ACA Federal Marketplace Sees 7% Enrollment Increase in 2021

CMS has released its final snapshot for Affordable Care Act enrollment on the federal platform for the 2021 open enrollment period.

This year’s open enrollment was unique in part due to the absence of two states on the federal platform: New Jersey and Pennsylvania.

These two states together contributed around seven percent of all plan selections during 2020. Thus, a comparison of enrollment levels after removing those two states from the 2020 open enrollment total shows that enrollment effectively rose seven percent from 2020 to 2021.

However, when New Jersey and Pennsylvania are included in 2020 enrollment, overall enrollment remained stable from 2020 to 2021, despite the extraordinary circumstances of the coronavirus pandemic.

Enrollees made over 8.25 million plan selections during the 2021 open enrollment. This was consistent with preliminary data that CMS released in December 2020 when open enrollment concluded. When dependents are included, over 10.16 million consumers are covered by a plan purchased on the federal platform.

“These results are consistent with recently released data showing higher effectuated enrollment mid-year due to fewer people dropping coverage and more people enrolling through special enrollment periods,” the press release stated.

By late May 2020, 12 of the 13 state-based marketplaces had opened their own special enrollment periods due to the economic impact of the coronavirus pandemic. However, the Trump Administration chose not to open a special enrollment period for the pandemic on the federal platform.

More than 1.88 million of the enrollees were new consumers. Over 6.36 million individuals renewed their coverage on the Affordable Care Act marketplace through the federal platform.

Compared to 2020 open enrollment—minus New Jersey and Pennsylvania’s results—, the number of new consumers was 3.6 percent lower in 2021. In contrast, the number of consumers who renewed with active plan selections rose by 13.2 percent and the share of those who renewed automatically also increased by 4.4 percent.

When broken down by state, Florida had the highest number of enrollees on the federal platform by far, with more than 2.12 million enrollees. Texas followed with nearly 1.3 million enrollees. No other states surpassed a million enrollees.

“CMS has layered year upon year of improvements on HealthCare.gov, a sterling record of success that puts the lie to baseless accusations of sabotage,” CMS Administrator Seema Verma said in a press release.

“Our policies have lowered premiums, brought issuers back to the market, stabilized a law that had been in a tailspin for years and improved the customer experience. I want to thank the team at CMS, which for so long has worked tirelessly for Americans in the individual market.”

Since 2018, the average second lowest-cost silver plan premiums for states on the federal platform have declined by eight percent on average.

The number of payers on the exchange—specifically, on HealthCare.gov—has likewise dropped.

Nearly three in ten HealthCare.gov enrollees had access to only one payer in 2018. Three years later, only four percent of enrollees had just one payer option on the federal platform. Around 75 percent of enrollees had access to three payer options or more.

CMS continued to leverage enhanced direct enrollment as a supplement for the federal platform. Around 1.13 million plans were selected through an enhanced direct enrollment pathway, which is more than double the number of plan selections in 2020 open enrollment (520,000 selections).

Additionally, around 50,000 agents and brokers registered to support enrollment on the federal platform. CMS sent hundreds of millions of reminders via email and text as well as millions of outreach emails.

The call center maintained a 90 percent consumer satisfaction rate during open enrollment. This service has received positive reviews during all four years of the Trump Administration, the press release pointed out.

Almost 4.4 million individuals called the call center. Around 331,300 spoke with a Spanish-speaking representative.

CMS also updated the application process on the federal platform and optimized it for mobile.