Number of Marketplace Plan Selections By Age Group (based on data reported as of 3-7-14) Cumulative Total, First Four Months 10-1-13 to 2-1-14 Cumulative Total, First Five Months 10-1-13 to 3-1-14 % Change MARKETPLACE TOTAL Ages 18 to 34 807,515 1,075,990 33% All Other Age Groups Combined 2,425,077 3,158,690 30% Subtotal With Available Data on Age 3,232,592 4,234,680 31% Unknown Age 66,900 7,645 -89% 3,299,492 4,242,325 29% 327,096 971,306 411,645 1,209,594 26% 25% 1,298,402 1,621,239 25% 61,502 0 -100% 1,359,904 1,621,239 19% Ages 18 to 34 All Other Age Groups Combined 480,419 1,453,771 664,345 1,949,096 38% 34% Subtotal With Available Data on Age 1,934,190 2,613,441 35% 5,398 7,645 42% 1,939,588 2,621,086 35% Marketplace Total SBM TOTAL Ages 18 to 34 All Other Age Groups Combined Subtotal With Available Data on Age Unknown Age Marketplace Total FFM TOTAL Unknown Age Marketplace Total Notes: These percentages for Ages 18 to 34 and All Other Age Groups Combined are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age. The number of Marketplace plan selections with unknown age decreased significantly for the SBMs in comparison to the previous reporting period due to an increase in the completeness of data reporting for this metric. Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. • Marketplace Plan Selections by Age – The proportion of Marketplace plan selections by persons between the ages of 18 and 34 has been increasing. Persons between the ages of 18 and 34 account for nearly a quarter (25 percent) of all Marketplace plan selections (SBMs and FFM) for the first five months of the initial open enrollment period (compared to 24 percent during the first three months of the initial open enrollment, and 27 percent during the months of January and February). o SBMs: 25 percent between the ages of 18 and 34 (10-1-13 to 3-1-14). o FFM: 25 percent between the ages of 18 and 34 (10-1-13 to 3-1-14). ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 9 Table 3 shows the age distribution of the Marketplace plan selections (SBMs and FFM) during the first five months of the initial open enrollment period. Table 3 Comparison of the Age Distribution of Marketplace Plan Selections (SBM & FFM) For the Five Month period: 10-1-13 to 3-1-14 (based on data reported as of 3-7-14) Age < 18 Age 18-25 Age 26-34 Age 35-44 Age 45-54 Age 55-64 Age ≥65 9 Total Ages 18 to 34 Percent of Total Individuals Who Have Selected a Marketplace Plan (1) 6% 10% 16% 16% 23% 30% 0% 100% 25% (1) These percentages are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for age. Additionally, these percentages have been rounded, and may not add to totals due to rounding errors. (Source: Centers for Medicare & Medicaid Services, as of 3-7-2014.) Consumer Shopping – Marketplace plan selection is expected to continue to grow. Consumer interest in gaining health coverage continues to be strong among Americans who currently lack insurance – a recent Gallup survey found that 55 percent of uninsured adults say that they are likely to get health insurance in 2014, and the majority of those who intend to get insurance plan to use the Marketplace. 10 Similarly, a recent McKinsey & Company survey found that most (65 percent) of the respondents who said that they intend to enroll in coverage are persons who were previously uninsured. 11 Recent national surveys indicate that the number of Americans with health insurance coverage is growing. For example, Gallup has found that the percentage of uninsured Americans has decreased by 1 percentage point during the first quarter of 2014 (16 percent uninsured, compared to 17.1 percent in the fourth quarter of 2013). 12 Similarly, McKinsey & Company’s February survey of consumers eligible to purchase individual coverage during open enrollment (either on or off the Marketplace) found that 27 percent of those surveyed who enrolled in health coverage in 2014 report they were previously uninsured (compared with 11 percent in earlier McKinsey 9 There are nearly 400,000 uninsured persons over the age of 65; some persons over 65 have selected Marketplace plans. 10 “Majority of Uninsured Say They Will Get Insurance,” Frank Newport, Gallup daily tracking poll, March 7, 2014, accessed at http://www.gallup.com/poll/167786/majority-uninsured-sayinsurance.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm _term=Well-Being. 11 McKinsey Center for U.S. Health System Reform, “Individual market enrollment: Updated view,” March 2014, accessed at healthcare.mckinsey.com/reform. 12 “U.S. Uninsured Rate Drops so Far in First Quarter of 2014,” Jenna Levy, Gallup Gallup-Healthways Well-Being Index survey, February 12, 2014, accessed at http://www.gallup.com/poll/167393/uninsured-rate-drops-far-firstquarter-2014.aspx ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 10 surveys), and 10 percent of all respondents who self-identified as being previously uninsured said that they had enrolled in a product (compared with 3 percent in January). 13 Overview of Enrollment-Related Activity to Date Selected a Marketplace Plan – To date, 4.2 million persons have selected a Marketplace plan during the first five months of the initial open enrollment period, including 1.6 million in SBMs and 2.6 million in the FFM (these numbers include those who have paid a premium and those who have not yet paid a premium, regardless of when their coverage begins). The following are additional highlights of the preliminary data on the characteristics of Marketplace plan selections during the first five months of the initial open enrollment period (see Appendix A for national-level tables, and see the Addendum to the March Marketplace Enrollment Report for state-level tables). 14 • Marketplace Plan Selections by Gender – The gender distribution of Marketplace plan selections has remained constant. More than half of the people who have selected a Marketplace plan through the SBMs and FFM during the first five months of the initial open enrollment period are female (55 percent of the total for the Marketplace as a whole, excluding plan selections where gender is unknown), while the remaining 45 percent are male. The comparable proportions for the first four months of the initial open enrollment period were 55 percent and 45 percent, respectively. o SBMs: 54 percent female, 46 percent male (10-1-13 to 3-1-14). o FFM: 56 percent female, 44 percent male (10-1-13 to 3-1-14). By comparison, males account for half (50 percent) of the total non-elderly population in the United States (ages 0 to 64). 