- Enrollment in the individual insurance market — including plans sold on the Affordable Care Act exchanges and elsewhere — may stabilize in 2019, assuming premiums remain flat as they were in the first quarter of 2019, suggests a study released Wednesday from the Kaiser Family Foundation.
- Total enrollment in individual insurance plans fell to 13.7 million as of the first quarter of 2019 — a 5% decline compared with the first quarter in 2018, according to Kaiser Family Foundation estimates. However, this was a much smaller decline in enrollees than was the case in 2017 (12%) and 2018 (11%) when insurance premiums increased substantially.
- Overall, the number of Americans with health insurance plans bought in the individual market increased from 10.6 million in 2013 to a peak of 17.4 million in 2015 — one year after the ACA marketplaces debuted — before declining to 13.8 million in 2018.
Critics had feared that Republican efforts to undermine the ACA, such as zeroing out of the individual mandate, would lead to large decreases in the number of people enrolled in plans sold in the individual insurance market. However, the analysis from the Kaiser Family Foundation suggests that large premium increases may play a larger role in consumers’ decisions about buying insurance, particularly for people who do not qualify for federal subsidies that cap premium payments based on income.
Kaiser Family Foundation researchers analyzed enrollment data on ACA exchanges from CMS and administrative data payers report to the National Association of Insurance Commissioners.
The researchers found declining enrollment in the individual insurance market has been concentrated in plans sold outside of the exchanges, where consumers who are not eligible for federal subsidies felt the full impact of insurers’ decision to raise premiums substantially in 2017 and 2018.
Between 2016 and 2018, enrollment in plans sold outside the exchanges dropped by 3.1 million, or 44%, compared with declines of 300,000, or 18%, for unsubsidized plans sold on the exchanges, and 200,000, or 2%, for subsidized plans.
Without the impact of the individual-mandate penalty and with relatively flat premiums, enrollment in plans sold outside the exchanges dropped by 400,000 people as of the first quarter of 2019 compared with 2018, while enrollment in subsidized plans remained relatively steady.
As enrollment in unsubsidized plans declined, particularly in 2017 and 2018, the individual market became dominated by enrollees in subsidized plans sold through the exchanges. As of the first quarter in 2019, enrollees eligible for subsidies accounted for more than two-thirds of all enrollees in individual plans, or 9.2 million people, according to Kaiser Family Foundation estimates.
Those enrolled in the exchanges are also sticking around longer. In 2018, monthly enrollment peaked at 10.5 million enrollees in February and slipped to 9.2 million by December, "meaning a higher percentage of individuals stayed in their plans throughout the year compared to 2017," CMS said.
It's not clear why though it could be because the population is sicker, according to some experts.