Open enrollment period

News Briefs: Almost 5.5M Sign Up for Marketplace Plans

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.

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News Briefs: DOJ, Two States Appeal Ruling in UnitedHealth/Change Antitrust Case

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.

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News Briefs: Health Insurance Call Center Workers Go on Strike

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.

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Enhanced Subsidies Drive ACA Enrollment Growth; Assister Programs and Brokers Play Key Roles

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.

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ACA Exchange Signup Season Kicks Off With Rich Subsidies, More Federal Oversight

When the 2023 open enrollment period for Affordable Care Act exchange plans officially begins on Nov. 1, health insurers will be offering plans in a market full of contrasts: where, for example, rising premiums are masked by enhanced subsidies, and where health plan competition is at its highest level but there’s fewer new-to-the market insurers than there were in 2022.

New regulatory changes are also taking effect in the 2023 plan year. Most notably, insurers will have to offer standardized plans alongside their other products for the first time since the Obama administration, and CMS will be evaluating plans for quantitative network adequacy standards.

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Three Major Insurers Will Expand ACA Exchange Footprints in 2023

Galvanized by a growing, stable Affordable Care Act exchange market and a looming dropoff in Medicaid membership, some of the country’s largest health insurers in 2023 are once again expanding their ACA marketplace footprints. At the same time, two startup insurers are pulling out of select markets — although one policy expert tells AIS Health that those moves mainly reflect how difficult it is to compete against companies with dominant market shares.

Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says significant enrollment growth in Southern states appears to be driving some insurers’ expansion moves this year.

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Major National Health Insurers Expand ACA Presence in 2023

Cigna Corp. will expand its Affordable Care Act exchange offerings in 2023 by 50 new counties in Georgia, Mississippi and North Carolina and add three new states — Texas, Indiana and South Carolina — the insurer said in August. If approved by the state regulators, Cigna’s market expansion has the potential to reach roughly 730,000 additional enrollees. The carrier has been expanding its footprint over the past few years, currently ranking 11th in national ACA enrollment with 340,000 members. Its major state markets are Tennessee (85,000 members), Virginia (62,000) and Missouri (49,000).

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Health Insurers, Feds Gear Up to Steer People to ACA Marketplaces

With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But they’ll also be prepping for a bigger challenge down the road: Ensuring a smooth transition for people who will no longer be covered by Medicaid after the COVID-19 public health emergency (PHE) ends.

To that end, the Biden administration on Aug. 30 rolled out a plan called the “Assister Strategy to Support Medicaid Unwinding.” As part of that plan, HHS said it’s allocating $100 million to Navigator grantee organizations for the 2022-2023 budget period as well as reviving the Enrollment Assistance Program (EAP), which established temporary storefronts and labor forces that the Obama administration used in the ACA marketplaces’ early years to supplement Navigators’ outreach efforts. For the new version of the EAP, the Biden administration will deploy “mobile assisters” across population centers identified by HHS.

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Expanded Footprints, Enhanced Benefits Aided Plans’ OEP Gains

Medicare Advantage enrollment reached nearly 28.8 million as of May, reflecting an overall increase of about 1% during the three-month Open Enrollment Period (OEP) that ended on March 31, according to the latest update to AIS’s Directory of Health Plans (DHP). That’s compared with growth of 5.3% from October 2021 to February, reflecting results from the Annual Election Period (AEP) that ran from Oct. 15 through Dec. 7. Beneficiaries who enrolled in an MA plan during the AEP have a one-time opportunity to change their coverage selection during the OEP, and insurers that made above-average membership gains during both periods attributed their successes to product enhancements, geographic expansions and strong distribution partnerships.

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UnitedHealth Dominates While Startups Make Gains in 2022 Medicare Open Enrollment Period

Medicare Advantage enrollment grew by about 232,000 lives during the 2022 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. As in the Annual Election Period (AEP), UnitedHealthcare dominated, holding 45.1% of the overall OEP gains, followed by CVS Health Corp.’s Aetna at 16.9% and Centene Corp at 13.5%. Among other large, publicly traded insurers, Cigna Corp. and Humana Inc. both flopped in the OEP, losing 12,600 and 4,200 members, respectively. Meanwhile, insurance startups Bright Health and Clover Health both made the top 20 despite recent financial challenges and questioned viability. See the top 25 OEP performers, plus their AEP results and current enrollment, in the chart below.

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