While Halloween is a time for ghouls and ghosts to openly romp about in merriment, one looming spectre this year is shadowing the post-sugar rush: the ACA Open Enrollment period. For consumers, rising ACA premiums could be scaring their pocketbooks while the federal administration is spooked that not enough individuals will sign up for coverage this season.
The outcomes for both are equally frightening. On the consumer side, some – though HHS has noted about 85% of individuals will be eligible for subsidies on the marketplace – will have to decide whether they pay for health insurance or forgo coverage. For the federal government, this fourth open enrollment period is crucial.
Why this enrollment period matters in under 100 words
The Congressional Budget Office projected 2016 ACA marketplace enrollment to be 22 million individuals. Unfortunately, the actual enrollment numbers landed around 10.4 million. The reinsurance and risk corridor programs – created in part to help offset costs for insurers as the newly-created marketplace stabilizes – are both ending this year. HHS is targeting to enroll more "young invincibles" as it is wildly believed this population can help stabilize the marketplaces by offsetting the costs of older, sicker individuals. According to McKinsey & Company, 27% of the the remaining 27 million uninsured individuals are younger than 30, and 68% are "healthy."
HHS is really going for it
In the past couple of months, the agency has made it clear it's going for broke on enrollment strategies this year. It's been purported that enrollment could actually slowdown next year but HHS projects a total of 13.8 million individuals will sign up for health plans through the ACA marketplaces, an increase of 1.1 million purchasing coverage on top of the 12.7 million existing customers.
Strategies to enroll more young adults will rely on "smarter" outreach, including calculated prompts and messages to help individuals complete the enrollment process. "We’ve learned that sending an email, with the right information, at just the right time, can make a significant difference in whether someone gets covered, and those are lessons we’ll act on this year," CMS stated.
In addition, HHS is partnering with companies to utilize technology to boost enrollment. For example, Lyft will provide discounted rides for new riders who need rides to Open Enrollment events while TaskRabbit will share alerts about the start of Open Enrollment as well as each of its key deadlines to its "Taskers."
Local efforts will hit the ground running
CMS last week announced its target markets for this enrollment season. These areas were identified as possessing strong opportunities for meaningful enrollment increases as well as a high percentage of eligible uninsured individuals. They include Miami, Dallas and Chicago.
One of the hardships to increased individual market enrollment is that diverse population demographics make up America. Such differences across the U.S. make it difficult to adopt a "one-size-fits-all" solution when it comes to encouraging individuals to sign up for health coverage. Whether it's a lack of understanding that consumers can afford insurance or they're unsure where and how to use it, enrollment advocates have their work cut out for them.
Getting technical about insurance
Echoing the feds' push for enrollment using technology, some state-based health insurance marketplaces are exploring digital tools. For example, Maryland Health Connection has a mobile app for download where a potential customer can shop around for plans as well as upload documents.
Dr. Linda Wharton Boyd, director of external affairs and stakeholder engagement at DC Health Benefit Exchange Authority, told Healthcare Dive that DC Health Link is targeting millennials through "hyped social media messaging, geo-fencing and digital/mobile outreach." The DC insurance marketplace will also engage in a text-a-thon and Google hangouts on National Youth Enrollment Day (December 10).
Linda Wedeen, interim CEO at beWellnm, told Healthcare Dive the New Mexico insurance marketplace is also using electronic notifications and reminders to help individuals finish the enrollment process. In addition, the organization's website highlights a subsidy calculator to help educate individuals that they could be eligible for reduced coverage payments.
A lot of the marketplaces' enrollment strategies focus on insurance education. Wedeen notes beWellnm's strategy uses a combination of messages. One is letting individuals know if they are eligible for subsidies. She says affordability is a big issue in New Mexico and once someone gains coverage, it can still be a challenge for some to stay insured. The percentage of uninsured individuals in the state has dropped since the passage of the ACA but they are getting past the "low-hanging fruit" enrollments, Wedeen says. Enrollment efforts include hitting the road to educate the state's rural, Native American and Hispanic populations on insurance coverage.
The organization also messages "be prepared" to help community members understand why having insurance is a benefit for them and their families. One unforeseen health event could change someone's life dramatically and coverage could help the transition. In a similar manner, Maryland Health Connection is posting stories how health coverage made a life-changing difference for some state residents on its website.
Sticking to its "intensive hyperlocal" outreach approach, DC Health Link will be visiting community farmers’ markets, night spots, sport arenas and fitness clubs to spread the word about enrollment. "Given new and more precise data on where the uninsured reside, we will engage in target-specific partnerships in neighborhoods, door-to-door canvassing, and solicit help from the public with identifying uninsured residents through the Each One Link One initiative," Boyd told Healthcare Dive.
A shopping spree?
Charles Gaba from ACASignups.net told Healthcare Dive he estimates 2-2.5 million of exchange enrollees will shop around for different coverage this enrollment season. However, reasons will differ as some may shop for a better price while other's existing policy may be canceled. Boyd noted that individuals who shopped around on DC Health Link saved an average 5% on health coverage.
Next year, 167 payers will participate in the ACA marketplace, a reduction from last year. While a lot of the recent ACA headlines have focused on insurer exits and premium hikes, there's also a possibility that plans with lower monthly premiums could mask higher deductibles. Still, with open enrollment beginning Nov. 1, it's yet to be seen how much of an impact these forces will have on enrollment and on the ACA individual market overall.