Individual market enrollment: Early assessments

Articles

Our fourth intelligence brief on exchange dynamics shares observations of the individual market through the mid-point of open enrollment.

During the first 15 weeks of the new individual market open enrollment period (OEP) — from October 2013 through early January 2014—we collected detailed information from both publicly available sources and our own national online consumer surveys to develop an initial assessment of the geographic, plan selection, and demographic characteristics of those enrolling in the individual market. We also obtained input from those who shopped and did not enroll, as well as those who had not yet shopped, to better understand why in each case they did not.

The publicly available data used in this analysis of the individual market come from official government sources at both the state and federal levels, including the most recent Health and Human Services (HHS) enrollment report on January 13, 2014. Our national survey data cover 4,563 adults aged 18 to 64 reporting their primary 2013 insurance coverage status as either uninsured, individually insured, or as having group coverage that will not continue into 2014. These respondents were eligible for neither Medicaid nor Medicare (we focused our research only on those eligible to enroll in the 2014 individual market), and were solicited in November, December, and early January (see full description of our methodology in the appendix). The total pool of Qualified Health Plan (QHP) eligible from which we drew our adult survey respondents is approximately 24 million uninsured and 10 million individually insured, as well as those who were insured by their employer in 2013 and are now QHP eligible. We refer to this as the addressable 2014 individual market.1

We are just past the mid-point of the individual market OEP, and many of the early technical website issues are resolving. Consistent with the recent publicly released HHS QHP exchange plan selection numbers, our surveys from November to January revealed an increasing percent of respondents indicating they had enrolled in individual insurance for 2014. All of the findings in this Intelligence Brief represent an early perspective through January 10th of the rapidly evolving individual insurance marketplace. Accordingly, the characteristics of enrollment may differ materially on March 31, 2014—the end of the open enrollment period.

We identified five key observations from our research to date:

  • QHP exchange enrollment across the U.S. is geographically concentrated
  • Silver-tier products are the most frequently chosen
  • Age of QHP exchange enrollees skews higher than the QHP eligible uninsured and individually insured
  • Our surveys of 4,563 QHP eligible consumers indicate 28 percent of all respondents at the time surveyed had enrolled in individual insurance for 2014; 31 percent of those who enrolled indicated they had purchased new plans, of whom 11 percent reported themselves as previously uninsured
  • In our January survey, of the 64 percent of all respondents who had not enrolled, 26 percent cited an intention to enroll. Of this 26 percent, 70 percent were uninsured, with perceived affordability as the most frequently cited factor for not enrolling

1. QHP eligible defined as over 138 percent of the federal poverty level (FPL) in Medicaid expansion states and over 100 percent FPL in non-Medicaid expansion states, among those 18 to 64 years old.