In this edition
- Eleven state-run exchanges extend open enrollment periods
- Two states move to state-run exchange platforms this fall
- Window shopping for 2021 health plans available in DC and eight states
- Mostly modest rate changes for 2021, with increases in some states and decreases in others
- Insurers join marketplaces or expand coverage areas in more than 20 states
- Wisconsin asks Trump administration to extend open enrollment
- Enrollment trends show unsubsidized enrollment down 45% from 2016 to 2019
- Nearly two years after voters approved it, Medicaid expansion is in effect in Nebraska
- KFF employer survey: Average cost of family premiums now exceeds $21,000
- Uninsured rate continues to rise for both the overall population and children
Welcome back to The Scoop! Open enrollment for individual (non-group) health insurance plans is just around the corner, and will be underway nationwide as of November 1. For those interested in open enrollment and individual-market coverage, there’s plenty of encouraging news this week regarding open enrollment extensions, new state enrollment platforms, the availability of plan browsing, and new insurers joining many states’ marketplaces.
If you’ve got questions about open enrollment, check out our comprehensive 2021 Open Enrollment Guide, which addresses all aspects of the OEP that starts November 1. (And although this site is all about individual market health coverage, you can also check out our guide to the Medicare open enrollment period – which starts today.)
There’s a lot of news to cover. Let’s get started!
Eleven state-run exchanges extend open enrollment periods for 2021 coverage
Although open enrollment is still a few weeks away, more than two-thirds of the fully state-run exchanges have already committed to extended open enrollment periods during which people can enroll in 2021 health coverage. Some of these are permanent extensions, while others only apply to the upcoming open enrollment period:
- Minnesota: November 1 to December 22, 2020.
- Colorado: November 1 to January 15, 2021
- Nevada: November 1, 2020, to January 15, 2021.
- Pennsylvania: November 1, 2020, to January 15, 2021.
- Washington: November 1, 2020, to January 15, 2021.
- Massachusetts: November 1, 2020, to January 23, 2021.
- Rhode Island: November 1, 2020, to January 23, 2021.
- California: November 1 to January 31, 2021.
- District of Columbia: November 1 to January 31, 2021.
- New Jersey: November 1, 2020, to January 31, 2021.
- New York: November 1, 2020, to January 31, 2021.
The other state-run exchanges are Connecticut, Idaho, Maryland, and Vermont. They all have the option to use the standard November 1 – December 15 enrollment window or issue an extension. And although they’ve currently all scheduled open enrollment to end on December 15, it’s possible that we could see additional extensions as the year goes on.
Two states move to state-run exchange platforms this fall
Most states in the U.S. use the federally run HealthCare.gov platform for individual and family health coverage enrollment. But there were already 13 fully state-run exchange platforms as of this year, and two more have joined them for the upcoming open enrollment season and future plan years.
Residents in Pennsylvania will use Pennie to sign up for coverage this fall, and New Jersey residents will use GetCoveredNJ. (In previous years, residents in both states used HealthCare.gov.)
Window shopping for 2021 health plans available in DC and eight states
In states that use HealthCare.gov and most of the state-run exchanges, window shopping for 2021 coverage will be enabled by late October. But plan browsing is currently available on some state-run exchange websites. Residents in California, DC, Idaho, Maryland, Minnesota, Nevada, New Jersey, New York, and Vermont can already see the available plans and pricing for 2021. And in California, current enrollees can even renew their coverage now, without having to wait for the official start of open enrollment.
Mostly modest rate changes for 2021: Increases in some states, decreases in others
For the last several months, we’ve been tracking proposed premiums for individual-market health insurance across the country. The rate review process has been finalized and approved rate changes made public in many states. As he does each year, Charles Gaba is tracking the proposed and approved rate changes in an at-a-glance spreadsheet. Thus far, the average approved rate change stands at an increase of just under half a percent. Although that’s not yet a complete picture, it is indicative of a fourth consecutive year of fairly stable rates in the individual market, with prices in many areas of the country fairly similar in 2021 to what they were in 2018.
We’ve got detailed overviews of numerous states’ approved rate changes for 2021, including some states where overall average rates are increasing. (See Florida, Idaho, Massachusetts, Nevada, New York, and Rhode Island) In other state, overall average rates are actually decreasing. (See Colorado, Delaware, Hawaii, Iowa, Maine, Maryland, and Washington.)
For 2021, Pennsylvania and New Hampshire are joining a dozen other states that have reinsurance programs, and average premiums are expected to decrease in both states as a result of the new reinsurance programs.
