START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

Massachusetts

Massachusetts has one of the stablest statewide insurance markets, no doubt in large part due to their having instituted the precursor to the ACA, "RomneyCare", 4 years earlier. Massachusetts also merged their small business and individual market risk pools, which helps stabilize things. As a result, they have a high number of carriers participating in their ACA exchange and are among the few states with single-digit average rate hikes...assuming CSR payments are forthcoming and the individual mandate is properly enforced.

Assuming CSR payments aren't made, I used the Kaiser Family Foundation's 19% average estimate for Silver plan hikes due to the CSR factor. Since a whopping 92% of MA's exchange enrollees chose Silver plans (it looks like MA's unique "ConnectorCare" plans are considered Silver as well), that means an average CSR factor of around 17.5 points across the entire individual market.

Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.

I just noted this morning that Rhode Island's enrollment numbers for 2017 are coming up significantly short of not only my own admittedly unrealistic hopes (I was hoping RI would buck the national trend and beef up enrollment by 15% this year), but is likely to actually come up lower than last year's 33.9K by several thousand people.

Fortunately, the opposite is proving to be the case in Massachusetts:

Through yesterday, we had 240,745 enrolled in January 2017 coverage...these are people who paid their bill. There are an additional 11,803 people who selected a plan but haven't paid for it yet. That's a total of 252,548.

That's, 252,548 QHP selections as of 12/28/16, of which over 95% have actually paid their first monthly premium (well above the 90% payment national average).

I noted a couple of weeks ago that Massachusetts has a unique methodology for reporting their ACA exchange enrollments. For one thing, they only officially count people who sign up for policies as "enrollees" after they've made their first monthly premium payment. In addition, like some other state exchanges, they "pre-renew" their current enrollees before the December deadline, and then reduce the official number from there as some people choose not to renew their coverage. As a result, instead of their "QHP selection" tally increasing, it actually starts out huge and then drops a bit as the enrollment period continues.

As a result, instead of 260,275 QHP selections, their number is a bit lower today:

Through Sunday, the 18th: 224,211 2017 enrollments. Plus, an additional 26,868 plans selected but unpaid at this point.

A couple of weeks ago, I noted that Massachusetts had confirmed just over 23,000 QHP selections for 2017 as of 11/17, consisting of around 15,800 renewing enrollees and 7,200 new people signing up.

Today I've received the latest enrollment data out of the Bay State:

As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.

That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.

OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.

A very quick update out of the Bay State:

  • As of 11/17: 23,026 total QHP selections (13,523 fully paid/enrolled for 1/1/17 coverage)
  • 15,800 renewals/reenrollees (69%), 7,226 new/returning enrollees (31%)

That's 1,355/day on average for the first 17 days; this is up from 1,281/day for the first 8 days.

For comparison, last year they only averaged around 575/day (for the first 7 days anyway), so it's definitely busier (2.3x faster) so far.

Even just looking at new enrollees: The first week averaged 183/day last year; this year it was 368/day the first 8 days and 425/day the first 17 days...again, more than twice last year's rate so far.

In addition to releasing their 2017 enrollment data for the first 8 days of November, the Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of October), and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.

The most recent hard current exchange QHP enrollment number I have for Massachusetts is 230,412 people as of September 1st. Due to MA's unique "ConnectorCare" program, they've actually seen a gradual increase in exchange enrollment during the off-season instead of net attrition like almost every other state.

Today I was informed that as of November 8th, they had a grand total of 2,942 new QHP selections via the state exchange...of which 510 are fully enrolled (i.e., they've paid their January premiums already). This does not, however, include any renewals / re-enrollments by current enrollees, which could be substantially higher.

UPDATE: OK, I have the total enrollment numbers now: 10,251 (7,309 renewals + 2,942 new additions). That's 1,281 per day, or about 4.8% of their total enrollment last season.

Minnesota and Massachusetts are the only state exchanges I have data for so far, and MN is a special case, so here's a simple extrapolation of MA's numbers:

Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.

The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.

Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.

The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of August), and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.

(sigh) Here's a good example of what a royal pain in the ass trying to estimate the annual rate change filings can be. Just 2 weeks ago, I was finally able to plug in the requested 2017 rate hikes requested by just about every carrier offering individual policies in Massachusetts, filling in one of the final blank states in my 2017 rate hike project.

This was a double headache: First, because the actual enrollment numbers were only available for 3 out of 11 carriers via the filings; I had to get the rest from the MA exchange's monthly dashboard report. Secondly, even with the dashboard report, I had to merge together 2 different enrollment numbers for each carrier due to MA's unique "ConnectorCare" program.

The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of July), and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.

Massachusetts' total individual market was only around 72,000 people in 2014, but their ACA exchange had disastrous technical problems during the first ACA open enrollment period, causing tens of thousands of Baystaters to enter a sort of "limbo" status healthcare coverage-wise (the first version of the exchange couldn't properly confirm which enrollees qualified for APTC assistance, so only those paying full price were actually enrolled in exchange QHPs; those claiming APTC status were temporarily transferred over to state-based coverage until it could be sorted out, which took nearly a year in most cases). Fortunately, in 2015, the state got their act together and enrolled nearly 214,000 people in exchange-based policies this year.

I just posted some key specs from the MA Health Connector's monthly enrollment report, but they also posted a bunch of other interesting stuff from their board meeting as well. In no particular order...

  • I already knew that Massachusetts was among the 30-odd states that UnitedHealthcare was dropping out of. However, it turns out that United is currently covering fewer than 500 of MA's exchange enrollees (considering that MA's entire individual market was only 72,000 people 2 years ago, and exchange enrollment alone is currently 224,000, I'd imagine that there aren't too many off-exchange United enrollees on top of those 500).
  • In addition, Guardian and MetLife are dropping off of MA's dental policy exchange, although according to their monthly report, neither one has any market share via the exchange this year anyway (Altus and Delta seem to make up 100% of the total). (correction: I was looking at the individual dental exchange; Guardian/MetLife are on the small group exchange this year)
  • The MA exchange reports an impressive 94% enrollment retention rate year over year:

The Massachusetts Health Connector has posted their latest monthly enrollment report, and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

Pages