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First Half of 2017 Average Effectuated Enrollment Report

Date
2017-12-13
Title
First Half of 2017 Average Effectuated Enrollment Report
Contact
press@cms.hhs.gov

First Half of 2017 Average Effectuated Enrollment Report

Effectuated Enrollment Analysis

According to data as of September 15, 2017, an average of 10.1 million individuals had effectuated their coverage through June 2017, meaning that they selected a plan and paid their premium. This is approximately 300,000 fewer effectuated individuals compared to the effectuated report for the first half of 2016 and about 2.1 million below the number of plan selections at the end of 2017 open enrollment.

Looking historically at Affordable Care Act trends from 2014 through 2017, we also see that a significant number of people who effectuate coverage do not stay in their plans for the full year. By June, 9.9 million individuals remained in coverage compared to the 12.2 million who selected plans. On average since 2014, more than a million enrollees per year dropped their coverage before the end of the plan year. 

This report also shows that the proportion of the population that enrolls on Federal and State-Based Exchanges and qualifies for financial assistance in the form of advance premium tax credits (APTC) or cost-sharing reduction (CSR) has remained relatively stable, but the average amount of APTC per eligible individual has risen by nearly 29% when compared with the 2016 average APTC per eligible enrollee. In addition, the average amount of APTC per eligible enrollee has risen slightly (from $371.49 to $373.37) when compared with the February 2017 snapshot average APTC per eligible enrollee. This indicates that individuals who effectuated after February 2017 and who remained covered were more likely to have or receive more APTC.

Background Information

The primary source for the first half of 2017 average effectuated enrollment are payment and enrollment data. Effectuated enrollment is the average number of individuals who had an active policy from January through June of 2017, and who paid their premium (thus effectuating their coverage) as of September 15, 2017. This data includes effectuated enrollment from both State-Based and Federally-Facilitated individual market Exchanges. 

APTC enrollment is the average number of individuals who had an active policy from January through June of 2017, who paid their premium, and who received an APTC subsidy. APTC is generally available if a consumer's household income is between 100 and 400 percent of the federal poverty level and certain other criteria are met. A consumer was defined as having an APTC if the applied APTC amount was greater than $0; otherwise, a consumer was classified as not having APTC.  

CSR enrollment is the average number of individuals who had an active policy from January through June 2017, who paid their premium, and received CSRs. A CSR is generally available if a consumer is eligible for APTC, has a household income between 100 percent and 250 percent of the federal poverty level, and the individual chooses a health plan from the silver plan category. Those who qualify have reduced out-of-pocket costs. American Indians and Alaskan Natives are eligible for CSRs under different criteria.

To see a breakdown of the data by state, click here.

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