2024 OEP State By State: Actual confirmed QHPs: 10.8M; y/y changes up to +101%, much more!

 Earlier today I posted the latest official above-the-fold numbers for the 2024 ACA Open Enrollment Period as reported by the Centers for Medicare & Medicaid Services (CMS):

...The graph below shows how these numbers have increased since the same time period last year. I've had to adjust slightly for the fact that there's one fewer day included for both the federal exchange (32 days vs. 33) and the state exchanges (25 days vs. 26).

I've also had to adjust for the fact that Virginia moved from the federal exchange to its own state-based exchange this year, which is further complicated by CMS reporting 5 weeks for the federal exchange but only 4 weeks for state-based exchange. Otherwise, the subtotals are accurate, while the new/returning breakout for 2023 are estimates,but should still be pretty close:

While the latest update shows a slowdown from the dramatic year over year increases a couple of weeks ago, the initial enrollment numbers are still significantly higher across the board:

• HC.gov is 42% higher (49% more new enrollees, 40% more returning enrollees)
• SBMs are 17% higher (14% more new enrollees, 18% more returning enrollees)
• Overall: 39% higher (44% more new enrollees, 37% more returning enrollees)

CMS has also provided the actual state by state breakout, which also includes a bunch of additional data....including auto-renewals for the state-based exchanges only (the federal exchange auto-renewals aren't added to the reports until after the first enrollment deadline on December 15th):

The Centers for Medicare & Medicaid Services (CMS) reports that nearly 7.3 million Americans have signed up for 2024 individual market health insurance coverage through the Marketplaces since the start of the 2024 Marketplace Open Enrollment Period (OEP) on November 1.

This includes 6.5 million plan selections in the 32 states using the HealthCare.gov platform for the 2024 plan year, through December 2, 2023 (Week 5), and 775,000 plan selections in the 18 states and the District of Columbia with State-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through November 25, 2023 (Week 4).

Total nationwide plan selections include 1.6 million consumers (23% of total) who are new to the Marketplaces for 2024, and 5.7 million consumers (77% of total) who have active 2023 coverage and returned to their respective Marketplaces to renew or select a new plan for 2024.

Here's the state-by-state breakout compared to the same point in time a year ago. Again, I've adjusted for the missing extra day (multiplying HC.gov states by 32/33 and SBM states by 25/26). I've also included relevant notes for specific states which have special circumstances or alterations this year:

It's important to note that New York's ACA exchange, NY State of Health, didn't launch their OEP until 11/16 either year. CMS's proposed 2025 NBPP rule would nip this in the bud by requiring all SBMs to start their OEPs no later than 11/01 going forward.

Overall, 2024 OEP enrollment is running 39% higher y/y when the date and platform shifts are accounted for.

The first big takeaway at the individual state level is that some states are massively outperforming last year so far while others are lagging way behind...and there's only reasonable explanations for some of this:

• Mississippi is still running more than 100% higher than last year so far. This is down from 126% higher a couple of weeks ago but it's still a stunning enrollment spike.

• 12 other states are running between 50% - 100% higher than the same point last year. Ten are on the federal exchange (TN, OH, WV, LA, IN, SC, AR, OK, GA, MO) while two are state-based exchanges (DC and Rhode Island).

• At the opposite end of the spectrum, Virginia is still officially running a whopping 63% behind their 2023 OEP enrollment at this point, almost certainly due to the state moving off of the federal exchange onto their own platform. However, when auto-renewals are also taken into account (see below), they're actually running about even or even a bit ahead in total enrollment; we'll see how this plays out when the dust settles.

• Four other states are also officially running slightly behind last year for now: Nevada, Hawaii, South Dakota and New Jersey

• Five states (AK, ME, WY, OR & ND) are running between 0.3 - 10% higher year over year

Next, let's look at the breakout between platform type (federal vs. state-based exchange) as well as Medicaid expansion status:

• Federal exchange states (HC.gov) are running 42% ahead of last year at the same point, while state-based exchange states (SBMs) are only up 17% y/y.

• Medicaid expansion states are running 32% higher y/y so far, but non-expansion states are running 43% higher.

• If you further break this out by platform type, expansion states on the federal exchange are running 40% higher while non-expansion states on the federal exchange are up 43% so far.

Some or all of these y/y changes could easily change in the upcoming weeks, of course.

Finally, we get to the "10.8 million" figure I mention in the headline above.

All of the above data only adds up to 7.3 million QHP selections so far, but in addition to those, I've confirmed additional enrollments from a handful of state-based exchanges which have posted interim enrollment reports which include additional data after the dates in CMS's press release:

• Just this morning, Colorado reported a total of 184,210 enrollees (w/auto-renewals)

• Connecticut reported 102,606 enrollees as of 12/01 (w/auto-renewals)

• Maine reported 58,497 enrollees thru 11/28 (w/auto-renewals)

• New Mexico reports 48,327 enrollees thru 12/05 (w/auto-renewals)

• Again, Virginia reported ~340,000 auto-renewals out of the gate, although some of those have since either actively cancelled or switched plans (changing their status to "active renewals).

• In addition, Colorado has also reported that all 11,000 subsidized QHP enrollment slots reserved for their "OmniSalud" program for undocumented residents have already been filled. While these enrollees aren't officially counted as OEP enrollments by CMS (they're technically "off-exchange"), that's still another 11,000 people gaining ACA-compliant individual market healthcare coverage.

Add all of these into the mix and you get a grand total of around 7.5 million confirmed QHP enrollees so far.

BUT WAIT, THERE'S STILL MORE!

As noted above, the Snapshot report from CMS also includes the number of auto-renewals reported by each fo the 19 state-based exchanges. These are not included in the "Cumulative 2024 OEP Plan Selections" above.

When you add these to the mix (ignoring CT, ME & NM auto-renewals which I already added above), you get a grand total of 10,853,701 Qualified Health Plan (QHP) selections to date.

I do need to add a word of caution, however: As you can see above, the number of auto-renewals tends to actually shrink over time, partly because of enrollees manually logging in and switching to a different plan (thus changing their status to "active renewals") and partly due to them actively canceling their renewal after it's entered into the system. If you disregard the states which hadn't already reported any auto-renewals yet two weeks ago (as well as California, which seems to report them in chunks), total auto-renewals across the remaining 14 states actually dropped around 72,000 people from the prior Snapshot report until this one.

Oh yeah...even this total still doesn't include the 1,320,418 Basic Health Plan (BHP) enrollees in Minnesota and New York so far (up around 15.5% y/y). Add those to the rest and you get a grand total of 12,174,119 QHPs + BHPs combined.

Behold, the updated Graph!