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December 31, 2015 Effectuated Enrollment Snapshot

Date
2016-03-11
Title
December 31, 2015 Effectuated Enrollment Snapshot
Contact
go.cms.gov/media

December 31, 2015 Effectuated Enrollment Snapshot

On December 31, 2015, about 8.8 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of December.i  Of the approximately 8.8 million consumers nationwide with effectuated Marketplace enrollments at the end of December 2015, about 84 percent, or about 7.4 million consumers, were receiving an advance payment of the 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 $272 per month.ii

There were 6.3 million consumers with effectuated enrollments at the end of December 2015 through the 37 Federally-Facilitated Marketplaces, including State Partnership Marketplaces and supported State-based Marketplaces that utilize the HealthCare.gov eligibility and enrollment platform (collectively known as HealthCare.gov states) and 2.5 million through the remaining State-based Marketplaces.iii Effectuated enrollment for the 37 states that use HealthCare.gov platform as of September 30, 2015 was 6.7 million, and 2.6 million for the remaining State-based Marketplaces.

 “At the end of 2015, about 8.8 million people had health insurance coverage through the Health Insurance Marketplaces, up from 6.3 million the year before, a nearly 40 percent year-over-year increase,” said Kevin Counihan, CEO of the Health Insurance Marketplace. “This rapid progress in expanding access to coverage through the Health Insurance Marketplace is a major reason why the share of Americans with health insurance rose above 90 percent in 2015 for the first time ever.

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 financial assistance, and the distribution of effectuated enrollment by qualified health plan metal level. Changes in effectuated enrollment are influenced by many factors and vary from quarter to quarter.

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.

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

Table 1: December 31, 2015 Total Effectuated Enrollment and Financial Assistance by State
Table 2: December 31, 2015 Average Advance Payment of Tax Credits by State
Table 3: December 31, 2015 Total Effectuated Enrollment Data by Metal Level by State

December 2015: Total Effectuated Enrollment and Financial Assistance

Of the approximately 8.8 million consumers who had effectuated Marketplace enrollments at the end of December 2015, about 84 percent or about 7.4 million consumers were receiving APTC and 56 percent or about 5 million consumers were benefiting from cost sharing reductions (CSRs) to make their coverage more affordable. CSRs are generally 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 (95.5%), Florida (92.2%), North Carolina (91.8%), Alabama (90.6%), Louisiana (90.5%), Georgia (90.4%), Arkansas (89.6%), Alaska (89.4%), South Carolina (88.8%) and Maine (88.7%). The states with the lowest rate of consumers who received APTC are: Washington, DC (8.9%), Minnesota (55.0%), Colorado (56.2%), Vermont (64.2%), New Hampshire (64.3%), Utah (64.5%), Kentucky (67.6%), Maryland (71.2%), New York (72.0%) and Oregon (72.3%).

Table 1: December 31, 2015 Total Effectuated Enrollment and Financial Assistance by State 

