A new Avalere Health analysis shows that, as of November 2, 30 percent of exchange applicants are eligible for federal subsidies to reduce their monthly insurance premiums and out-of-pocket costs for medical care, far below the 84 percent of enrollees who are ultimately expected to qualify for financial assistance. Additionally, state-based exchanges (SBEs) are tracking behind states with federally run exchanges, with 23 percent of eligible applicants being subsidy-eligible in SBEs compared with 34 percent in federally run exchanges.
“The figures show the potential for increased exchange enrollment in the coming weeks as we get closer to the deadline for 2014 insurance,” said Dan Mendelson, CEO of Avalere Health. “As lower-income Americans determine that they have access to subsidized commercial insurance products, we can expect to see many enroll to save money.”
Low Rates of Subsidy Eligibles: On November 12, the Department of Health and Human Services released enrollment data for the health insurance exchanges from October 1 to November 2. The data showed that 106,000 people nationwide had enrolled in coverage and selected a health plan. However, nearly 1.1 million individuals had applied and been deemed eligible for coverage. Among those, 30 percent were eligible for subsidies, meaning they had incomes below 400 percent of the poverty line. By contrast, Avalere Health projects that 84 percent of final exchange enrollees are ultimately expected to qualify for subsidies.
State vs. Federally Run Exchanges: Surprisingly, rates of subsidized applicants in states with federally run exchanges are outpacing those in state-based exchanges. In the 15 state-based exchanges (including D.C.), 23 percent of applicants deemed eligible for exchanges were below 400 percent of the poverty line, whereas subsidized applicants constituted 34 percent in federally run states. By comparison, Avalere Health projects that state-run exchanges will ultimately have 88 percent of subsidized enrollees and federally run states will have 83 percent of subsidized enrollees.
State
Total Eligible to Enroll in a Marketplace Plan
Unsubsidized Eligibles
Subsidized Eligibles
Subsidized as % of Total Eligible
Avalere Projected % Subsidized
California
93,663
93,663
0
0%
85%
Colorado
36,335
27,593
8,742
24%
82%
Connecticut
12,325
5,518
6,807
55%
89%
District of Columbia
0
0
0
-
95%
Hawaii
1,156
1,156
0
0%
89%
Kentucky
39,207
26,006
13,201
34%
88%
Maryland
3,498
860
2,638
75%
82%
Massachusetts
0
0
0
-
74%
Minnesota
21,532
14,773
6,759
31%
86%
Nevada
0
0
0
-
86%
New York
134,897
100,630
34,267
25%
93%
Oregon
190
190
0
0%
85%
Rhode Island
3,326
1,240
2,086
63%
92%
Vermont
3,341
2,263
1,078
32%
94%
Washington
29,503
16,128
13,375
45%
84%
SBM Subtotal
378,973
290,020
88,953
23%
88%
Alabama
14,696
9,786
4,910
33%
89%
Alaska
1,606
1,008
598
37%
90%
Arizona
20,741
13,585
7,156
35%
89%
Arkansas
6,123
3,844
2,279
37%
33%
Delaware
2,204
1,530
674
31%
84%
Florida
93,456
63,819
29,637
32%
89%
Georgia
41,426
28,669
12,757
31%
87%
Idaho
7,733
4,428
3,305
43%
91%
Illinois
35,802
24,199
11,603
32%
86%
Indiana
19,093
11,203
7,890
41%
90%
Iowa
6,104
4,025
2,079
34%
74%
Kansas
9,087
6,078
3,009
33%
88%
Louisiana
10,294
7,017
3,277
32%
87%
Maine
5,061
2,945
2,116
42%
94%
Michigan
34,197
21,729
12,468
36%
85%
Mississippi
5,822
4,160
1,662
29%
91%
Missouri
20,121
13,010
7,111
35%
90%
Montana
3,815
2,104
1,711
45%
91%
Nebraska
7,453
4,486
2,967
40%
90%
New Hampshire
5,767
3,751
2,016
35%
81%
New Jersey
23,985
15,903
8,082
34%
85%
New Mexico
4,249
2,700
1,549
36%
89%
North Carolina
42,110
27,059
15,051
36%
91%
North Dakota
1,180
810
370
31%
89%
Ohio
34,374
22,508
11,866
35%
88%
Oklahoma
9,952
8,520
1,432
14%
89%
Pennsylvania
43,966
28,469
15,497
35%
42%
South Carolina
15,257
10,284
4,973
33%
91%
South Dakota
2,279
1,457
822
36%
90%
Tennessee
24,334
15,761
8,573
35%
89%
Texas
80,960
55,440
25,520
32%
90%
Utah
9,318
5,435
3,883
42%
92%
Virginia
32,534
23,201
9,333
29%
83%
West Virginia
3,442
2,174
1,268
37%
88%
Wisconsin
22,038
13,127
8,911
40%
94%
Wyoming
2,040
1,218
822
40%
90%
FFM Subtotal
702,619
465,442
237,177
34%
83%
National Total
1,081,592
755,462
326,130
30%
84%
Methodology:
Avalere Health reviewed enrollment statistics in the HHS report, “Health Insurance Marketplace: November Enrollment Report,” dated November 13, 2013, for total, subsidized and unsubsidized exchange applicants. Avalere also examined data from its proprietary state-based Health Insurance Enrollment Model for projected total, subsidized and unsubsidized applicants at the end of the 2014 year. Avalere aggregated these data points by state-based exchanges and federally run exchanges for purposes of comparison.
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For more information, contact Frank Walsh at [email protected] or 202-745-5110.
Read the full analysis on Avalere Health’s website.