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June 30, 2015 Effectuated Enrollment Snapshot

Date
2015-09-08
Title
June 30, 2015 Effectuated Enrollment Snapshot
Contact
press@cms.hhs.gov

June 30, 2015 Effectuated Enrollment Snapshot

On June 30, 2015, about 9.9 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of June.1 These numbers are consistent with HHS’s effectuated enrollment target of 9.1 million for the end of 2015.

Of the approximately 9.9 million consumers nationwide with effectuated Marketplace enrollments at the end of June 2015, about 84 percent, or more than 8.3 million consumers, were receiving an advanced premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $270 per month.2  

There were 7.2 million consumers with effectuated enrollments at the end of June 2015 through the 37 Federally-Facilitated Marketplaces (including State Partnership Marketplaces) and supported State-based Marketplaces (collectively known as HealthCare.gov states) and 2.7 million through the remaining State-based Marketplaces.3

“Consumers from coast-to-coast are continuing to show how important health coverage is to their families,” said HHS Secretary Sylvia Burwell. “Millions of Americans are benefiting from the peace of mind that comes with having quality coverage at a price they can afford as they access coverage through the Affordable Care Act’s Marketplace.”

CMS releases Marketplace state-by-state effectuated enrollment snapshots on a quarterly basis, detailing how many consumers have an effectuated enrollment, how many are benefiting from APTC and/or cost-sharing reductions (CSR), and the distribution of effectuated enrollment by qualified health plan metal level. The first Marketplace enrollment snapshot for 2015 was released on June 2 and covered effectuated enrollment through March 31, showing that 10.2 million consumers had effectuated coverage. Today’s snapshot also provides an update through June 30 on the number of individuals with citizenship, immigration status, or household income data matching issues.

The Marketplace effectuated enrollment snapshot provides point-in-time estimates. CMS expects enrollment numbers will change over time as consumers find other coverage or experience changes in life circumstances such as employment status or marriage, which may cause consumers to change, newly enroll in, or terminate their plans.4

The following tables are included in the June 2015 Marketplace Effectuated Enrollment Snapshot:

Table 1: June 30, 2015 Total Effectuated Enrollment and Financial Assistance by State
Table 2: June 30, 2015 Average Advance Payment of Tax Credits by State
Table 3: June 30, 2015 Total Effectuated Enrollment Data by Metal Level by State

June 2015: Total Effectuated Enrollment and Financial Assistance

Of the approximately 9.9 million consumers who had effectuated Marketplace enrollments at the end of June 2015, about 84 percent or about 8.3 million consumers were receiving APTC to make their premiums more affordable.5 In addition, 56 percent or about 5.6 million consumers were benefiting from CSRs to lower the amount they pay out-of-pocket for deductibles, coinsurance, and copayments. This financial assistance generally is available if a consumer’s household income is between 100 percent and 250 percent of the federal poverty level, the consumer is otherwise eligible for APTC, and the individual chooses a health plan from the silver plan category.

The ten states with the highest rate of consumers who received financial assistance through APTC were: Mississippi (95.4%), Wyoming (92.2%), North Carolina (91.6%), Florida (91.3%), Alabama (90.9%), Louisiana (90.7%), Georgia (90.0%), Arkansas (90.0%), Wisconsin (89.6%), and Alaska (88.8%). The states with the lowest rate of consumers who received APTC are: District of Columbia (10.2%), Minnesota (54.8%), Colorado (55.3%), Hawaii (61.4%), New Hampshire (62.8%), Vermont (64.2%), Utah (65.6%), Kentucky (69.8%), Maryland (70.7%), and New York (71.4%).  

Nine of the ten states with the highest rate of consumers receiving financial assistance (all but Arkansas) had not expanded Medicaid programs under the Affordable Care Act as of June 30.6 As such, residents in those states with household incomes from 100 to 133 percent of the federal poverty level who are otherwise eligible can qualify for coverage through the Marketplace with tax credits. In states that do not decide to expand Medicaid, APTC eligibility ranges from 100 percent to 400 percent of the federal poverty level.