Insurers join marketplaces or expand coverage areas in about half the states
In many states across the country, new insurers are joining the exchanges for 2021, and existing insurers are expanding their coverage areas within the states where they offer coverage. We’re seeing new insurers in numerous states, including Arkansas, California, Colorado, Florida, Illinois, Idaho, Illinois, Indiana, Iowa, Maryland, Minnesota, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Utah, Virginia, Washington, and Wyoming. And existing insurers are expanding their coverage areas in many other states, bringing increasing plan options to residents in some areas.
There are a few states where existing insurers will no longer offer plans in the marketplace after 2020: New Mexico Health Connections will shut down at the end of 2020, Virginia Premier is leaving the individual market, and Highmark Choice Company is leaving Pennsylvania’s market (but several other Highmark affiliates will remain, and Highmark Choice Company had very low enrollment).
But overall, the trend is overwhelmingly towards increasing insurer participation and expanding coverage areas. This is the same trend we saw for 2019 and 2020. And it’s a reversal of the trend we saw in 2017 and 2018, when insurers were fleeing the exchanges and the individual market.
Wisconsin asks Trump administration to extend open enrollment
Late last month, numerous Wisconsin stakeholders — including the insurance commissioner, the Department of Health Services, numerous health insurance companies, and consumer advocates — sent a letter to the Trump administration, asking for an extension of the upcoming open enrollment period through the end of January, instead of having it end on December 15.
Wisconsin uses the federally run marketplace (HealthCare.gov), so the state does not have the option of extending open enrollment itself, the way several of the state-based exchanges have done. The letter points out how an extended open enrollment period would give the state more time to help people affected by the pandemic who need to select an individual market health plan for 2021.
An extension would also give those individuals – many of whom are not accustomed to buying their own health insurance – more time to carefully consider their options. The letter concludes by pointedly noting that along with those practical benefits, “an extension would signal that the federal government understands the plight of the newly uninsured, values their welfare and is prepared to do all in its power to protect our health system and economy.”
Nearly two years after voters approved it, Medicaid expansion is in effect in Nebraska
In November 2018, voters in Nebraska approved a Medicaid expansion ballot measure. After an implementation process that lasted nearly two years, Medicaid expansion took effect this month in Nebraska. Nebraska residents were able to start enrolling in expanded Medicaid in August, and nearly 11,000 people had done so by the beginning of October. Enrollment will continue year-round for eligible residents.
Now that Nebraska has expanded coverage, there are only 14 states that still have not accepted federal funding to expand Medicaid, and two of them (Oklahoma and Missouri) will expand coverage by mid-2021 under the terms of ballot measures approved by voters this past summer.
CMS report: Unsubsidized individual market enrollment declined 45% from 2016 to 2019
The Centers for Medicare and Medicaid Services published a new enrollment trends report last week, with data updated to include the 2019 plan year. The CMS totals are based on risk adjustment data, but they do not include enrollments in Massachusetts and Vermont, since both states have merged individual and small group markets for risk adjustment.
Enrollment in the health insurance marketplaces/exchanges has remained fairly steady over the last few years, due mainly to the premium subsidies that keep coverage affordable for most exchange enrollees. But enrollment has declined sharply among people who don’t receive premium subsidies – which includes everyone who enrolls outside the exchange, as well as about 15 percent of on-exchange enrollees. Across 48 states and Washington, DC, total unsubsidized enrollment in ACA-compliant individual market plans has dropped from 6.3 million in 2016 to 3.4 million in 2019.
KFF employer survey: Average cost of family premiums now exceeds $21,000
The Kaiser Family Foundation’s annual employer health insurance survey report was published last week. As usual, it contains a wealth of information about the current state of employer-sponsored health insurance in the United States. Among the interesting data points:
- 67 percent of employees with employer-sponsored health coverage are enrolled in self-insured health plans. This is up from 61 percent last year (state health insurance regulations do not apply to self-insured plans, as they are instead regulated at the federal level).
- The average cost of employer-sponsored family health coverage has grown to $21,342 in annual premiums this year, up from $20,576 last year.
The uninsured rate continues to rise, and is rising particularly fast among children
Last month, the U.S. Census Bureau published its annual health insurance report, with data about health coverage during 2019. About 8 percent of the population had no health coverage at all during 2019, and about 9.2 percent had no health coverage at the time they were surveyed. This is an increase from 8.9 percent in 2018, but it’s also the continuation of a steady upward trend in the uninsured rate since the Trump administration took office: It had been 8.7 percent in 2017 and 8.6 percent in 2016. The uninsured rate is still well below where it was prior to the ACA; 15.5 percent of the population was uninsured as of 2010.
In addition to the continued increase in the overall uninsured rate in recent years, Georgetown University’s Health Policy Institute published a sobering report last week, indicating that the uninsured rate among children in the U.S. increased more in 2019 than it had in any other year over the last decade. In 2016, just 4.7 percent of children in the U.S. were uninsured, which was a historic low. But by 2019, it had increased to 5.7 percent.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.