2019 Open Enrollment Sees a Slight Drop in Signups Overall

The number of people who signed up for a health insurance plan through a federal or state exchange decreased 2.6 percent from 2018 to 2019, according to the final open enrollment tally released by the Centers for Medicare and Medicaid Studies (CMS) on March 25. During the 2019 open enrollment period, just over 11.4 million people chose a plan on HeathCare.gov or a state-equivalent Obamacare marketplace, down from just under 11.8 million people last year. CMS is citing this as a sign that the marketplaces are stabilizing despite the lower enrollment tally.

There were also fewer new enrollees during the most recent signup period, which ended nationally on December 15. A handful of states had lengthier enrollment periods. In 2018, new enrollees accounted for about 27 percent of the total number of exchange customers. That figure dropped to 24 percent during this year’s enrollment season.

CMS tracks final, general enrollment data for all 50 states and the District of Columbia, but it measures more specific data for states that use HealthCare.gov, the federal platform established under the Affordable Care Act. In 2019, nearly every state (39) uses the federal exchange while 11 states plus D.C. use a state-based marketplace instead. Among the 39 states that utilize the federal platform:

• Most consumers chose to renew policies from last year (47%) or were automatically re-enrolled into existing plans (30%). That’s an increase of 6 percentage points in re-enrollments compared to 2018 but the same number of active renewals as last year.
• About 87 percent of consumers qualified for advanced premium tax credits (“subsidies”) to reduce monthly premium costs. This represents an increase over last year, when 85 percent of consumers qualified for subsidies.
• Average, non-subsidized premiums dropped from $621 a month in 2018 to $612 a month this year.
• The average subsidy was worth $469 in 2019, an increase of just $1 over last year’s average subsidy, bringing the average premium among all consumers down to $143 a month after applying the tax credit.
• Premiums for people who qualified for subsidies dropped from $89 a month in 2018 to $87 a month this year.

Plan selection types remained largely the same among consumers who signed up for coverage using HealthCare.gov. There was a slight drop in the number of people who chose a silver-level plan this year (61%) over last year (65%). Catastrophic plans (1%), bronze plans (30%), gold plans (7%) and platinum plans (less than 1%) saw negligible, if any, changes compared to the 2018 tally.

Demographic information – age, gender, race and ethnicity, location and household income – also stayed the same, for the post part. Young adults (aged 18 to 34), for instance, made up about 26 percent of the final enrollment tally in 2018 and 2019.

Citing the record high satisfaction rate (90%) for the federal marketplace call center during the 2019 open enrollment period, CMS Administrator Seema Verma noted that the relatively stable tally this year “directly reflects the strong work CMS staff put into ensuring that Exchange consumers experience a seamless enrollment process free from unnecessary hurdles and IT glitches.”

Along with reporting data on the open enrollment period for 2019, CMS also extended the non-enforcement policy for so-called “grandmothered plans” under the Affordable Care Act. Similar to grandfathered plans – plans that existed on or before March 23, 2010 and don’t meet the requirements of the ACA – grandmothered plans do not provide the same benefits or protections as fully compliant plans under Obamacare.

The Trump administration considers the extension of the non-enforcement policy as part of its overall effort to provide consumers with more options for affordable coverage in light of increasing premiums under the ACA. Last year, the cap put in place on short term health plans by former President Obama was lifted while the administration promoted association health plans as an alternative to Obamacare.