Insurance Exchanges

SHADAC’s Marketplace Enrollment Reports provide monthly updates of Marketplace enrollment by state using data included on the Assistant Secretary for Planning and Evaluation (ASPE) Marketplace enrollment reports. SHADAC focuses its reports on states running their own State-Based Marketplace and includes a map displaying which states are operating State-based; Federal-State Partnerships; and Federally-facilitated Marketplaces. This resource is updated regularly as additional state and ASPE enrollment reports are published and made available.

The National Health Council and its patient advocacy members have created this web tool where people can enter their unique health needs – the number of doctor visits, specialist visits, hospitalizations, and specific medications (both generic and brand name) – to learn how the different metal plans in their state’s Marketplace can affect their out-of-pocket costs. The tool generates a personalized report that a patient can print off or e-mail, and the report helps the person focus in on the metal plan level that more appropriately meets his or her needs.

Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process. The following resource guides, prepared by Manatt Health Solutions, were developed to help consumer assisters answer some of the most common eligibility and enrollment questions: Minimum Essential Coverage; Household Composition Eligibility Rules; MAGI Household Income Eligibility Rules; and Immigrant Eligibility.

Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the ACA. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policy makers.

The participation of young adults in the health insurance marketplaces has received considerable attention. At issue is whether men and women ages 19 to 34—a group uninsured at disproportionately high rates but generally healthier than older adults—will enroll in marketplace health plans at a rate high enough to ensure the marketplaces' success. The conclusion of health insurance actuaries, health plan representatives, researchers, and federal officials invited to participate in a Commonwealth Fund meeting on the topic is that while young adult participation is important for the stability of the marketplaces and 2015 premiums, it was, and will continue to be, one of many factors that affect premiums.