The Affordable Care Act's fourth open enrollment kicked off Tuesday just a week after HHS announced double-digit premium hikes for some unsubsidized exchange plans, but the news didn't seem to spook early-bird shoppers from signing up for 2017 coverage.
Open enrollment kicked off Nov. 1 for federal and state-based exchanges and will run through Jan. 31. HHS said more health insurance shoppers got an early start this year, submitting 60,000 applications for coverage through the federal marketplace in the first six hours of open enrollment Tuesday, up 50% compared to the early hours of last year's open enrollment.
In total, there were about 150,000 applications submitted over the first day, and on Wednesday “tens of thousands of consumers continue to submit applications,” HHS spokeswoman Marjorie Connolly said.
HHS estimates that 13.8 million individuals will sign up for coverage through the exchanges during the fourth open enrollment, compared with 12.7 million last year. Of those projected to enroll, HHS predicted that 9.2 million will be re-enrollees from last year, 3.5 million will be new enrollees who were previously uninsured, and 1.1 million are individuals transferring to exchange coverage from off-exchange, nongroup plans.
Open enrollment in the federal and state-based exchanges ran rather smoothly, though some shoppers attempting to sign up for coverage through the federal marketplace on Tuesday and Wednesday may have been directed to a “waiting room” on the site. The HHS spokeswoman said the waiting room, which has been used in past open enrollments, helps improve the consumer experience on the site.
Open enrollment so far “has been going really well,” said Ambar Calvillo, national director of field and partner engagement at Enroll America, a D.C.-based not-for-profit group that helps people sign up for coverage. Calvillo said the group, which works with enrollment assistors across the nation, hasn't seen any major obstacles. Before open enrollment, exchange shoppers scheduled more than 5,400 appointments for in-person enrollment assistance through Enroll America's Get Covered Connector tool, up 80% over last year.
Calvillo said the large number of appointments that continue to be scheduled show people are “engaged in their health coverage” and are heeding calls from the Obama administration and assistor organizations to shop around on the marketplace for a better deal.
Elizabeth Hagan, senior policy analyst at Families USA, a D.C.-based not-for-profit organization that provides technical support and other resources to enrollment assistors, said the exchanges are seeing a mix of new and returning customers. Several states said “a good amount of people” are coming to the exchanges and showing interest, she said, and the exchanges will likely see a big spike in enrollment closer to Dec. 15, the last day to enroll in coverage for Jan. 1.
State-run exchanges in California, Colorado, Idaho and Massachusetts reported no problems on the first day of enrollment.
Pat Kelly, executive director of Idaho's exchange, Your Health Idaho, said the marketplace “had a really strong first day.” Web page views were up 60% from last year, while call volumes increased 10% to 15%, he said. The Idaho marketplace also saw a greater mix of new users. The state marketplace now has about 95,000 enrollees.
Minnesota's health exchange marketplace, MNSure, said it experienced “historically high call volume” and extended its call center hours. A spokesman for Colorado's exchange said the first day's plan selections “were significantly ahead” of last year's and enrollment ran smoothly in part because of the exchange's newly launched quick cost and plan finder tools.
A spokesman for California's exchange said its systems are running well and service centers are responding to customer's questions, but the state is holding off on marketing the exchanges until after the presidential election, so it doesn't expect large enrollment numbers in the first few weeks.
The increased traffic among exchange shoppers comes as a relief to federal and state officials at the start of what is a pivotal year for the public insurance exchanges. Many large insurers, like UnitedHealth Group, Aetna and Humana, have scaled back their participation because high-cost exchange enrollees are choking insurer profits. Moreover, the results of the Nov. 8 presidential election could have far-reaching consequences for the future of the marketplaces.
This year, the exchanges are set to face a myriad of challenges. Late last month, HHS announced that benchmark exchange plans before subsidies are set to rise 25% on average in 2017—an eye-popping figure that could deter exchange shoppers from seeking coverage. HHS has said that 85% of exchange customers are eligible for financial assistance that will protect them from the premium increases, and assistor organizations are working to drive that point home.
Additionally, some exchange customers will have less choice when shopping. The number of insurers offering health plans in the 39 states using HealthCare.gov in 2017 is dropping to 167 from 232 this year. While 83 insurers are exiting, just 15 are entering the market, according to HHS data.
About 1 in every 5 exchange shoppers will have only one insurer to choose from this open enrollment, though that insurer may offer multiple health plan options. Five states participating in the federally run exchange—Alabama, Arkansas, Oklahoma, South Carolina and Wyoming—will have only one insurer offering plans, according to HHS data.
That means some shoppers will be forced to change insurers, which could mean, depending on the new insurer's network, that they no longer can access their normal doctor or hospital at in-network rates.
“You are going to see a lot of switching, and some of this is going to be forced plan-switching” said Noah Lang, founder of Stride Health, a San Francisco-based tech company that helps independent workers from companies like Uber and Postmates enroll in exchange coverage. “It's tough for consumers to understand which plan is the right plan to switch into, and what amount of coverage is right. Even when you have a slimmed-down number of carriers, you still have to make a decision.”
Still, federal officials said the average customer will be able to choose from 30 health plans. About 79% of shoppers will have a choice of two or more insurers, and 56% can choose between three or more.
Despite the challenges, “We anticipate that people are going to continue actively shopping for health insurance,” said Sophie Stern, director of policy and strategic initiatives for Enroll America. “The folks who have entered the marketplaces, they have done so because they need health insurance and they value health insurance. …This is not going to make them not value health insurance,” she said.