15 • Marketplace Plan Selections by Metal Level – The proportion of Silver Marketplace plan selections has continued to increase. Silver plans account for nearly two-thirds (63 percent) of the Marketplace plan selections in the SBMs and FFM between 10-1-13 and 3-1-14 (compared with 62 percent during the first four months of the initial enrollment period). o SBMs: 58 percent Silver (10-1-13 to 3-1-14). o FFM: 67 percent Silver (10-1-13 to 3-1-14). The metal level distribution of the remaining Marketplace plan selections (SBMs and 13 McKinsey Center for U.S. Health System Reform, “Individual market enrollment: Updated view,” March 2014, accessed at healthcare.mckinsey.com/reform. 14 The percentages cited in this section are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for a given metric (e.g., age, gender, metal level, etc.) Aggregate data on the total number of plan selections with available data for a given metric, and the corresponding number of plan selections with unknown data for a given metric can be found in Appendix Table A1. 15 ASPE analysis of the 2010-2012 Current Population Survey Annual Social and Economic Supplement (CPS ASEC, covering calendar years 2009-2011), adjusted using ASPE’s TRIM3 microsimulation to include only estimated nonelderly U.S. citizens and others lawfully present. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 11 FFM) are as follows: bronze (18 percent), gold (11 percent), platinum (6 percent), and catastrophic (1 percent). • Marketplace Plan Selections by Financial Assistance Status – The proportion of Marketplace plan selections with financial assistance (i.e., Marketplace plan selections by individuals who are eligible to receive financial assistance) has also continued to increase. Based on data for the first five months of the initial open enrollment period, more than eight out of ten (83 percent) of the people who have selected a Marketplace plan through the SBMs and FFM are eligible to receive Federal financial assistance in paying their premiums. 16 The comparable proportion for the first four months of the initial open enrollment period was 82 percent. o SBMs: 81 percent in Marketplace plans with financial assistance (10-1-13 to 3-114). o FFM: 85 percent in Marketplace plans with financial assistance (10-1-13 to 3-114). Tax credits for premium assistance may be available to individuals with family incomes between 100 and 400 percent of the Federal Poverty Level (138 to 400 percent of FPL in states taking the Federally-funded option to expand Medicaid). These percentages are consistent with previous estimates. 17 Additional Characteristics of FFM Marketplace Plan Selections – The following are highlights of preliminary data on additional characteristics of FFM Marketplace plan selections, based on cross-tabulations of the abovementioned metrics (see Appendix B for national-level tables, and see the Addendum to the Marketplace Enrollment Report for state-level tables). • FFM Marketplace Plan Selections by Gender and Age o Young adults (ages 18-34) accounted for 26 percent of all males selecting Marketplace plans through the FFM, compared with 25 percent of all females selecting Marketplace plans through the FFM, and 25 percent of all FFM Marketplace plan selections as a whole. o Meanwhile, adding children ages 0 to 17 results in males between the ages of 0 and 34 accounting for nearly a third (33 percent) of all males selecting Marketplace plans through the FFM, compared with 30 percent for females, and 31 percent for all persons who selected a Marketplace plan through the FFM. • FFM Marketplace Plan Selections by Gender and Metal Level o Females were more likely to select Silver plans in the FFM (69 percent versus 65 16 This includes people who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR). 17 For example, the Congressional Budget Office (CBO) estimates for CY 2014 were as follows: 6 million subsidized / 7 million total in Marketplace = 86% with financial assistance. (Source: "Effects on Health Insurance and the Federal Budget for the Insurance Coverage Provisions in the Affordable Care Act—May 2013 Baseline," May 14, 2013, accessed at http://www.cbo.gov/sites/default/files/cbofiles/attachments/44190_EffectsAffordableCareActHealthInsuranceCover age_2.pdf.) ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 12 percent for males). o Males were more likely to select Bronze plans in the FFM (17 percent versus 15 percent for females). • FFM Marketplace Plan Selections by Financial Assistance Status and Metal Level o Persons selecting a Marketplace plan who are eligible to receive financial assistance were more likely to select Silver plans in the FFM (74 percent versus 26 percent for persons selecting a Silver Marketplace plan without financial assistance). o Persons selecting a Marketplace plan without financial assistance were more likely to select Bronze plans in the FFM than other metal levels (30 percent versus 13 percent for persons selecting a Marketplace plan with financial assistance). They were also more likely to select gold, platinum and catastrophic plans than were persons who are eligible to receive financial assistance. o More than nine out of ten (93 percent) of the persons selecting a Silver plan in the FFM are eligible to receive Federal financial assistance in paying their premiums. • FFM Marketplace Plan Selections by Metal Level and Age o Among young adults (ages 18 to 34), 66 percent selected a Silver plan, while 15 percent selected a Bronze plan, 10 percent selected a Gold plan, 5 percent selected a Platinum plan, and 4 percent selected a Catastrophic plan. o Nearly one out of three (30 percent) of the nearly 543,270 persons who selected a standalone dental plan through the FFM are young adults (ages 18-34). Table 4 Cumulative Marketplace Enrollment-Related