Open enrollment period

Medicare Advantage enrollment grew by more than 507,000 lives during the 2023 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a significant increase from last year’s OEP, when plans added about 230,000 new members from February to May 2022. The news comes just weeks after a KFF analysis found that the number of seniors enrolled in MA vs. original Medicare officially crossed the 50% threshold.

A record high 16.4 million people enrolled in Affordable Care Act marketplace coverage during the 2023 Open Enrollment Period, including 12.2 million people who live in states using HealthCare.gov and 4.2 million in 18 states with their own marketplace, according to CMS. Enrollment in HealthCare.gov marketplaces was up 19% compared with 2022, while signups in the state-based marketplaces saw a slight decline for the first time since 2019.

More than half of states saw their enrollment increase by at least 5% from 2022 to 2023, with five states experiencing signup surges of more than 25%. Meanwhile, plan selections in Kentucky, Massachusetts and New Mexico shrunk by over 10% year over year.

With nearly all the 2023 open enrollment period data now tallied, it appears that something curious is happening in states that run their own Affordable Care Act exchanges: Enrollment levels are on track to decline compared to 2022. That trend follows years in which state-based marketplaces (SBMs) outperformed states using the HealthCare.gov platform in terms of year-over-year enrollment growth, and it comes as HealthCare.gov states are reporting a significant signup surge compared to 2022.

Health policy experts tell AIS Health, a division of MMIT, that there are likely multiple factors causing the reversal of fortunes between HealthCare.gov and SBM enrollment. But in an important takeaway for health insurers that operate in the exchanges, they say the trend could indicate that the “addressable market” in certain states is reaching its saturation point.

During the open enrollment period that ended on Jan. 15 in most states, 16,306,448 people selected an Affordable Care Act marketplace plan, the Biden administration said on Jan. 25. That total represents a 13% increase compared to the same time last year, and accounts for plan selections through Jan. 15 on the 33 states using HealthCare.gov and through Jan. 14 or 15 on the 18 state-based marketplaces. While record-breaking for the exchanges, the signup total for 2023 is not final, as open enrollment continued through Jan. 23 for Massachusetts Health Connector and through Jan. 31 for DC Health Link, Covered California, Get Covered New Jersey, New York State of Health and Health Source Rhode Island. Still, the Biden administration hailed the new enrollment figures, with CMS Administrator Chiquita Brooks-LaSure stating: “On the tenth anniversary of the ACA Marketplaces, the numbers speak for themselves: more people signed up for plans this year than ever before, and the uninsured rate is at an all-time low.”

Nearly 11.5 million people selected or were automatically reenrolled in health plans for 2023 on HealthCare.gov as of Dec. 15, 2022, an 18% increase over the same time period in 2021, according to CMS. Although the average premium for benchmark silver plans (before accounting for tax credits) increased by 4.1% in 2023 after four years of declines, enrollees receiving subsidies may find their net premiums for low-cost bronze, silver and gold plans are lower than last year, according to a Kaiser Family Foundation analysis.

In a move made at a critical juncture in the annual Affordable Care Act open enrollment period, Oscar Health, Inc. recently said it will “temporarily stop accepting new members in the state of Florida.”

Industry observers tell AIS Health, a division of MMIT, that the decision is clearly linked to fellow startup Bright Health Group, Inc.’s exit from all 15 states in which it was set to sell plans next year. But they’re divided on what the implications are for Oscar’s viability as a business.

In a Dec. 12 press release, Oscar — which was founded in 2012 and went public in 2021 — said that it “proactively engaged regulators [in Florida], as a result of the changing market dynamics following market exits by certain carriers, regarding options to manage its membership growth.”

Nearly 5.5 million people have selected health plans since the Affordable Care Act open enrollment period began on Nov. 1, CMS said in its latest marketplace enrollment update. That total captures signups on HealthCare.gov through Dec. 3 and through Nov. 26 for the state-based marketplaces, and it represents an 18% increase compared to the same time period last year. So far 22% of total plan selections have been from individuals who are new to the marketplaces, while 78% are returning customers, CMS said. The open enrollment period lasts through Jan. 15 for HealthCare.gov states and most state-based marketplaces.

Blue Shield of California — which lost its bid to continue to serve California’s Medicaid managed care program — plans to lay off 373 employees by Jan. 25, Modern Healthcare reported. The decision from California’s Dept. of Health Care Services came in August after the state held its first competitive bidding process for Medi-Cal contracts. Blue Shield was not chosen — prompting the insurer to later sue the state — while Elevance Health’s Anthem Blue Cross Partnership Plan, Centene Corp.’s Health Net and Molina Health Care were selected to participate in varying service areas across 21 counties. The layoffs represent a small portion of Blue Shield’s total workforce of 7,800, Modern Healthcare noted, and the cuts are mostly concentrated at the insurer’s Sacramento-area offices.

The U.S. Dept. of Justice, Minnesota and New York have filed an appeal in their antitrust case against UnitedHealth Group’s now-completed acquisition of Change Healthcare, Inc. The DOJ and state attorneys general filed their notice of appeal on Nov. 18, roughly two months after Judge Carl Nichols of the U.S. District Court of the District of Columbia dismissed their case against the $13 billion transaction. Regulators had argued that the deal would give UnitedHealth’s OptumInsight division too much power over health care data, but Nichols ruled that Change’s planned divestiture of its claims-editing technology, ClaimsXten, would assuage any anticompetitive concerns. UnitedHealth has now officially closed its deal with Change, and press reports indicate that the firm TPG Capital has finalized its acquisition of ClaimsXten.

Workers employed by the federal contractor Maximus — which handles calls about Medicare and Affordable Care Act plans — went on strike in four states on Nov. 1. The employees based in Louisiana, Mississippi, Kentucky and Virginia want to be paid $25 per hour and have more breaks between calls, of which they field 15 to 20 daily lasting about 30 minutes each, NPR reported. Although the workers are not unionized, they had been organizing for months. In a statement to NPR, Maximus said it “welcomes the opportunity to work directly with our employees and discuss and hopefully resolve their concerns,” adding that it does not anticipate any service disruptions as a result of the strike. The Annual Election Period for Medicare Advantage plans began on Oct. 15 and the ACA open enrollment period started Nov. 1.

Open enrollment for 2023 Affordable Care Act exchange plans starts on November 1, with the Biden administration hoping to continue the enrollment growth seen over the past few years. As of early 2022, about 16.9 million people were enrolled in the individual market, a 20% increase from early 2020, according to a recent Kaiser Family Foundation analysis.

The growth is largely driven by enhanced subsidies enacted by American Rescue Plan Act (ARPA) and extended through 2025 by the Inflation Reduction Act. Overall, about 75% of individual market enrollees are now subsidized. The study estimated that about 3 million people will buy unsubsidized coverage off- marketplace during 2023 open enrollment, a decrease compared to prior years.