Individual market enrollment: Updated view

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The latest round of our national survey of QHP-eligible consumers tells a story of deeper engagement than previous surveys.

In February 2014 we conducted another round of our national survey of consumers eligible to purchase individual coverage during the open enrollment period (either on or off the exchanges). Our goal was to refresh our insights into the emerging 2014 individual market. Because we now have conducted our online survey four times since November, we have longitudinal data about consumers’ product selection trends and demographic characteristics, which indicate how enrollment is progressing. Each round has included consumers who enrolled in healthcare coverage for 2014 (either on or off exchange), those who have shopped but not yet enrolled, and those who have not yet shopped.

Three important points help clarify how the survey findings should be interpreted. First, some of the respondents purchased coverage through channels other than the exchanges; as a result, the numbers in our survey cannot be directly compared to the publicly reported exchange enrollment numbers. Second, respondents’ previous insurance coverage (uninsured or insured) was defined by their self-reported answers to the question: “Which of the following best describes your primary insurance coverage in 2013? For most of the year I was covered by ….” Respondents were categorized as previously uninsured if the answer they selected was: “I did not have health insurance, I was uninsured.” Third, respondents categorized as having renewed their 2013 policy include both those who were automatically renewed by their 2013 insurer or elected to renew their pre-ACA policy. Respondents categorized as having selected a new 2014 product include insured who switched (those insured who switched from one carrier to another, or who switched policies but stayed with the same carrier) and previously uninsured (those self-reported uninsured who enrolled). In all cases, the products could have been selected on or off the exchanges.

All of the findings in this Intelligence Brief represent a view of the rapidly evolving individual insurance marketplace through February 13th. As such, enrollment trends may differ materially on March 31, 2014, the end of the open enrollment period. Six key observations emerged from our February survey findings:

  • Previously uninsured respondents accounted for 27 percent of February respondents who reported having selected a new 2014 product (i.e., insured who switched and previously uninsured who enrolled), up from 11 percent in earlier surveys.
  • In total, 10 percent of all previously uninsured February respondents said that they had enrolled in a product, up from 3 percent in January.
  • More than three-quarters of those who reported having obtained coverage also said they had paid their premium (out of all February respondents who said they had selected a new 2014 product, i.e., insured who switched or uninsured who enrolled). The payment rate was higher among the previously insured (86 percent) than among the previously uninsured (53 percent).
  • A smaller proportion of the respondents who had not yet enrolled reported that they are likely to enroll, compared to prior surveyed months. However, most (65 percent) of those who said that they intend to enroll continue to be the previously uninsured.
  • The most common reason for not enrolling cited by both previously insured and previously uninsured respondents continues to be perceived affordability challenges (this was cited by ~50 percent of the respondents who had not yet enrolled).
  • Over 80 percent of the respondents who cited affordability as the reason for not enrolling are eligible for subsidies; 66 percent of these consumers were not aware of their subsidy eligibility status or subsidy amount.

Reported enrollment has continued to increase, particularly among the previously uninsured

Across the four surveys conducted since November, reported enrollment has continued to increase. Of the 2,096 QHP-eligible respondents in February’s survey, 48 percent said that they enrolled in a 2014 individual product, up from 37 percent in January, 31 percent in December, and 19 percent in November (Exhibit 1).

February survery results reflect a continuing trend of increased individual market enrollment

The uninsured represented the biggest percentage of enrollment growth over the past month. In February, 10 percent of respondents reported having enrolled, up from 3 percent in January (Exhibit 2). Enrollment among the previously insured also increased to 82 percent in February, up from 72 percent in January.

A higher percentage of both previously uninsured and individually insured Feb respondents obtained coverage for 2014 compared to earlier months

Because the percentage growth in enrollment reported in February was greater among the previously uninsured than previously insured, the coverage mix of those enrolled has shifted. Of all February respondents who reported they selected a new 2014 product (insured who switched, previously uninsured who enrolled), 27 percent were previously uninsured, compared with 11 percent in the earlier surveys (Exhibit 3).

Of all selecting a new product, 27 percent of Feb respondents reported to be uninsured, up from 11 percent in the period from Nov to Jan