Information For the Five Month period: 10-1-13 to 3-1-14 (1) (based on data reported as of 3-7-14) Visits on the Marketplace websites (2) Calls to the Marketplace call centers Number of individuals who have selected a Marketplace plan Males who have selected a Marketplace plan (3) 18 to 34 year olds who have selected a Marketplace plan (3) Individuals who have selected a Silver Marketplace plan (3) Individuals who have selected a Marketplace plan with financial assistance (3) Marketplace Total SBM Total FFM Total 74,625,397 19,357,291 4,242,325 45% 25% 63% 22,563,745 6,227,452 1,621,239 47% 25% 58% 52,061,652 13,129,839 2,621,086 44% 25% 67% 83% 81% 85% (1) The reporting period for the first 5 months is from 10-1-13 to 3-1-14. Any differences in reporting periods among states are noted in footnotes accompanying the tables in the Addendum to the March Marketplace Enrollment Report. See Appendix D for methodological information. Visitors to the Marketplace websites is the sum of monthly data and has been unduplicated to the extent possible; however, we do not believe that all duplication has yet been removed. (2) While all SBMs have provided updated data on call center activity, not all SBMs have provided updated data on website visits. (3) Percentages shown in this table are based on the total number of plan selections for which the applicable data are available, excluding plan selections with unknown data for a given metric (e.g., age, gender, etc.) Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 13 Web Site and Call Center Volume – Interest in the Marketplaces continues to be high, as measured by visits on the SBM and FFM websites (over 74 million), 18 and calls to the SBM and FFM call centers (over 19 million) through the end of February.). Methodological Overview The data reported here have been generated by the information systems of the Centers for Medicare & Medicaid Services (CMS), based on information reported to CMS by SBMs, and information collected by the FFM for states with HHS-supported or fully run Marketplaces (including those run in partnership with states). Data for certain metrics are not yet available for some SBM states due to information system issues. (Please refer to Appendix D for additional methodological information.) As discussed earlier, this report includes cumulative data for the five-month period (10-1-13 to 3-1-14) because some people apply, shop, and select a plan across more than one monthly reporting period. To the extent possible, these counts seek to avoid potential duplication associated with monthly reporting. This report also includes preliminary data on the characteristics of persons who have selected a Marketplace plan (by gender, age, metal level, and financial assistance status for the SBMs and FFM; and for the FFM, by gender and age, gender and metal level, financial assistance status and metal level, and metal level and age). In some cases, the data for certain characteristics of Marketplace plan selections are not yet available. Detailed state-level tables can be found in Appendix C, and in the Addendum to the March Marketplace Enrollment Report. 19 We believe that the information contained in this issue brief provides the most systematic “snapshot” of enrollment-related activity in the Marketplaces to date because the data for the various metrics are counted using comparable definitions for data elements across states, and between the SBMs and FFM. It is important to note that the SBM enrollment-related data that are reported in this issue brief represent state data that have been reported to CMS through March 7, 2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report. APPENDICES Appendix A: Characteristics of Marketplace Plan Selection by Gender, Age, Metal Level, and Financial Assistance, 10-1-2013 to 3-1-2014 • A1 – Summary • A2 - By Gender and State • A3 - By Age and State Page 15 Addendum Addendum 18 While all SBMs have provided updated data on call center activity, not all SBMs have provided updated data on website visits. In addition, duplication has been removed from the data on the cumulative number of website visitors to the extent possible; however, it is possible that not all duplication has been removed. 19 The Addendum to the March Enrollment Report is available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014Mar_enrollAddendum.pdf . ASPE Office of Health Policy March 2014 ASPE Issue Brief Appendix B: Appendix C: Appendix D: Page 14 • A4 - By Metal Level and State • A5 - By Financial Assistance and State Summary of Additional Characteristics of FFM Marketplace Plan Selections, 10-1-2013 to 3-1-2014 • B1 – Summary • B2 - By Gender and Age and State • B3 - By Gender and Metal Level and State • B4 - By Financial Assistance Status and Metal Level and State • B5 - By Metal Level and Age and State Total Marketplace Eligibility Determinations, and Marketplace Plan Selections by Marketplace Type and State, 10-1-2013 to 3-1-2014 Addendum Addendum Methodology and Technical Notes Page 29 Page 17 Addendum Addendum Addendum Addendum Page 26 Note: The Addendum to the March Enrollment Report is available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014Mar_enrollAddendum.pdf . ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 15 APPENDIX A: CHARACTERISTICS OF MARKETPLACE PLAN SELECTION BY GENDER, AGE, METAL LEVEL, AND FINANCIAL ASSISTANCE STATUS 10-1-2013 TO 3-1-2014 APPENDIX TABLE A1 Marketplace Plan Selection by Gender, Age, Metal Level, Financial Assistance Status, and Marketplace Type (1) 10-1-2013 to 3-1-2014 Marketplace Total (SBMs & FFM) Description States Implementing Their Own Marketplaces (SBMs) % of Available Data, Excluding Unknown (3) Number (2) 4,242,325 n/a 1,621,239 n/a 2,621,086 n/a Female 2,317,686 55% 844,042 53% 1,473,644 56% Male 1,882,504 45% 735,368 47% 1,147,136 44% 4,200,190 100% 1,579,410 100% 2,620,780 100% 42,135 n/a 41,829 n/a 306 n/a Number (2) % of Available Data, Excluding Unknown (3) States With Marketplaces that are Supported by or Fully-Run by HHS (FFM) Number (2) % of Available Data, Excluding Unknown (3) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan By Gender Subtotal: Plan Selections