Avalere Analysis Projects Potential for Increased Subsidized Exchange Enrollment

The Lund Report

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 fwalsh@gymr.com or 202-745-5110.

 

Read the full analysis on Avalere Health’s website.

 
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