Table 1: June 30, 2015 Total Effectuated Enrollment and Financial Assistance by State 

 

June 30, 2015
Total Effectuated Enrollment and Financial Assistance by State

State

Total
Enrollment

APTC
Enrollment

Percentage of
Enrollment
with APTC

CSR Enrollment

Percentage of
Enrollment
with CSR

National Total

9,949,079

8,329,966

83.7%

5,572,833

56.0%

AK

19,380

17,207

88.8%

10,331

53.3%

AL

141,361

128,432

90.9%

102,696

72.6%

AR

51,436

46,299

90.0%

29,395

57.1%

AZ

154,121

117,514

76.2%

83,165

54.0%

CA

1,393,567

1,227,770

88.1%

715,158

51.3%

CO*

122,976

68,027

55.3%

33,042

26.9%

CT

92,213

71,937

78.0%

37,841

41.0%

DC

14,637

1,493

10.2%

399

2.7%

DE

23,163

19,373

83.6%

10,267

44.3%

FL

1,314,890

1,200,960

91.3%

909,344

69.2%

GA

417,890

376,138

90.0%

280,163

67.0%

HI

8,802

5,404

61.4%

3,165

36.0%

IA

39,347

33,627

85.5%

19,262

49.0%

ID

85,981

70,179

81.6%

54,198

63.0%

IL

297,406

231,310

77.8%

138,487

46.6%

IN

167,261

146,160

87.4%

79,964

47.8%

KS

84,872

67,733

79.8%

46,897

55.3%

KY

88,904

62,048

69.8%

33,915

38.1%

LA

141,740

128,524

90.7%

82,070

57.9%

MA

156,448

114,240

73.0%

92,973

59.4%

MD

120,517

85,225

70.7%

60,200

50.0%

ME

66,628

59,027

88.6%

38,298

57.5%

MI

288,751

224,354

77.7%

156,423

54.2%

MN

49,066

26,874

54.8%

7,432

15.1%

MO

212,256

188,352

88.7%

122,573

57.7%

MS

73,223

69,825

95.4%

56,710

77.4%

MT

48,591

40,231

82.8%

24,731

50.9%

NC

459,714

421,307

91.6%

294,130

64.0%

ND

16,651

14,244

85.5%

7,021

42.2%

NE

63,776

56,192

88.1%

31,884

50.0%

NH

44,727

28,068

62.8%

15,865

35.5%

NJ

194,194

161,255

83.0%

98,463

50.7%

NM

44,307

32,341

73.0%

20,684

46.7%

NV

60,879

49,734

81.7%

34,258

56.3%

NY

370,058

264,156

71.4%

175,524

47.4%

OH

188,223

157,976

83.9%

80,964

43.0%

OK

108,614

86,904

80.0%

64,830

59.7%

OR

102,912

77,153

75.0%

45,318

44.0%

PA

397,967

320,162

80.4%

219,923

55.3%

RI

32,451

**

N/A

**

N/A

SC

165,276

146,530

88.7%

103,664

62.7%

SD

18,983

16,618

87.5%

12,138

63.9%

TN

177,453

149,920

84.5%

111,844

63.0%

TX

943,218

804,918

85.3%

557,752

59.1%

UT

126,784

83,155

65.6%

78,763

62.1%

VA

327,026

274,044

83.8%

178,092

54.5%

VT

33,306

21,399

64.2%

10,733

32.2%

WA

164,280

127,760

77.8%

70,185

42.7%

WI

183,682

164,541

89.6%

105,884

57.6%

WV

31,106

26,673

85.7%

16,472

53.0%

WY

18,065

16,653

92.2%

9,343

51.7%

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.
**Validated APTC and CSR enrollment data for Rhode Island was not available at the time of publication. We will update this report with validated data as soon as it is available.

June 2015: Average APTC by State

Consumers with household incomes between 100 percent and 400 percent of the FPL may qualify for APTC, which helps make their coverage more affordable throughout the year by lowering their share of monthly premium costs. Consumers who qualify for APTC may choose how much of the APTC to apply to their premiums each month, up to the maximum amount for which they are eligible.

The overall average APTC Marketplace consumers received was $270 per month at the end of June 2015. Because the amount of APTC an enrollee may receive depends on household income and the cost of the second lowest cost silver plan available to the enrollee, the average APTC ranged from $534 per month in Alaska to $159 per month in Arizona. Of the 7.0 million consumers in the 34 states with Federally-facilitated Marketplaces, nearly 6.0 million or 86 percent received APTC which averaged $271.