With Available Data on Gender Unknown Gender By Age Age < 18 251,256 6% 100,852 6% 150,404 6% Age 18-25 411,915 10% 155,405 10% 256,510 10% Age 26-34 664,075 16% 256,240 16% 407,835 16% Age 35-44 678,084 16% 260,357 16% 417,727 16% Age 45-54 957,110 23% 374,358 23% 582,752 22% Age 55-64 1,254,977 30% 465,591 29% 789,386 30% 17,263 0% 8,436 1% 8,827 0% Age ≥65 Subtotal: Plan Selections With Available Data on Age 4,234,680 100% 1,621,239 100% 2,613,441 100% Unknown Age 7,645 n/a 0 n/a 7,645 n/a Ages 18 to34 1,075,990 25% 411,645 25% 664,345 25% Ages 0 to 34 1,327,246 31% 512,497 32% 814,749 31% 781,703 18% 370,944 23% 410,759 16% By Metal Level Bronze Silver 2,690,598 63% 937,598 58% 1,753,000 67% Gold 458,757 11% 158,858 10% 299,899 11% Platinum 272,864 6% 134,148 8% 138,716 5% 47,030 1% 19,690 1% 27,340 1% Catastrophic ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 16 Marketplace Plan Selection by Gender, Age, Metal Level, Financial Assistance Status, and Marketplace Type (1) 10-1-2013 to 3-1-2014 Marketplace Total (SBMs & FFM) Description States Implementing Their Own Marketplaces (SBMs) Number (2) Subtotal: Plan Selections With Available Data on Metal Level (4) Standalone Dental % of Available Data, Excluding Unknown (3) Number (2) 4,242,314 100% 1,621,239 100% 2,621,075 100% 544,075 n/a n/a n/a 544,075 n/a 11 n/a 0 n/a 11 n/a 3,468,666 83% 1,238,133 81% 2,230,533 85% 689,973 17% 299,420 19% 390,553 15% 4,158,638 100% 1,537,552 100% 2,621,086 100% 83,687 n/a 83,687 n/a 0 n/a Unknown Metal Level % of Available Data, Excluding Unknown (3) States With Marketplaces that are Supported by or Fully-Run by HHS (FFM) Number (2) % of Available Data, Excluding Unknown (3) By Financial Assistance Status With Financial Assistance Without Financial Assistance Subtotal: Plan Selections With Available Data on Financial Assistance Unknown Financial Assistance Status Notes: Percentages in this table have been rounded. Some numbers may not add to totals due to rounding. (1) Unless otherwise noted, the data in this table represent cumulative Marketplace enrollment-related activity for 10-1-13 to 3-1-14. For additional methodological information, please refer to Appendix D of this report. (2) For each metric, the data represent the total number of Individuals Determined Eligible to Enroll in a plan Through the Marketplace who have selected a plan (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period, excluding plan selections with unknown data for a given metric. This is also known as pre-effectuated enrollment. (3) In some cases, the data for certain characteristics of Marketplace plan selections are not yet available. For this reason, for each metric, we have calculated the comparable percentages based on the number of plan selections with known data for that metric. (4) The FFM subtotals for each metal tier type do not sum to the total number of Plan Selections With Available Data on Metal Level due to instances where consumers enrolled in more than one plan type in their state (for example, some consumers may have enrolled in both a health plan and a standalone dental plan). As a result, the corresponding percentages also do not sum to 100 percent. This also affects the data for the Marketplace total. To the extent possible, duplication associated with standalone dental plan selection has been removed from the data shown in this table. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 17 APPENDIX B – SUMMARY OF ADDITIONAL DEMOGRAPHIC CHARACTERISTICS OF FFM MARKETPLACE PLAN SELECTIONS APPENDIX TABLE B1 FFM Marketplace Plan Selections by Gender and Age; Gender and Metal Level; Financial Assistance Status and Metal Level; and Metal Level and Age (1) 10-1-2013 to 3-1-2014 FFM Total Description Number (2) Females - FFM % of Available Data, Excluding Unknown (3) Number (2) Males - FFM % of Available Data, Excluding Unknown (3) Number (2) % of Available Data, Excluding Unknown (3) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan 2,621,086 By Gender and Age Number n/a % of Gender Total (4) n/a % of Age Group Total (5) 1,473,644 Number n/a % of Gender Total (4) n/a % of Age Group Total (5) 1,147,136 Number n/a % of Gender Total (4) n/a % of Age Group Total (5) Age < 18 150,404 6% 100% 73,702 5% 49% 76,654 7% 51% Age 18-25 256,510 10% 100% 139,925 10% 55% 116,567 10% 45% Age 26-34 407,835 16% 100% 226,380 15% 56% 181,421 16% 44% Age 35-44 417,727 16% 100% 231,921 16% 56% 185,769 16% 44% Age 45-54 582,752 22% 100% 331,376 23% 57% 251,316 22% 43% Age 55-64 789,386 30% 100% 461,827 31% 59% 327,465 29% 41% 8,827 0% 100% 4,733 0% 54% 4,092 0% 46% 2,613,441 100% 100% 1,469,864 100% 56% 1,143,284 100% 44% Age ≥65 Subtotal: Plan Selections With Available Data on Age Unknown Age 7,645 n/a n/a 3,780 n/a n/a 3,852 n/a n/a Ages 18 to34 664,345 25% 100% 366,305 25% 55% 297,988 26% 45% Ages 0 to 34 814,749 31% 100% 440,007 30% 54% 374,642 33% By Gender and Metal Level Number Bronze % of Gender Total (4) % of Metal Level Total (5) Number % of Gender Total (4) % of Metal Level Total (5) Number % of Gender Total (4) 46% % of Metal Level Total (5) 410,759 16% 100% 218,168 15% 53% 192,549 17% 47% 1,753,000 67% 100% 1,009,736 69% 58% 743,103 65% 42% Gold 299,899 11% 100% 162,879 11% 54% 136,972 12% 46% Platinum 138,716 5% 100% 73,735 5% 53% 64,965 6% 47% 27,340 1% 100% 14,159 1% 52% 13,172 1% 48% 2,621,075 100% 100% 1,473,644 100% 56% 1,147,136 100% 44% 544,075 n/a n/a 303,859 n/a n/a 240,203 n/a n/a 11 n/a n/a n/a n/a n/a n/a n/a n/a Silver Catastrophic Subtotal: Plan Selections With Available Data on Metal Level Standalone Dental Unknown Metal Level ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 18 FFM Total Description Number (2) With Financial Assistance - FFM % of Available Data, Excluding Unknown (3) % of Available Data, Excluding Unknown (3) Number (2) Without Financial Assistance FFM Number (2) % of Available Data, Excluding Unknown (3) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan By Financial Assistance Status and Metal Level (6) Bronze 2,621,086 Number n/a % of Financial Assistance Status Total (4) n/a % of Metal Level Total (5) 2,230,533 n/a % of Financial Assistance Status Total (4) Number n/a % of Metal Level Total (5) 410,759 Silver 16% 100% 294,897 13% 72% 390,553 Number n/a % of Financial Assistance Status Total (4) 115,862 30% n/a % of Metal Level Total (5) 28% 1,753,000 67% 100% 1,653,307 74% 94% 99,693 26% 6% Gold 299,899 11% 100% 198,359 9% 66% 101,540 26% 34% Platinum 138,716 5% 100% 89,067 4% 64% 49,649 13% 36% 27,340 1% 100% 0 0% 0% 27,340 7% 100% 2,621,075 100% 100% 2,230,524 100% 85% 390,551 100% 15% 544,075 n/a n/a 0 n/a n/a 544,075 n/a n/a 11 n/a n/a n/a n/a n/a n/a n/a n/a Catastrophic Subtotal: Plan Selections With Available Data on Metal Level Standalone Dental Unknown Metal Level FFM Total Description Number (2) Bronze Plan Selections - FFM % of Available Data, Excluding Unknown (3) Number (2) % of Available Data, Excluding Unknown (3) Silver Plan Selections - FFM Number (2) % of Available Data, Excluding Unknown (3) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan 2,621,086 By Metal Level and Age (6) Number n/a % of Metal Level Total (4) n/a % of Age Group Total (5) 410,759 Number n/a % of Metal Level Total (4) n/a % of Age Group Total (5) 1,753,000 Number n/a % of Metal Level Total (4) n/a % of Age Group Total (5) Age < 18 150,404 6% 100% 30,457 7% 20% 73,810 4% 49% Age 18-25 256,510 10% 100% 35,727 9% 14% 176,904 10% 69% Age 26-34 407,835 16% 100% 64,068 16% 16% 264,378 15% 65% Age 35-44 417,727 16% 100% 61,352 15% 15% 285,055 16% 68% Age 45-54 582,752 22% 100% 88,706 22% 15% 404,989 23% 69% Age 55-64 789,386 30% 100% 127,781 31% 16% 538,099 31% 68% 8,827 0% 100% 1,432 0% 16% 6,334 0% 72% 2,613,441 100% 100% 409,523 100% 16% 1,749,56 9 100% 67% 7,645 n/a n/a 1,236 n/a n/a 3,431 n/a n/a Ages 18 to34 664,345 25% 100% 99,795 24% 15% 441,282 25% 66% Ages 0 to 34 814,749 31% 100% 130,252 32% 16% 515,092 29% 63% Age ≥65 Subtotal: Plan Selections With Available Data on Age Unknown Age ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 19 Gold Plan Selections - FFM Description Platinum Plan Selections - FFM % of Available Data, Excluding Unknown (3) Number (2) % of Available Data, Excluding Unknown (3) Number (2) Catastrophic Plan Selections FFM % of Available Data, Excluding Unknown (3) Number (2) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan 299,899 n/a % of Metal Level Total (4) By Metal Level and Age (6) Number n/a % of Age Group Total (5) 138,716 n/a % of Metal Level Total (4) Number n/a % of Age Group Total (5) 27,340 n/a % of Metal Level Total (4) Number n/a % of Age Group Total (5) Age < 18 32,440 11% 22% 13,404 10% 9% 750 3% 0% Age 18-25 22,449 8% 9% 11,265 8% 4% 10,979 40% 4% Age 26-34 43,133 14% 11% 23,559 17% 6% 13,743 50% 3% Age 35-44 46,031 15% 11% 25,751 19% 6% 796 3% 0% Age 45-54 61,534 21% 11% 29,013 21% 5% 629 2% 0% Age 55-64 91,694 31% 12% 34,454 25% 4% 361 1% 0% 677 0% 8% 405 0% 5% 0 0% 0% 297,958 100% 11% 137,851 100% 5% 27,258 100% 1% 1,941 n/a n/a 865 n/a n/a 82 n/a n/a Ages 18 to34 65,582 22% 10% 34,824 25% 5% 24,722 91% 4% Ages 0 to 34 98,022 33% 12% 48,228 35% 6% 25,472 93% 3% Age ≥65 Subtotal: Plan Selections With Available Data on Age Unknown Age Description Standalone Dental Plan Selections - FFM Number (2) % of Available Data, Excluding Unknown (3) Total Who Have Selected a Marketplace Plan Number of Individuals Who Have Selected a Marketplace Plan Number Who Have Selected a Standalone Dental Plan By Metal Level and Age 544,075 Number n/a % of Metal Level Total (4) n/a % of Age Group Total (5) Age < 18 26,591 5% 18% Age 18-25 55,489 10% 22% Age 26-34 110,100 20% 27% Age 35-44 102,156 19% 24% Age 45-54 117,911 22% 20% Age 55-64 129,386 24% 16% 1,633 0% 19% 543,266 100% 21% Age ≥65 Subtotal: Plan Selections With Available Data on Age Unknown Age 809 n/a n/a Ages 18 to34 165,589 30% 25% Ages 0 to 34 192,180 35% 24% ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 20 Notes: Percentages in these tables table have been rounded. Some numbers may not add to totals due to rounding. (1) Unless otherwise noted, the data in these tables represent cumulative FFM Marketplace enrollment-related activity for 10-1-13 to 3-114. For additional methodological information, please refer to Appendix D of this report. (2) For each metric, the data represent the total number of Individuals Determined Eligible to Enroll in a plan Through the Marketplace who have selected a plan through the FFM (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period, excluding plan selections with unknown data for a given metric. This is also known as preeffectuated enrollment. (3) In some cases, the data for certain characteristics of Marketplace plan selections are not yet available. For this reason, for each metric, we have calculated the comparable percentages based on the number of plan selections with known data for that metric. (4) Represents the vertical percentage for the data that are being shown based on a given set of metrics. For example, if the rows show Age Groups and the columns show Gender, then this percentage represents the data for a given Age Group / Gender combination as a percentage of the comparable Gender total for all Age Groups (e.g., Persons between the ages of 18 and 34 represent X percent of the all of the Female Marketplace Plan selections). (5) Represents the horizontal percentage of the data that are being shown based on a given set of metrics. For example, if the rows show Age Groups and the columns show Gender, then this percentage represents the data for a given Age Group / Gender combination as a percentage of the comparable Age Group total for all Genders (e.g., Females represent X percent of the Marketplace Plan selections for persons between the ages of 18 and 34). (6) The FFM subtotals for each metal tier type do not sum to the total number of Plan Selections With Available Data on Metal Level due to instances where consumers enrolled in more than one plan type in their state (for example, some consumers may have enrolled in both a health plan and a standalone dental plan). As a result, the corresponding percentages also do not sum to 100 percent. This also affects the data for the Marketplace total. To the extent possible, duplication associated with standalone dental plan selection has been removed from the data shown in this table. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 21 APPENDIX C TOTAL MARKETPLACE ELIGIBILITY DETERMINATIONS, AND MARKETPLACE PLAN SELECTIONS BY MARKETPLACE TYPE AND STATE, 10-1-2013 TO 3-1-2014 Total Marketplace Eligibility Determinations, and Marketplace Plan Selections By Marketplace Type and State (1) (2) 10-1-2013 to 3-1-2014 Number of Individuals Determined Eligible to Enroll in a Marketplace Plan State Name Total Eligible to Enroll in a Marketplace Plan (3) Number Eligible to Enroll in a Marketplace Plan with Financial Assistance (4) Number Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace (5) Number of Individuals Who Have Selected a Marketplace Plan (6) Number Number States Implementing Their Own Marketplaces (SBMs) California (7) 1,190,260 897,256 850,000 Colorado (8) 145,877 57,605 135,560 83,469 85,804 59,638 73,842 57,465 Connecticut District of Columbia 868,936 9,750 2,073 9,630 6,249 10,968 2,628 N/A 4,661 Kentucky 165,684 67,323 222,448 54,945 Maryland 50,900 42,786 103,670 38,070 Hawaii (9) Massachusetts (10) 5,943 12,965 72,170 32,030 94,926 New York N/A 33,920 61,008 125,272 28,535 533,948 Nevada N/A 95,667 Minnesota (11) 258,556 310,645 244,618 Oregon (12) 76,223 60,142 104,715 38,806 Rhode Island 30,158 22,155 45,226 18,902 Vermont 64,872 20,894 24,333 24,326 197,220 117,751 628,893 107,262 2,758,200 1,703,735 2,706,404 1,621,239 Washington (13) SBM Subtotal States With Marketplaces that are Supported by or Fully-Run by HHS (FFM) Idaho (14) 74,085 54,624 9,443 43,861 New Mexico (14) 35,416 22,203 20,620 15,012 134,329 67,379 17,980 55,034 13,893 8,872 2,901 6,666 137,069 84,008 66,991 57,611 Arkansas 58,173 38,500 57,455 27,395 Delaware 15,085 9,023 7,663 6,538 990,455 621,139 124,363 442,087 Georgia 341,650 181,790 62,162 139,371 Illinois 246,188 151,238 131,995 113,733 Indiana 145,189 93,720 65,846 64,972 Iowa 40,113 24,467 28,981 15,346 Kansas 65,057 36,083 10,344 29,309 107,480 59,896 9,105 45,561 Alabama Alaska Arizona Florida Louisiana ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 22 Total Marketplace Eligibility Determinations, and Marketplace Plan Selections By Marketplace Type and State (1) (2) 10-1-2013 to 3-1-2014 Number of Individuals Determined Eligible to Enroll in a Marketplace Plan State Name Total Eligible to Enroll in a Marketplace Plan (3) Number Maine Eligible to Enroll in a Marketplace Plan with Financial Assistance (4) Number Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace (5) Number of Individuals Who Have Selected a Marketplace Plan (6) Number Number 47,444 Mississippi 5,494 25,412 313,644 Michigan 31,634 187,057 40,347 144,587 68,562 36,687 8,753 25,554 Missouri 170,180 96,985 32,890 74,469 Montana 39,917 27,192 3,643 22,542 Nebraska 54,311 35,213 10,557 25,582 New Hampshire 43,256 24,326 5,409 21,578 New Jersey 187,231 110,509 123,092 74,370 North Carolina 390,925 251,953 55,691 200,546 10,394 7,032 4,812 5,238 193,152 115,611 97,477 78,925 78,444 41,964 11,709 32,882 Pennsylvania 349,151 195,218 32,793 159,821 South Carolina 136,414 77,173 19,747 55,830 16,047 9,884 2,862 6,765 Tennessee 204,075 105,003 55,672 77,867 Texas 758,344 414,272 94,954 295,025 78,258 55,994 36,353 39,902 251,566 133,492 33,897 102,815 North Dakota Ohio Oklahoma South Dakota Utah Virginia West Virginia 25,133 15,965 16,569 10,599 Wisconsin 158,048 107,157 68,655 71,443 Wyoming 14,296 9,507 1,646 6,838 5,992,974 3,542,770 1,378,871 2,621,086 8,751,907 5,246,641 4,377,932 4,242,325 FFM Subtotal MARKETPLACE TOTAL, All States Notes: “N/A” means that the data for the respective metric is not yet available for a given state. (1) Unless otherwise noted, the data in these tables represent cumulative FFM Marketplace enrollment-related activity for 10-113 to 3-1-14. For additional methodological information, please refer to Appendix D of this report. (2) We are no longer showing data on the total number of completed applications and total number of individuals applying for coverage in completed applications in this table because we believe that there is duplication in these metrics. (3) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace” (i.e., a Marketplace plan) represents the total number of individuals for whom a Completed Application has been received and who are determined to be eligible for plan enrollment through the Marketplace during the reference period, whether or not they qualify for advance payments of the premium tax credit or cost-sharing reductions. These individuals may or may not have enrolled in coverage by the end of the reference period. Individuals who have been determined or assessed eligible for Medicaid or CHIP are not included. (4) “Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with Financial Assistance” represents the total number of individuals determined eligible to enroll in a Marketplace plan who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR). ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 23 (5) “Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace” represents the number of individuals who have been determined or assessed by the Marketplace as eligible for Medicaid or CHIP, based on modified adjusted gross income (MAGI). In some states, Completed Applications for individuals, whom the Marketplace has assessed as potentially eligible for Medicaid or CHIP, based on MAGI, are transferred to the relevant state agency for a final eligibility determination. In these “assessment states” the data include those accounts where a final decision is pending. In other states, the Marketplace has been delegated the final Medicaid/CHIP determination responsibility for these individuals. Thus, this data element includes FFM determinations and assessments, regardless of the state Medicaid/CHIP agency’s final eligibility determination. These data may vary from accounts transferred via ‘flat file’ to states by the FFM. Quality assurance continues on Medicaid assessments and determinations in advance of transfers to states and these figures might alter further based on that review. Note: this data element does not include eligibility determinations made by State Medicaid/CHIP agencies