Fact sheet

Effectuated Enrollment for the First Half of 2018

Effectuated Enrollment for the First Half of 2018

This report provides average effectuated enrollment and premium data for the Federal and State-Based Exchanges for the first six months of the 2018 plan year. The Centers for Medicare & Medicaid Services (CMS) publishes effectuated enrollment data semiannually to provide a more accurate picture of enrollment trends for the Exchanges than indicated by the number of individuals who simply selected a plan during Open Enrollment. For coverage to be considered effectuated, individuals generally must pay their premium for the given month.

As of September 15, 2018, an average of 10.3 million individuals had effectuated their coverage through June 2018, meaning that they selected a plan and paid their premium, if applicable. The average effectuated enrollment for the first six months of 2018 was approximately 137,000, or 1 percent, higher compared to the same time period in 2017.[1] 

Similar to past years, the number of individuals who effectuated coverage is lower than the number with plan selections at the end of Open Enrollment. The average number of consumers with effectuated coverage for the first half of 2018 was about 1.5 million lower than the number of consumers with plan selections at the end of the 2018 Open Enrollment Period.[2] However, this reflects lower attrition of consumers compared to the previous year. Effectuated enrollments for the first half of 2017 were about 2.1 million lower than the number of plan selections at the end of the 2017 Open Enrollment Period (as of September 15, 2017).

The data released today also show that the average monthly premium per enrollee for the first six months of 2018 was $595.89, an increase of 26 percent compared to the first six months of 2017, while the average monthly amount of advanced premium tax credits (APTC) per enrollee receiving APTC rose 39 percent to $519.18 when compared with the first six months of 2017 average APTC per enrollee with APTC. The average premium and average APTC amounts have been relatively stable since the start of the 2018 plan year, however, as indicated in the Early 2018 Effectuated Enrollment Snapshot. The proportion of total enrollees who received APTC in the first six months of the year was 87 percent, up from 84 percent in the first half of 2017.

Background Information                                  

The primary source for the first half of 2018 average effectuated enrollment is payment and enrollment data. Effectuated enrollment is the average number of individuals who had an active policy from January through June of 2018, and who paid their premium (thus effectuating their coverage) as of September 15, 2018. This data includes effectuated enrollment for both State-Based Exchanges and States using the HealthCare.gov platform.

APTC enrollment is the average number of individuals who had an active policy from January through June 2018, who paid their premium, if applicable, and received an APTC. 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 2018, who paid their premium, if applicable, and received cost-sharing reductions (CSR).[3] A consumer is generally eligible for CSR if the individual is eligible for APTC, has a household income between 100 percent and 250 percent of the federal poverty level, and enrolled in a health plan from the silver plan category. American Indians and Alaskan Natives are eligible for CSRs under different criteria.

To see a breakdown of the data by state, click here: https://www.cms.gov/sites/drupal/files/2018-11/11-28-2018%20Effectuated%20Enrollment%20Table.pdf

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[1] FIRST HALF OF 2017 AVERAGE EFFECTUATED ENROLLMENT REPORT, https://www.cms.gov/newsroom/fact-sheets/first-half-2017-average-effectuated-enrollment-report

[2] EXCHANGE 2018 OPEN ENROLLMENT PERIOD FINAL ENROLLMENT REPORT: Centers for Medicare & Medicaid Services, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-03.html

[3] On October 12, 2017, the Acting Secretary of HHS directed that cost-sharing reduction payments to issuers be discontinued until a valid appropriation exists. Therefore, CSR enrollment is provided in this report for informational purposes only.