Table 2: June 30, 2015 Average Advance Payment of Tax Credits by State

June 30, 2015
Average Advance Payment  of Tax Credits by 
State
(for individuals receiving APTC)

State

Average APTC per Month
(for all APTC enrollees)

National Average

$270

AK

$534

AL

$268

AR

$283

AZ

$159

CA

$302

CO*

$231

CT

$359

DC

$181

DE

$260

FL

$296

GA

$274

HI

$195

IA

$267

ID

$227

IL

$212

IN

$315

KS

$210

KY

$223

LA

$322

MA

$188

MD

$221

ME

$341

MI

$269

MN

$160

MO

$278

MS

$350

MT

$230

NC

$315

ND

$231

NE

$257

NH

$264

NJ

$309

NM

$196

NV

$270

NY

$226

OH

$251

OK

$207

OR

$196

PA

$220

RI

**

SC

$280

SD

$224

TN

$221

TX

$244

UT

$209

VA

$257

VT

$276

WA

$260

WI

$312

WV

$310

WY

$424

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.
**Validated APTC and CSR enrollment data for Rhode Island was not available at the time of publication. We will update this report with validated data as soon as it is available.

June 2015: Total Effectuated Enrollment by Metal Level

There are generally four “metal levels” of coverage available through the Marketplace, plus catastrophic plans. Plans in each category can be expected to pay different amounts of the total costs of an average person’s care. This takes into account the plans’ deductibles, copayments, coinsurance, and out-of-pocket maximums. The actual percentage a consumer pays in total or per service will depend on the services used during the year.

  • Catastrophic: The health plan pays less than 60% of the total average cost of care on average, with consumers paying the balance. These plans are only available to people who are under 30 years old at the beginning of the plan year, or those who have a hardship or affordability exemption.
  • Bronze: The health plan pays 60% on average. Consumer pays about 40%.
  • Silver: The health plan pays 70% on average. Consumer pays about 30%. Consumers eligible for CSRs can only receive them by enrolling in a silver plan. (Note, American Indians and Alaska Natives can receive CSRs through any metal-level plan.)
  • Gold: The health plan pays 80% on average. Consumer pays about 20%.
  • Platinum: The health plan pays 90% on average. Consumer pays about 10%.

Of the 9.9 million consumers with effectuated enrollment in Marketplace plans at the end of June 2015, 1% were enrolled in Catastrophic plans, 21% in Bronze plans, 68% in Silver plans, 7% in Gold plans, and 3% in Platinum plans.

Table 3: June 30, 2015 Total Effectuated Enrollment Data by Metal Level by State

June 30, 2015
Total Effectuated Enrollment by Metal 
Level by State

State

Metal Level

Enrollees

Total

N/A

9,949,079

 

Catastrophic

63,174

 

Bronze

2,096,542

National Total

Silver

6,761,363

 

Gold

695,377

 

Platinum

332,624

 

Catastrophic

131

 

Bronze

6,771

AK

Silver

11,613

 

Gold

865

 

Catastrophic

950

 

Bronze

10,813

AL

Silver

117,222

 

Gold

7,187

 

Platinum

5,189

 

Catastrophic

288

 

Bronze

9,319

AR

Silver

36,040

 

Gold

5,789

 

Catastrophic

1,170

 

Bronze

24,009

AZ

Silver

102,609

 

Gold

14,113

 

Platinum

12,220

 

Catastrophic

9,302

 

Bronze

350,225

CA

Silver

895,657

 

Gold

74,067

 

Platinum

64,316

 

Catastrophic

3,823

 

Bronze

49,809

CO*

Silver

56,463

 

Gold

12,280

 

Platinum

601

 

Catastrophic

1,294

 

Bronze

19,831

CT

Silver

55,010

 

Gold

15,033

 

Platinum

1,045

 

Catastrophic

468

 

Bronze

4,050

DC

Silver

3,905

 

Gold

3,273

 

Platinum

2,941

 

Catastrophic

94

 

Bronze

3,897

DE

Silver

14,322

 

Gold

3,881

 

Platinum

969

 

Catastrophic

3,884

 

Bronze

196,786

FL

Silver

1,007,527

 

Gold

46,139

 

Platinum

60,555

 

Catastrophic

2,955

 

Bronze

58,480

GA

Silver

321,834

 

Gold

18,607

 

Platinum

16,014

 

Catastrophic

32

 

Bronze

2,267

HI

Silver

4,108

 

Gold

1,149

 

Platinum

1,246

 

Catastrophic

 0

 

Bronze

12,008

IA

Silver

23,139

 

Gold

4,176

 

Platinum

24

 

Catastrophic

370

 

Bronze

16,736

ID

Silver

60,263

 

Gold

6,759

 

Platinum

1,853

 

Catastrophic

1,267

 

Bronze

78,430

IL

Silver

178,288

 

Gold

36,241

 

Platinum

3,180

 

Catastrophic

843

 

Bronze

57,019

IN

Silver

102,305

 

Gold

6,988

 

Platinum

106

 