 December 31, 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

Total

8,780,545

7,375,489

84.0%

4,955,281

56.4%

Alabama

121,079

109,709

90.6%

87,454

72.2%

Alaska

16,156

14,445

89.4%

8,785

54.4%

Arizona

135,036

101,478

75.1%

73,337

54.3%

Arkansas

49,612

44,459

89.6%

28,549

57.5%

California

1,252,343

1,108,727

88.5%

645,162

51.5%

Colorado*

103,609

58,280

56.2%

27,868

26.9%

Connecticut

84,263

65,195

77.4%

41,616

49.4%

Delaware

20,343

16,791

82.5%

8,852

43.5%

Florida

1,110,652

1,024,043

92.2%

778,807

70.1%

Georgia

347,394

314,131

90.4%

236,597

68.1%

Hawaii

16,238

13,077

80.5%

11,019

67.9%

Idaho

81,867

65,704

80.3%

51,514

62.9%

Illinois

259,104

204,144

78.8%

122,874

47.4%

Indiana

146,673

127,096

86.7%

69,455

47.4%

Iowa

36,085

31,039

86.0%

17,726

49.1%

Kansas

76,491

61,116

79.9%

42,105

55.0%

Kentucky

85,919

58,049

67.6%

31,834

37.1%

Louisiana

117,077

105,897

90.5%

67,344

57.5%

Maine

63,090

55,964

88.7%

36,289

57.5%

Maryland

115,297

82,126

71.2%

58,435

50.7%

Massachusetts

178,465

133,621

74.9%

111,497

62.5%

Michigan

259,834

201,395

77.5%

139,674

53.8%

Minnesota

46,481

25,561

55.0%

6,904

14.9%

Mississippi

60,198

57,518

95.5%

46,147

76.7%

Missouri

188,173

166,591

88.5%

109,499

58.2%

Montana

44,044

36,693

83.3%

22,361

50.8%

Nebraska

59,348

52,603

88.6%

29,585

49.9%

Nevada

53,077

42,943

80.9%

30,277

57.0%

New Hampshire

41,323

26,581

64.3%

14,416

34.9%

New Jersey

181,036

150,475

83.1%

90,297

49.9%

New Mexico

37,452

27,160

72.5%

17,355

46.3%

New York

313,197

225,550

72.0%

148,594

47.4%

North Carolina

401,523

368,789

91.8%

256,475

63.9%

North Dakota

15,847

13,505

85.2%

6,497

41.0%

Ohio

175,404

145,907

83.2%

76,548

43.6%

Oklahoma

95,902

77,942

81.3%

58,286

60.8%

Oregon

91,289

66,026

72.3%

38,371

42.0%

Pennsylvania

347,784

275,300

79.2%

188,555

54.2%

Rhode Island

31,010

25,323

81.7%

18,184

58.6%

South Carolina

147,955

131,364

88.8%

92,544

62.5%

South Dakota

17,898

15,595

87.1%

11,321

63.3%

Tennessee

159,790

135,017

84.5%

100,161

62.7%

Texas

791,306

673,836

85.2%

472,304

59.7%

Utah

117,634

75,868

64.5%

73,597

62.6%

Vermont

29,244

18,764

64.2%

9,341

31.9%

Virginia

285,614

242,126

84.8%

158,754

55.6%

Washington

144,720

113,145

78.2%

62,323

43.1%

Washington, DC

13,907

1,240

8.9%

379

2.7%

West Virginia

27,030

23,196

85.8%

14,368

53.2%

Wisconsin

169,288

149,860

88.5%

96,498

57.0%

Wyoming

16,444

14,525

88.3%

8,547

52.0%

Source: February 2016 CMS
* Validated enrollment data was not available for Colorado’s catastrophic plans at the time of publication.

December 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 $272 per month at the end of December 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 $544 per month in Alaska to $154 per month in Minnesota.

Table 2: December 31, 2015 Average Advance Payment of Tax Credits by State

December 2015
Average Advanced Premium Tax Credit by State
(for individuals receiving APTC)

State

Average APTC per Month
(for all APTC enrollees)

National Average

$272

Alabama

$273

Alaska

$544

Arizona

$167

Arkansas

$284

California

$305

Colorado

$235

Connecticut

$356

Delaware

$263

Florida

$300

Georgia

$277

Hawaii

$201

Idaho

$226

Illinois

$213

Indiana

$314

Iowa

$268

Kansas

$208

Kentucky

$222

Louisiana

$323

Maine

$332

Maryland

$221

Massachusetts

$184

Michigan

$264

Minnesota

$154

Mississippi

$354

Missouri

$280

Montana

$228

Nebraska

$255

Nevada

$277

New Hampshire

$250

New Jersey

$299

New Mexico

$200

New York

$231

North Carolina

$314

North Dakota

$229

Ohio

$251

Oklahoma

$208

Oregon

$201

Pennsylvania

$221

Rhode Island

$247

South Carolina

$280

South Dakota

$223

Tennessee

$224

Texas

$251

Utah

$212

Vermont

$275

Virginia

$261

Washington

$262

Washington, DC

$175

West Virginia

$315

Wisconsin

$315

Wyoming

$442

Source: February 2016 CMS

December 2015: Total Effectuated Enrollment by Metal Level by State

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 approximately 8.8 million consumers with effectuated enrollment in Marketplace plans at the end of December 2015, less than half a percent were enrolled in Catastrophic plans, 20% were enrolled in Bronze plans, 68% enrolled in Silver plans, 7% enrolled in Gold plans, and 4% enrolled in Platinum plans.

