Insurance Exchanges

Analysis of Marketplace enrollment has focused primarily on the initial 2014 open enrollment period. But as the second open enrollment period ends—and as open enrollment periods shorten in future years—special enrollment periods (SEPs) will warrant increasing attention. This paper analyzes the legal framework, limited enrollment data, and first year special enrollment experiences in five State-Based Marketplaces (SBMs) and finds that Marketplace systems and consumer outreach and enrollment efforts did not yet match the significant potential for SEP enrollment. The paper identifies several themes that may help policymakers improve SEP enrollment systems in 2015 and beyond.

How would a Supreme Court ruling for the plaintiff in King v. Burwell affect consumers, insurers, providers, and states? A new series on The Commonwealth Fund Blog looks at the potential real-world impact of the case being argued next week. The series will examine the consequences of a decision that would end subsidies for residents of the 34 states that have federally run health insurance marketplaces. The first post looks at how individual consumers would fare in health insurance markets that would likely function even more poorly than those that existed before the Affordable Care Act was enacted.

Many tax filers who were uninsured for all or part of 2014 are learning for the first time that they must pay a penalty, and have missed the opportunity to enroll in 2015 coverage. These gaps in consumer awareness, combined with the timing of this year’s open enrollment period (OEP), have led to several Marketplaces allowing certain uninsured consumers additional time to enroll in order to avoid paying a penalty next year. The Federal government and nine State-based Marketplaces have already announced plans to establish a Special Enrollment Period (SEP) to permit individuals subject to the tax penalty to enroll in 2015 coverage outside of this year’s OEP, thereby minimizing the penalty they could incur when filing their 2015 taxes. This document, prepared by Manatt Health Solutions, provides a summary of the tax season SEPs being utilized by each of these Marketplaces.

The Affordable Care Act's drafters envisioned a continuing, significant role for brokers in the reformed nongroup insurance markets, but circumstances limited their active participation in the first year of marketplace enrollment. This analysis delineates the early barriers to brokers' full engagement, highlights the main concerns with their having a more prominent role and offers options for making them more effective in enrolling the uninsured. The information presented in this brief is based upon interviews conducted with stakeholders (e.g., providers, insurers, consumer advocates, navigators, assisters, brokers) in 21 states and the District of Columbia during the first half of 2014.

Private insurance plans typically require some form of cost sharing (also called out-of-pocket costs) when enrollees receive a health care service covered by their plan.  These expenses, which are in addition to the amount an enrollee spends on his or her monthly premium, come in a variety of forms, including copayments, coinsurance, and deductibles. Insurers use cost sharing to keep down monthly premiums, but cost sharing can also lead to unexpected costs for some enrollees and can be difficult to decipher when shopping for plans or reviewing medical bills. This brief shows the cost sharing in plans sold to individuals through Healthcare.gov, with a focus on the variation in the ways plans may set cost sharing for services, such as physician visits, prescription drugs, and hospital stays.

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics.

During this second year of open enrollment in marketplaces, states are renewing current enrollees for the first time, in addition to enrolling new customers. Renewing coverage for existing enrollees is essential to avoid coverage gaps, but state approaches to renewals and re-enrollment in marketplace coverage vary. This chart looks at how states are handling Advanced Premium Tax Credits (APTC) and plan renewals for consumers already enrolled in a plan through the marketplace, as well as some of the resources states have produced to educate consumers.

The Supreme Court will hear the King v. Burwell case, in which the plaintiff argues that the ACA prohibits payment of premium tax credits and cost-sharing reductions to people in states without state-managed Marketplaces. This report estimates that a victory for the plaintiff would increase the number of uninsured by 8.2 million people and eliminate $28.8 billion in tax credits and cost-sharing reductions in 2016 ($340 billion over 10 years) for 9.3 million people. With lower cost individuals leaving the market, average nongroup premiums in 34 states would increase by 35 percent, affecting those purchasing inside and outside those Marketplaces.

Research indicates that the Affordable Care Act (ACA) is working to enhance competition, expand choice and promote affordability among Marketplace health insurance plans in 2015. This brief presents analysis of qualified health plan data in the Marketplace for 35 states, providing a look at the plan choice and premium landscape that new and returning consumers will see for 2015. It also examines plan affordability in 2015 after taking into account premium tax credits. The findings presented here include states for which sufficient plan data were available for both 2014 and 2015.

This report analyzes the public education and application assistance strategies employed during the 2014 open enrollment period based primarily the Health Reform Monitoring Survey (HRMS) and interviews with diverse informants in 24 states.  In addition to describing general trends involving public education and application assistance, this analysis shares promising practices used by particular states as well as suggestions offered by stakeholders and researchers. Such practices and suggestions focus primarily on state-based and partnership marketplaces, but many could also apply to federally-facilitated marketplaces.