Catastrophic

651

 

Bronze

16,562

KS

Silver

56,279

 

Gold

9,803

 

Platinum

1,577

 

Catastrophic

708

 

Bronze

17,417

KY

Silver

47,303

 

Gold

12,422

 

Platinum

11,054

 

Catastrophic

448

 

Bronze

32,588

LA

Silver

92,811

 

Gold

8,766

 

Platinum

7,127

 

Catastrophic

1,102

 

Bronze

9,487

MA

Silver

131,039

 

Gold

8,000

 

Platinum

6,820

 

Catastrophic

1,711

 

Bronze

26,739

MD

Silver

75,348

 

Gold

10,652

 

Platinum

6,067

 

Catastrophic

420

 

Bronze

13,898

ME

Silver

48,502

 

Gold

3,808

 

Catastrophic

1,876

 

Bronze

66,982

MI

Silver

195,923

 

Gold

20,023

 

Platinum

3,947

 

Catastrophic

409

 

Bronze

17,407

MN

Silver

19,160

 

Gold

8,652

 

Platinum

3,438

 

Catastrophic

425

 

Bronze

53,684

MO

Silver

141,362

 

Gold

15,989

 

Platinum

796

 

Catastrophic

158

 

Bronze

7,200

MS

Silver

61,347

 

Gold

2,186

 

Platinum

2,332

 

Catastrophic

519

 

Bronze

14,362

MT

Silver

28,512

 

Gold

3,460

 

Platinum

1,738

 

Catastrophic

3,823

 

Bronze

83,701

NC

Silver

343,721

 

Gold

17,063

 

Platinum

11,406

 

Catastrophic

238

 

Bronze

4,126

ND

Silver

7,826

 

Gold

4,461

 

Catastrophic

471

 

Bronze

21,346

NE

Silver

37,926

 

Gold

3,872

 

Platinum

161

 

Catastrophic

560

 

Bronze

15,619

NH

Silver

23,344

 

Gold

5,154

 

Platinum

50

 

Catastrophic

1,516

 

Bronze

26,513

NJ

Silver

139,322

 

Gold

19,880

 

Platinum

6,963

 

Catastrophic

109

 

Bronze

10,821

NM

Silver

27,238

 

Gold

6,005

 

Platinum

134

 

Catastrophic

307

 

Bronze

12,618

NV

Silver

40,985

 

Gold

4,352

 

Platinum

2,617

 

Catastrophic

4,430

 

Bronze

60,399

NY

Silver

220,668

 

Gold

38,775

 

Platinum

45,786

 

Catastrophic

2,223

 

Bronze

61,970

OH

Silver

101,424

 

Gold

20,543

 

Platinum

2,062

 

Catastrophic

384

 

Bronze

27,712

OK

Silver

73,049

 

Gold

7,415

 

Platinum

54

 

Catastrophic

625

 

Bronze

25,635

OR

Silver

67,013

 

Gold

8,880

 

Platinum

759

 

Catastrophic

1,495

 

Bronze

44,866

PA

Silver

283,720

 

Gold

53,456

 

Platinum

14,430

 

Catastrophic

154

 

Bronze

6,557

RI

Silver

21,720

 

Gold

4,020

 

Catastrophic

998

 

Bronze

30,734

SC

Silver

121,286

 

Gold

12,220

 

Platinum

38

 

Catastrophic

192

 

Bronze

3,024

SD

Silver

14,657

 

Gold

683

 

Platinum

427

 

Catastrophic

349

 

Bronze

37,582

TN

Silver

129,442

 

Gold

7,296

 

Platinum

2,784

 

Catastrophic

2,907

 

Bronze

234,331

TX

Silver

643,413

 

Gold

44,549

 

Platinum

18,018

 

Catastrophic

520

 

Bronze

21,507

UT

Silver

86,874

 

Gold

16,870

 

Platinum

1,013

 

Catastrophic

4,155

 

Bronze

75,147

VA

Silver

215,563

 

Gold

29,636

 

Platinum

2,525

 

Catastrophic

212

 

Bronze

6,633

VT

Silver

18,779

 

Gold

3,616

 

Platinum

4,066

 

Catastrophic

936

 

Bronze

59,633

WA

Silver

90,746

 

Gold

12,266

 

Platinum

699

 

Catastrophic

1,163

 

Bronze

40,166

WI

Silver

131,129

 

Gold

8,148

 

Platinum

3,076

 

Catastrophic

61

 

Bronze

4,383

WV

Silver

21,624

 

Gold

5,038

 

Catastrophic

48

 

Bronze

4,742

WY

Silver

12,003

 

Gold

871

 

Platinum

401

Source: August 2015 CMS
* Validated enrollment data was not available for Colorado at the time of publication, so this snapshot includes the same data as the March report.