Table 3: December 31, 2015 Total Effectuated Enrollment Data by Metal Level by State

December 2015
Total Effectuated Enrollment by Metal Level

State

Metal Level

Enrollees

National Total

Total

8,780,545

National Total

Catastrophic

42,290

Bronze

1,788,315

Silver

5,993,766

Gold

645,390

Platinum

310,784

Alabama

Catastrophic

706

Bronze

8,462

Silver

100,742

Gold

6,425

Platinum

4,744

Alaska

Catastrophic

74

Bronze

5,708

Silver

9,656

Gold

718

Arizona

Catastrophic

970

Bronze

20,631

Silver

89,536

Gold

12,845

Platinum

11,054

Arkansas

Catastrophic

165

Bronze

8,511

Silver

35,409

Gold

5,527

California

Catastrophic

6,721

Bronze

306,425

Silver

811,909

Gold

68,100

Platinum

59,188

Colorado

Catastrophic

*

Bronze

42,555

Silver

49,289

Gold

11,214

Platinum

551

Connecticut

Catastrophic

949

Bronze

17,938

Silver

50,311

Gold

13,937

Platinum

1,128

Delaware

Catastrophic

82

Bronze

3,189

Silver

12,621

Gold

3,524

Platinum

927

Florida

Catastrophic

3,158

Bronze

154,218

Silver

851,358

Gold

43,730

Platinum

58,188

Georgia

Catastrophic

2,200

Bronze

42,724

Silver

270,721

Gold

16,959

Platinum

14,790

Hawaii

Catastrophic

24

Bronze

1,982

Silver

11,937

Gold

1,091

Platinum

1,204

Idaho

Catastrophic

268

Bronze

15,903

Silver

57,370

Gold

6,565

Platinum

1,761

Illinois

Catastrophic

894

Bronze

64,858

Silver

157,207

Gold

33,039

Platinum

3,106

Indiana

Catastrophic

684

Bronze

50,147

Silver

89,136

Gold

6,617

Platinum

89

Iowa

Catastrophic

*

Bronze

10,791

Silver

21,423

Gold

3,846

Platinum

*

Kansas

Catastrophic

513

Bronze

14,576

Silver

50,748

Gold

9,150

Platinum

1,504

Kentucky

Catastrophic

596

Bronze

16,520

Silver

46,565

Gold

12,266

Platinum

9,972

Louisiana

Catastrophic

299

Bronze

25,554

Silver

76,416

Gold

7,827

Platinum

6,981

Maine

Catastrophic

330

Bronze

12,967

Silver

46,110

Gold

3,683

Maryland

Catastrophic

1,549

Bronze

24,474

Silver

72,869

Gold

10,223

Platinum

6,182

Massachusetts

Catastrophic

998

Bronze

9,027

Silver

153,646

Gold

7,934

Platinum

6,860

Michigan

Catastrophic

1,605

Bronze

58,827

Silver

176,907

Gold

18,730

Platinum

3,765

Minnesota

Catastrophic

370

Bronze

16,218

Silver

17,985

Gold

8,403

Platinum

3,505

Mississippi

Catastrophic

129

Bronze

6,039

Silver

49,997

Gold

1,969

Platinum

2,064

Missouri

Catastrophic

368

Bronze

45,761

Silver

126,204

Gold

15,072

Platinum

768

Montana

Catastrophic

336

Bronze

12,820

Silver

26,089

Gold

3,189

Platinum

1,610

Nebraska

Catastrophic

431

Bronze

19,877

Silver

35,234

Gold

3,690

Platinum

116

Nevada

Catastrophic

228

Bronze

10,670

Silver

36,012

Gold

3,832

Platinum

2,335

New Hampshire

Catastrophic

487

Bronze

14,395

Silver

21,500

Gold

4,900

Platinum

41

New Jersey

Catastrophic

1,190

Bronze

23,033

Silver

128,450

Gold

20,620

Platinum

7,743

New Mexico

Catastrophic

79

Bronze

8,633

Silver

23,137

Gold

5,459

Platinum

144

New York

Catastrophic

2,307

Bronze

54,328

Silver

186,927

Gold

30,564

Platinum

39,071

North Carolina

Catastrophic

1,235

Bronze

70,571

Silver

302,456

Gold

16,131

Platinum

11,130

North Dakota

