Health Insurance Marketplace Updates


Insurance Exchanges: March Results and Next Steps

Health Insurance Marketplaces (or Exchanges) established under provisions of the Affordable Care Act (ACA) had a six-month enrollment period in each state. Open enrollment was defined as Oct. 1, 2013 through Monday, March 31, 2014. 

Enrollment Deadlines:  For most individuals and families, the deadline to purchase an individual market policy has passed for 2014; all exchanges or marketplaces will begin selling 2015 policies as of Nov. 15, 2014.  However, on March 26, HHS officials issued procedures for those that attempted to buy health insurance, but miss the March 31 deadline. Some will be able to apply for a temporary extension, described in Guidance for Issuers on "People “In Line” and for "Complex Cases."    These situations may allow them to complete the enrollment process into April, or in some cases, May 2014.

Marketplace Open Enrollment Process by the Numbers* - 

  • According to the Fact Sheet dated 4/17/2014, released by the White House:
    • 8 million people signed up for private insurance in the Health Insurance Marketplace. For states that have Federally-Facilitated Marketplaces, 35 percent of those who signed up are under 35 years old and 28 percent are between 18 and 34 years old.  These numbers happen to be "virtually the same youth percentage that signed up in Massachusetts" in 2007, their first year of state health reform run by the Massachusetts Connector.
    • 3 million young adults gained coverage basd on the Affordable Care Act by being able to stay on their parents plan.
    • 3 million more people were enrolled in Medicaid and CHIP as of February, compared to before the Marketplaces opened. Medicaid and CHIP enrollment continues year-round.
    • 5 million people are enrolled in plans that meet ACA standards outside the Marketplace, according to a CBO estimate. When insurers set premiums for next year, they are required to look at everyone who enrolled in plans that meet ACA standards, both on and off the Marketplace.
    • 5.7 million people will be uninsured in 2016 in the 24 states have not expanded Medicaid.
  • An earlier compilation, from April 1, reported enrollment reached 7.1 million according to a White House announcement. It was also reported that, on March 26 "more than 1.5 million people went to, and another 430,000 called one of the call centers."  New: Medicaid through Exchanges: Enrollment report - released by HHS Apr. 4, 2014 
    • California reported 1 million enrolled as of Mar. 17; non-final applicants have until Apr. 15 to complete that process.
    • Colorado reports 106,000 enrolled, "uninsured-show-up in droves" with heavy use at their walk-in site in Denver. (Denver Post, 4/1/2014). Connect for Health CO will "work with customers" who were not able to complete applications.
    • Connecticut has not formally extended its enrollment deadline, but has an exception for those who sought to enroll by telephone prior to midnight Mar. 31.
    • Kentucky's Kynect enrolled 66,586 in exchange plans, plus 269,781 in Medicaid, with an estimated 360,000 by Monday’s midnight deadline for the ACA open-enrollment period (Courier-Journal, 4/1/2014). Applicants will have until Apr. 15 to pick a plan if needed..
    • Maryland Health Secretary Dr.Sharfstein said that Maryland has enrolled about 60,000 people in private health plans as of Apr. 1; in addition 232,025 had enrolled in Medicaid. That, Sharfstein said, would push the state beyond its goal of enrolling 260,000 total people in the first enrollment period.

      Sharfstein said the federal government awarded Maryland about $180 million to build its exchange; about $129 million has been spent.(CBS Local News, 4/3/2014)

    • Massachusetts has not provided a public extension as of Apr. 3, indicating that reguar enrollment continues: residents "can apply at any time of the year if you are applying for dental plans or help paying for health coverage including MassHealth, Children’s Medical Security Plan (CMSP), or Health Safety Net. Or, if you’ve experienced a qualifying event" or seek a SHOP/small business health plan.
    • Nevada established a 60-day special enrollment period, through May 30 for those who attempted to apply.  Nevada Health Link has 35,191 fully enrolled with a plan; 22,889 have confirmed first-month payments. 
           Nevada also has a new law NRS 687B Sec480  that took effect in January, 2014 providing that any insurer that sells individual health plans outside the state's health insurance exchange must offer those plans year round. To avoid patients from waiting until they get sick to buy a plan, insurers can require a waiting period of up to 90 days for coverage to take effect. 
    • Oregon extended the enrollment application to Apr. 30, based on HHS approval, received Mar. 26.  The process also waives the federal mandate penalty during April.  On April 24 the governing board of the state-run exchnage voted to terminate the state-created website, and move operations to the federall facilitated, after persistent technical problems. Oregon is the first state to announce a switch from state to federal web operations.
    • Rhode Island reports "just over 26,000 individuals had signed up for private-plan coverage through HealthSource RI, with most having paid the first month's premium" as of Mar. 31.  In early March, state officials had reported another 48,602 Medicaid enrollment.  (CT Post, Providence), 3/31/2014)
    • Washington state has not set and extended deadline, for those applicants who "were unable to reach the toll-free customer support center or experienced other technological barriers to completing enrollment." (Exchange statement, 3/31/2014)

* Sources and disclaimer: All enrollment statistics have been tallied and reported by federal, state or other documented sources, as noted.  NCSL is not responsible for the reported numbers or any opinions or interpretations contained in third-party articles or links.

​​Added Rule Will Offer Subsidies for Insurance Policies Bought Outside Exchanges

In a changed policy announced Friday, Feb. 27, 2014, HHS officials agreed to authorize premium subsidies retroactively for insurance purchased in the private market. The change came in response to Oregon's request because of serious delays and errors that occurred with the Cover Oregon website over several months. You can read the HHS Guidance memorandum, "CMS Bulletin to Marketplaces on Availability of Retroactive Advance Payments in 2014 Due to Exceptional Circumstances." This can mean payments may be available in most states, because technical problems had prevented consumers from using the online exchanges.

Additional Resources

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