Five Things to Watch this Open Enrollment


Perhaps one of the most stressful times of the year for issuers and brokers is Open Enrollment. During this critical time of year, consumers around the country can renew their current coverage or enroll in new coverage.

On October 19, Secretary Burwell offered the Department of Health and Human Services’ (HHS) projections. Based on HHS’ forecasts and recent news developments, here are five things to watch this open enrollment:

  1. On- and Off-Exchange Enrollment: This year, HHS is expecting that 8 Million individuals will gain – renew or purchase for the first time – coverage through the marketplace, including 9.2 Million re-enrollees, 3.5 Million uninsured individuals, and 1.1 Million individuals with 2016 off-exchange coverage [1]. HHS’ projection represents a 1.1 Million or 9.9% rise in state and federal on- and 0ff-exchange enrollment, compared to the 12.7 Million that gained coverage last year [1].
  2. Basic Health Program (BHP): Established under the Affordable Care Act, BHP provides states the option to create a health benefits coverage program for low-income residents, thus allowing states to deliver both more affordable coverage options and improved care delivery. So far, Minnesota and New York have elected to implement BHPs – with Minnesota’s program beginning January 1, 2015, and New York’s program beginning April 1, 2015 [2]. In addition to the 13.8 Million enrollees, HHS is anticipating that an additional 650,000 consumers will purchase coverage through Minnesota and New York’s Basic Health Programs (BHP) this year [1].
  3. Millennials: Millennials, which widely surpass the number of baby boomers residing across the county by nearly 7.7M, have presented new and unique market challenges for issuers [3].  For insurers, enrolling millennials is important because they represent a healthier population, in comparison to older, sicker consumers. By enrolling more millennials into policies, issuers can help to stabilize their risk pools and outspread reduced costs and premiums to their members. In turn, millennials have gained great attraction in the healthcare space.  Leading up to this year’s open enrollment, the Centers for Medicare and Medicaid Services launched an outreach plan targeting this population of young adults, including the #H
    ealthyAdulting social media campaign.  To date, HHS has predicted that more than 40 percent of QHP-eligible uninsured individuals will be aged 18-34 [1].
  1. Subsidies: Announcements of premium increases have gained controversial attention in the weeks preceding open enrollment. While premiums are estimated to rise nationally, many consumers may be safeguarded by subsidies, which will help to keep their health insurance costs reasonably priced. Health insurance affordability is a number one concern among consumers. This year alone, more than 84 percent or 8 in 10 QHP-eligible consumers are estimated to qualify for advanced payments of the premium tax (APTC) [1]57 percent will conceivably qualify for cost-sharing reductions (CSR), in addition to APTC [1]. And, the remaining 16 percent have family incomes above 400% FPL [1]. Taking financial assistance into consideration, more than 70 percent of consumers can find marketplace plans for less than $75 per month and 77 percent will be able to find plans with premiums below $100, according to the Department of Health and Human Services [4].
  1. Brokers and Agents: Brokers and agents have played a pivotal role in the Affordable Care Act’s success and will continue to reveal their positive impact on enrollment this year. During the 2015-2016 open enrollment period:Brokers and agents enrolled nearly half of all Marketplace enrollments [5];
    • Nearly half of all marketplace applications last year were recorded using alternative enrollment platforms (26% insurance company website & 23% Web Broker (WBE) websites) [1]; [6]
    • On average, each broker assisted 110 consumers with applications for marketplace coverage [7]; and
    • 55% of brokers surveyed agreed that OE3 outperformed OE2 in overall results [8].

With this said, brokers and agents will continue to have a major impact on enrollment this year.

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. (dba Welltheos). 

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Yvonne Villante
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Yvonne Villante

Senior Research Manager, Healthcare Reform at Welltheos
As our Senior Research Manager, I work closely with our Solution Architect, Product Management, and Sales teams. My role centers around competitive and market analyses, constructing premium content (whitepapers, research briefs, infographics), curating stories for our newsletters, and blogging.

I earned my BAA from the State University of New York at Stony Brook and MBA in Healthcare Administration from the University of Ohio (Athens). I was born and raised on Long Island, NY and enjoy capturing what the island has to offer through photography.
Yvonne Villante
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