based on applications originally submitted to the State agency or other Medicaid/CHIP assessments or determinations. (6) “Individuals Who Have Selected a Marketplace plan” represents the total number of “Individuals Determined Eligible to Enroll in a plan Through the Marketplace” who have selected a plan (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period. This is also known as pre-effectuated enrollment. (7) California - Number of assessed/determined for Medicaid/CHIP reflects new Medicaid applicants and some ongoing caseload eligibility activity that is conducted via the state’s Marketplace. (8) Colorado – Colorado’s Marketplace, Connect for Health Colorado, uses real-time online determinations made by the Medicaid agency. Data for “Individuals Assessed Eligible for Medicaid/CHIP” includes individuals determined eligible under the Medicaid expansion and does not include CHP+ clients or those determined eligible who were previously eligible for coverage prior to the expansion of Medicaid. (9) Hawaii -- Because the Hawaii Marketplace’s eligibility system is not integrated with its state Medicaid department, the data for “Individuals Assessed Eligible for Medicaid/CHIP” are not available at this time. The Marketplace is in the process of receiving data from the state Medicaid department on applicants who have been determined ineligible for Medicaid or CHIP. It is anticipated that the proportion of QHP eligible individuals with Financial Assistance will increase as these applicants are transferred from the Medicaid agency to the Marketplace. (10) Massachusetts – Data for "Number of Individuals Determined Eligible for Enrollment into a QHP" are as of 11/30/13. Due to Massachusetts’ system constraints, data for “Individuals Determined or Assessed Eligible for Medicaid/CHIP” are not available at this time. Massachusetts’ cumulative data for “Individuals Who Have Selected a Marketplace Plan” does not include 48,000 new applicants above 133 percent FPL who are in Temporary Subsidized Coverage; these individuals will be processed for QHP Eligibility Determination and potential coverage retroactive to the current reporting period. There are also 109,000 persons between 133 and 300 percent FPL currently in extended Commonwealth Care coverage, who were scheduled to transition to QHP coverage following October 1, 2013, but who have not been processed due to systems problems. Another 32,000 persons with income >300% FPL currently in the Commonwealth Choice program are current members who are scheduled to be processed for QHP coverage by March 31, 2014. Without the systems obstacles faced by the Massachusetts Marketplace, the number of individuals enrolled in a QHP with the Massachusetts Health Connector as of 3/1/14 might be as many as 201,000. (11) Minnesota -- Minnesota's cumulative data for “Individuals Determined Eligible to Enroll in a Marketplace Plan,” “Individuals Determined Eligible to Enroll in a Marketplace Plan with Financial Assistance,” and “Individuals Who Have Selected a Marketplace Plan” do not include adults between 133% and 200% of the Federal Poverty Level (FPL) because these individuals are enrolled in the MinnesotaCare program. In addition, children up to 275% FPL are covered through the Medicaid program. Hence, when comparing Minnesota's cumulative data for these indicators with other State-Based Marketplaces, the number of individuals determined eligible for MinnesotaCare and enrolled in MinnesotaCare are worth noting. (12) Oregon - Oregon - Oregon's data for QHP eligible individuals broken out by financial assistance are estimates based on analysis of special-purpose enrollment files for the reporting period. "Total Eligible with APTC" is an estimate based on analysis of enrollment files sent to issuers through December 31, 2013. The total rolls up to actual total QHP eligible individuals. Cover Oregon will update with actuals as soon as its electronic reporting application is configured and tested to accurately report determinations. (13) Washington -- Washington’s cumulative total for “Individuals Assessed Eligible for Medicaid/CHIP” may include some persons whose eligibility is being re-determined rather than newly determined. For example, an application for a family may include parents applying to the Marketplace for initial coverage, while children are already covered. Additionally, the "Number of Individuals Enrolled in a QHP (Plan Selection)" is an undercount, as Washington is only able to report individuals who have both enrolled and paid for coverage. (14) Idaho and New Mexico are Federally supported SBMs for 2014; they are using the FFM platform for 2014. Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 24 APPENDIX D: METHODOLOGY AND TECHNICAL NOTES The data that are reported in this issue brief have been generated by the information systems of the Centers for Medicare & Medicaid Services, based on information reported to CMS by SBMs, and information collected by the FFM for states with Marketplaces supported by or fully run by HHS (including those run in partnership with states). Unless otherwise noted, the data in this issue brief represent cumulative Marketplace enrollmentrelated activity for the 10-1-13 to 3-1-14 reporting period, with information available as of 3-714. We believe that the information contained in this issue brief provides the most systematic “snapshot” of enrollment-related activity in the Marketplaces to date because the data for the various metrics are counted using comparable definitions for data elements across states, and between the SBMs and FFM (see table below). It is important to note that the SBM enrollment-related data that are rep3-7-2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report. While this issue brief includes some data for all states, data for certain metrics are not available for some states due to information system issues. For example, CMS did not receive data on some metrics for certain states, as noted in Appendix C, and in the Addendum to the March Marketplace Enrollment Report (which contains additional state-level tables). 