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Open enrollment sign-ups for 2021 match 2020's total, says CMS

The data indicates enrollment remained stable and more consumers were able to actively enroll or re-enroll in coverage.

Jeff Lagasse, Associate Editor

The Centers for Medicare and Medicaid Services has released the final weekly enrollment snapshot that shows about 8.3 million people selected individual market plans through the marketplaces using the federal platform during the 2021 open enrollment period. 

This total enrollment is nearly the same as enrollments during the 2020 open enrollment period, despite the fact that New Jersey and Pennsylvania transitioned to state-based exchange platforms starting with the 2021 open enrollment period. As a result of their transition, selections in New Jersey and Pennsylvania are not included in the snapshot. 

After removing these states from the total plan selection totals in the 2020 open enrollment period and comparing year-over-year trends, the results show plan selections this year increased by 7% from 2020, despite a decline in new consumers. Also, for the fourth straight year, the consumer satisfaction rate at the call center remained high – averaging over 90% – throughout the entire stretch.

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The data indicates enrollment remained stable, and, with the investments over recent years to improve the stability and experience on the HealthCare.gov platform, more consumers were able to actively enroll or re-enroll in coverage this year without the need for waiting rooms, CMS said.

WHAT'S THE IMPACT?

Total plan selections are driven by three types of consumers: new consumers, renewing consumers who actively come back and shop for a plan, and consumers whose coverage is automatically renewed. 

Compared to last year's open enrollment period and removing plan selections in New Jersey and Pennsylvania, the number of new consumers declined by 3.6%, while the number of renewing consumers with active plan selections increased by 13.2% and the number of renewing consumers who were automatically re-enrolled increased by 4.4%. All together, total plan selections increased by 7%.

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.

CMS also released a report showing the third consecutive year of improving market conditions, including lower premiums and more plan options. Three years of declining average second lowest cost silver plan (benchmark plan) premiums have combined to deliver an 8% average premium reduction across states using HealthCare.gov since the 2018 coverage year. 

Many consumers found more options, as issuer participation also increased for the third year in a row. The percentage of HealthCare.gov enrollees with access to only one issuer decreased from 29% in 2018 to 4% in 2021 and more than three-quarters of HealthCare.gov enrollees had access to at least three issuers in 2021.

This year, resources were available for consumers including an increase in the number of licensed agents and brokers registered with the federal exchange. Nearly 50,000 agents and brokers were registered with the exchange to help consumers during the 2021 open enrollment period. 

Consumers continued to have the option to apply for and enroll in an exchange plan directly through an approved issuer or web broker by using the enhanced direct enrollment pathway, which eliminates the need to be redirected to HealthCare.gov or to contact the exchange call center and provides more avenues for consumers to apply for and enroll in exchange coverage.

The number of consumers who selected a plan through the EDE pathway grew from about 520,000 plan selections in the 2020 open enrollment period to roughly 1,130,000 plan selections in 2021. In addition to the increased plan selections, the EDE pathway attracted a higher proportion of new consumers compared to other enrollment channels and increased the percentage of returning consumers who made active plan selections during the 2021 open enrollment period.

Despite the strong volume in the final days, both HealthCare.gov and the call center operated optimally, CMS said. An online waiting room didn't need to be deployed at any time during the open enrollment period, and less than five hours of planned maintenance was used. This meant consumers were able to shop for and pick a plan with little interruption, according to CMS.

THE LARGER TREND

According to a recent report from the Kaiser Family Foundation, insurer participation in the ACA marketplace in 2021 is seeing a third straight year of growth as several insurers are entering the market or expanding their service area. For 2021, 30 insurers are entering the individual market, and an additional 61 are expanding their service area within states.

It remains unknown how many new enrollees in 2021 signed up because they lost employer coverage. According to the Kaiser Family Foundation, there's little data indicating how many of those who lost employment also lost insurance. In an analysis of insurer-reported enrollment through June, KFF found employer group enrollment had dropped by 1.3%, indicating that many employers had kept furloughed workers on coverage at least temporarily.

ON THE RECORD

"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," said CMS Administrator Seema Verma. "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."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com