ACA's hidden statistic: 7.8 million enrolled outside exchanges

HHS announced last week that 7.5 million Americans had signed up for health coverage through the Obamacare exchanges, exceeding the Congressional Budget Office's original estimate of 7.1 million. What's gotten less attention is the large number of people who have signed up for coverage outside the exchanges, either directly with health plans or through brokers.

While the federal government hasn't released any totals, a new study by the RAND Corp. estimates that 7.8 million people enrolled outside the exchanges between November and mid-March and that 94% previously had coverage.

America's Health Insurance Plans complained in a letter to the CMS that the option of signing up directly with insurers hasn't been more prominently featured on the HealthCare.gov website.

The exchanges' technological problems likely contributed to the sizable off-exchange enrollment. Quincy, Mass.-based Harvard Pilgrim Health Care said it added 11,000 members in Maine and New Hampshire for coverage that kicked in at the start of 2014, even though it did not participate in the exchanges. “We were getting inundated with telephone calls from frustrated individuals who believed they were eligible for subsidies but didn't have any reasonable method for getting enrolled,” said Eric Schultz, the plan's president and CEO.

Some state regulators and individual health plans have released their data on signups outside the exchanges:

  • Blue Cross and Blue Shield plans signed up 1.7 million people outside of the exchanges through February.

  • Washington state reported roughly 184,000 off-exchange enrollments through the end of February.

  • CoOpportunity Health, a new, consumer-governed insurer in Iowa and Nebraska, signed up 11,000 of its 70,000 enrollees outside of the federal exchange.

  • In Rhode Island, the two health plans selling products on the exchange enrolled 29% of their customers outside of the online marketplace.

  • PreferredOne, owned by Minneapolis-based Fairview Health Services, said more than 70% of its 68,000 enrollments since Oct. 1 have come via its website.

    • Consumers enrolling outside the exchanges are thought to be healthier and wealthier than those signing up on the exchanges, particularly since federal premium subsidies are available only through exchanges. Nearly half the customers who enrolled through eHealth, an online broker, between Jan. 1 and March 23 were ages 18 to 34, a much higher percentage than those enrolling through the exchanges.

    Follow Paul Demko on Twitter: @MHPDemko

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