20 The following section provides highlights of major methodological changes since the January Marketplace Enrollment Report. For additional technical information about the metrics that are included in this report, please refer to the earlier Marketplace enrollment reports. 21 Highlights of Major Methodological Changes Since the February Marketplace Enrollment Report Reporting of Cumulative Five-Month Data - This report includes cumulative data for the fivemonth period (10-1-13 to 3-1-14) because some people’s process of applying, shopping, and selecting a plan may span across multiple monthly reporting periods (for example, a person may have applied for a Marketplace plan in October and then selected a Marketplace plan in December). We believe that these cumulative data provide the best “snapshot” of Marketplace enrollment-related activity to date. Ongoing efforts are underway to eliminate duplication associated with counting people in more than one month. Additionally, some SBM data systems are still working to eliminate duplication in their cumulative counts, so all duplication has not yet been removed in this report. Data on Total Number of Completed Applications and Total Individuals Applying for Coverage in Completed Applications – We are no longer showing data on the total number of completed applications and total number of individuals applying for coverage in completed 20 The Addendum to the March Enrollment Report is available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014Mar_enrollAddendum.pdf . 21 The previous Marketplace Enrollment Reports can be accessed at http://www.aspe.hhs.gov/health/reports/2012/ACAResearch/index.cfm. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 25 applications in Appendix C and in the main body of this report because we believe that there is duplication in these metrics. SBM Data – While all SBMs have provided updated data on call center activity, not all SBMs have provided updated data on website visits. For additional state-specific technical notes, please see the footnotes of the tables in Appendix C, and in the Addendum to the March Marketplace Enrollment Report. Data on Characteristics of Marketplace Plan Selections by Metal Level – The FFM subtotals for each metal tier type do not sum to the total number of Plan Selections With Available Data on Metal Level due to instances where consumers enrolled in more than one plan type in their state (for example, some consumers may have enrolled in both a health plan and a standalone dental plan). As a result, the corresponding percentages also do not sum to 100 percent. This also affects the data for the Marketplace total. For the March enrollment report, to the extent possible, duplication associated with standalone dental plan selection has been removed from the data shown for each metal tier type. Additionally, separate totals for standalone dental plan selections are shown separately where appropriate. Data distributions for States with very small numbers of Marketplace plan selections for a given metal level have been suppressed. Standalone Dental Plan Selection – For the FFM, total standalone dental plan selections includes data for both the “High” and “Low” standalone dental plan metal tier types. For the SBMs, separate data are not yet available on standalone dental plan selections. Data on Additional Characteristics of FFM Marketplace Plan Selections – This report also includes preliminary additional data on the characteristics of persons who have selected a Marketplace plan through the FFM (by Gender and Age; Gender and Metal Level; Financial Assistance Status and Metal Level; and Metal Level and Age). In some cases, the data for certain characteristics of Marketplace plan selections are not yet available. For this reason, for each metric, we have calculated the comparable percentages based on the number of plan selections with known data for that metric. ASPE Office of Health Policy March 2014 ASPE Issue Brief Page 26 APPENDIX TABLE D1 Summary of Marketplace Monthly EnrollmentRelated Information By Marketplace Type (10-1-13 to 3-1-14) Completed Applications (1) Number of Individuals Applying for Coverage in Completed Applications (1) Eligible for Marketplace Plan Enrollment Eligible for Marketplace Plan with Financial Assistance (non-add) Other Marketplace Plan-Eligible Individuals (non-add) Determined or Assessed Eligible for Medicaid/CHIP by the Marketplace Pending/Other Total Individuals Eligible to Enroll in a Marketplace Plan Marketplace Eligible Individuals Who Have Selected a Marketplace Plan Number 8,211,932 % of Total* n/a States Implementing Their Own Marketplaces (SBMs) % of Number Total* 3,315,796 n/a 14,594,930 100.0% 7,052,437 100.0% 7,542,493 100.0% 8,751,907 60.0% 2,758,933 39.1% 5,992,974 79.5% 5,246,641 35.9% 1,703,871 24.2% 3,542,770 47.0% 3,505,266 24.0% 1,055,062 15.0% 2,450,204 32.5% 4,377,932 30.0% 2,999,061 42.5% 1,378,871 18.3% 1,629,175 11.2% 1,458,527 20.7% 170,648 2.3% 8,751,907 100.0% 2,758,933 100.0% 5,992,974 100.0% 4,242,325 48.5% 1,621,239 58.8% 2,621,086 43.7% Marketplaces Total (SBMs and FFMs) States With Marketplaces that are Supported by or Fully-Run by HHS (FFM) % of Number Total* 4,896,136 n/a (1) We are no longer showing data on the total number of completed applications and total number of individuals applying for coverage in completed applications in Appendix C and in the main body of this report because we believe that there is duplication in these metrics. * Percent of total represents the percent of total individuals applying for coverage in completed applications, or the percent of total individuals eligible to enroll in a Marketplace plan who have selected a Marketplace plan. ** Pending/Other does not sum to 100 percent due to differences in process flows and potentially missing data. *** Total SBM and FFM data on the number of persons with processed eligibility determinations or assessments do not add to the total number of persons applying for coverage in completed applications due to missing data and differences in process flow for Marketplace plan and Medicaid/CHIP eligibility determinations / assessments. Source: Centers for Medicare & Medicaid Services, as of 3-7-2014. ASPE Office of Health Policy March 2014