2015 Data Matching

In operating the Marketplaces, we are committed to providing access to coverage and financial assistance to individuals and families who are eligible while maintaining strong program integrity. Throughout 2014 and into 2015, the Marketplaces have worked to resolve consumers’ data matching issues, including for those individuals whose citizenship, immigration status, or household income application information did not match information in our trusted data sources. In 2014, the Marketplace extended the deadline for consumers to submit documentation verifying the information in their applications and conducted an extensive outreach campaign in coordination with local assisters, stakeholders, and insurance companies to contact consumers with data matching issues.

In 2015, the Marketplaces have moved to regular monthly action for consumers with unresolved data matching issues who have not provided adequate documentation within 95 days for citizenship or immigration status data matching issues and within 90 days for household income inconsistencies. Consumers who do not submit sufficient documentation to resolve their annual household income data matching issue will have a recalculation of their APTC and/or CSRs based on available tax data. Individuals who have not provided the necessary documentation for their citizenship or immigration status will have their enrollment through the Marketplace terminated. Those individuals whose enrollment through the Marketplace was terminated because of citizenship or immigration status data matching issues are not included in effectuated enrollment totals.

During the time period from April 1, 2015 to June 30, 2015, enrollment in coverage through the Federally-facilitated Marketplaces was terminated for about 306,000 consumers with citizenship or immigration status data matching issues who failed to produce sufficient documentation of their citizenship or immigration status. In addition, during the same time period, about 734,000 households with annual household income inconsistencies had their APTC and/or CSRs for 2015 coverage adjusted.

Overall, as of June 30, 2015 the Marketplace has ended 2015 coverage for approximately 423,000 consumers with 2015 coverage who failed to produce sufficient documentation on their citizenship or immigration status and has adjusted APTC and/or CSRs for about 967,000 households.

If a consumer believed they had the appropriate documentation but their enrollment through the Marketplace was terminated based on a citizenship/immigration status data matching issue, the individual is able to submit his or her documentation to the Marketplace to resolve the data matching issue and regain enrollment through the Marketplace through a Special Enrollment Period.   


NOTES:

1Individuals effectuate their enrollment by paying their first month’s premium. This snapshot measures individuals who effectuated their enrollment and have an active policy on the date of the snapshot; it does not measure the rate at which consumers pay their first month’s premium. Active policies include those who have paid for the current month and individuals who may be in a grace period for non-payment. Grace periods can vary by state and issuer. For those individuals receiving APTC, issuers are required to give enrollees a three month grace period. 45 CFR §§ 155.430 and 156.270.

2This data is reported by insurance companies with plans in the Health Insurance Marketplaces as part of the interim payment process. Issuers report total effectuated enrollment counts, and the estimated APTC amounts owed to the issuer for those effectuated enrollments. After CMS validates these amounts, issuers are paid monthly based on these estimates. Each month, issuers are permitted to restate prior months’ enrollment and payment data to reflect enrollee cancellations, terminations, or other fluctuations in enrollment. The data in this snapshot represents issuer estimates of individuals with effectuated enrollment for June 2015 as of August 2015 interim payment process data submission.

3For 2015, there are 37 HealthCare.gov states; including, Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. New Mexico, Nevada, and Oregon are State-based Marketplaces using the HealthCare.gov platform for 2015. Thirteen states – California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington – plus the District of Columbia – have their own State-based Marketplaces and are using their own technology platform for 2015. Effectuated enrollment for the 34 states that are part of the Federally-facilitated Marketplaces on June 30, 2015 was 7.0 million, and 2.9 million for State-based Marketplaces, including those in New Mexico, Nevada, and Oregon which use the HealthCare.gov platform.

4As announced in the 2015 Special Enrollment Period Report, between February 23 and June 20, 2015, nearly 950,000 new consumers selected a plan through HealthCare.gov platform. Supporting these types of changes is an important function of the Health Insurance Marketplace.

5Consumers reconcile differences between their projected 2015 household income and their actual household income to determine the final premium tax credits they should receive. This reconciliation process ensures individuals receive the correct amount of tax credit, which will be reflected on their tax return: taxpayers may see a smaller refund or owe money back if they underestimated their household income, or they may get a bigger refund if they overestimated their household income.

6Alaska implemented Medicaid expansion on September 1, 2015.

.