Catastrophic

204

Bronze

3,917

Silver

7,453

Gold

4,273

Ohio

Catastrophic

1,893

Bronze

55,846

Silver

95,538

Gold

20,153

Platinum

1,974

Oklahoma

Catastrophic

275

Bronze

24,622

Silver

64,269

Gold

6,701

Platinum

35

Oregon

Catastrophic

497

Bronze

22,519

Silver

58,815

Gold

8,620

Platinum

838

Pennsylvania

Catastrophic

1,199

Bronze

36,923

Silver

245,877

Gold

50,439

Platinum

13,346

Rhode Island

Catastrophic

143

Bronze

5,948

Silver

21,012

Gold

3,907

South Carolina

Catastrophic

*

Bronze

26,588

Silver

109,440

Gold

11,587

Platinum

*

South Dakota

Catastrophic

171

Bronze

2,777

Silver

13,882

Gold

687

Platinum

381

Tennessee

Catastrophic

290

Bronze

33,330

Silver

116,681

Gold

6,834

Platinum

2,655

Texas

Catastrophic

2,251

Bronze

187,775

Silver

543,564

Gold

40,701

Platinum

17,015

Utah

Catastrophic

414

Bronze

19,263

Silver

81,028

Gold

16,088

Platinum

841

Vermont

Catastrophic

138

Bronze

5,686

Silver

16,671

Gold

3,083

Platinum

3,666

Virginia

Catastrophic

2,310

Bronze

64,656

Silver

189,009

Gold

27,183

Platinum

2,456

Washington

Catastrophic

689

Bronze

51,856

Silver

80,467

Gold

11,106

Platinum

602

Washington, DC

Catastrophic

448

Bronze

3,668

Silver

3,719

Gold

3,203

Platinum

2,869

West Virginia

Catastrophic

53

Bronze

3,598

Silver

18,805

Gold

4,574

Wisconsin

Catastrophic

1,022

Bronze

36,823

Silver

120,560

Gold

7,671

Platinum

3,212

Wyoming

Catastrophic

38

Bronze

4,188

Silver

11,099

Gold

801

Platinum

318

Source: February 2016 CMS
*Validated enrollment data was not available for Colorado’s catastrophic plans at the time of publication.
**Data needed to be suppressed for Iowa and South Carolina catastrophic and platinum plans due to small totals.

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 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 October 1, 2015 to December 31, 2015, enrollment in coverage through the Federally-facilitated Marketplaces was terminated for about 30,000 consumers with citizenship or immigration status data matching issues who failed to produce sufficient documentation of their citizenship or immigration status. During the same time period, about 57,000 households with annual household income inconsistencies had their APTC and/or CSRs for 2015 coverage adjusted. In total during 2015, coverage was terminated for about 500,000 consumers with citizenship or immigration data matching issues and APTC and/or CSRs were adjusted for 1.2 million consumers. Data matching issues often impact effectuated enrollment with a lag, because consumers who stop paying premiums after an APTC adjustment have a grace period before their coverage is ended.

If a consumer believes he or she has the appropriate documentation but his or her 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.  
 


i This snapshot does not include effectuated plan selections from the most recent open enrollment period. Individuals 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.
ii This 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 December 2015 as of February 2016 interim payment process data submission.
iii For 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.
.