November 2023

A couple of weeks ago, Ariel Hart of the Atlanta Journal-Constitution reported that after over a decade of refusing to consider ACA Medicaid expansion for over 400,000 state residents, Georgia's Republican-controlled legislature may finally be warming up to the idea of embracing full expansion of the program:

For the first time in a decade, high-ranking Georgia GOP legislators on Thursday convened a meeting to hear testimony on full Medicaid expansion to all the state’s poor people.

At the hearing Thursday, the idea was floated over whether to expand Medicaid in exchange for a political deal to roll back regulations that restrict who can open a new health care business. Those regulations are called Certificate of Need, or CON.

The 2024 ACA Open Enrollment Period is going on right now and will continue through January 16th in most states. So far, I've confirmed that over 4.7 million Americans have enrolled in either ACA exchange Qualified Health Plan (QHP) policies nationally or Basic Health Plan (BHP) policies in New York & Minnesota specifically; the odd are that the combined total will be over 18.5 million by the time the dust settles in January.

Via Access Health CT's News/Press Releases page:

Stats as of November 24, 2023

Qualified Health Plans (QHP):

• QHP Enrollment In 2023 Coverage: 97,004
• 2024 OE Acquisition Summary: 6,962

Medicaid:

• Completed applications/redeterminations processed through the integrated eligibility system: 25,244

It's my understanding that "Acquisition Summary" refers to CT residents who are brand-new enrollees (never enrolled via the exchange before).

Obviously this 97K figure includes auto-renewals being piled on top of the new/active renewal tally, which stood at 19,145 a week earlier.

By comparison, last year Access Health CT reported enrolling 87,161 people through Nov. 25th (one extra day since Nov. 1st fell on a Tuesday last year); this also included auto-renewals:

Earlier today I posted the initial 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 (18 days vs. 19) and the state exchanges (11 days vs. 12).

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 3 weeks for the federal exchange but only 2 weeks for state-based exchanges. I've done my best to adjust for all of these factors below (the subtotals are accurate; the new/returning breakout for 2023 are estimates but should be pretty close):

via CoverME.gov, Maine's state-based ACA exchange:

Plan Selection Snapshot

The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.  

Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2024. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.   

The deadline to select a plan for coverage beginning January 1, 2024 is December 15, 2023. Consumers who select a plan between December 16, 2023 and January 16, 2024 will have coverage beginning February 1, 2024. 

CoverME.gov Activity Through November 14, 2023 

Earlier this week the Centers for Medicare & Medicaid Services (CMS) announced that they had approved Missouri's plan to take advantage of the Biden administration's Maternal Health Blueprint (made possible by the American Rescue Plan & Consolidated Appropriations Act) to extend postpartum Medicaid/CHIP coverage to a full 12 month period:

As a result of today’s announcement, up to an additional 18,000 people in Missouri will be eligible for Medicaid for a full year after pregnancy. Medicaid covers 41% of all births in the nation and more than half of all children in the country. With the approval of Missouri’s plan, an estimated 641,000 Americans across 40 states, the District of Columbia, and the U.S. Virgin Islands now have access to extended postpartum coverage. If all states adopted this option, as many as 720,000 people across the United States would be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy.

Well, it's not much, but we have our first official 2024 ACA Open Enrollment Period enrollment report, out of Connecticut:

Via Access Health CT's News/Press Releases page:

Stats as of November 17, 2023

Qualified Health Plans (QHP):

• QHP Enrollment In 2023 Coverage: 19,145
• 2024 OE Acquisition Summary: 4,958

Medicaid:

• Completed applications/redeterminations processed through the integrated eligibility system: 10,656

It's my understanding that "Acquisition Summary" refers to CT residents who are brand-new enrollees (never enrolled via the exchange before).

The report was posted this morning so it obviously only includes enrollment data through yesterday (Nov. 16th).

It's worth noting that last year, Access Health CT reported enrolling 17,879 people through Nov. 17th (one extra day since Nov. 1st fell on a Tuesday last year).

BeWell NM, New Mexico's state-based ACA exchange, has launched a very handy new Enrollment Data portal which includes plenty of info for a data hound like myself to pore over. The initial 2024 Open Enrollment Period numbers are impressive...but also a bit misleading if you don't know how the exchange enters data.

First, the top line numbers (as of 11/15/23):

• Number of enrolled consumers: 45,496
• Consumers enrolled in Medical coverage: 44,917
• Consumers enrolled in Dental coverage: 10,759

While dental coverage is also important, standalone dental plans aren't considered Qualified Health Plans (QHPs); it's the "Medical Coverage" which is the key number here.

Also, the total number above may look confusing, but most of the Medical & Dental coverage enrollees overlap:

The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.

While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)

Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year (actually, it's the year after the following year, since the final rule is generally released in mid-December).

For example, here's what the actual PPACA legislative text itself said about the annual Open Enrollment Period (OEP):

Oh wow...this is a blast from the past. I'm gonna have to essentially repost much of a blog entry from August 2018 to provide the backstory:

[In 2017], Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.

In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.

I'm a bit late following up on this, but since New York State of Health isn't launching their 2024 ACA Open Enrollment Period until tomorrow anyway (Nov. 16th...every other state already started theirs on Nov. 1st or earlier), it's still timely.

Two weeks ago a Twitter follower of mine gave me a heads up:

The letter I received had the Essential Plan at 250%. My Navigator told me it was a mistake and pending approval? DM me for specifics

This is definitely cause for concern, since New York's Essential Plan is only available to NY residents who earn between 138 - 200% of the Federal Poverty Level ($29,160/yr for a single adult, $60,000/yr for a family of four).

Sure enough, they sent me the full letter they received from New York State of Health (personal info redacted, of course):

Well, it's not much, but we have our first official 2024 ACA Open Enrollment Period enrollment report, out of Connecticut:

Via Access Health CT's News/Press Releases page:

Stats as of November 10, 2023

Qualified Health Plans (QHP):

• QHP Enrollment In 2023 Coverage: 11,319
• 2024 OE Acquisition Summary: 3,081

Medicaid:

• Completed applications/redeterminations processed through the integrated eligibility system: 7,283

It's my understanding that "Acquisition Summary" refers to CT residents who are brand-new enrollees (never enrolled via the exchange before).

The report was posted this morning so it obviously only includes enrollment data through yesterday (Nov. 9th).

It's worth noting that last year, Access Health CT reported enrolling 10,011 people through Nov. 10th (one extra day since Nov. 1st fell on a Tuesday last year).

Originally posted 9/13/23; updated 11/08/23

via the Washington Insurance Dept.:

Fourteen health insurers have been approved to sell in Washington's 2024 individual health insurance market.  Insurers requested an average increase of 9.11% but 8.94% was approved. How much premium someone pays will depend on the plan they select, the number of people covered, their age, whether or not they smoke and where they live. 

Originally posted 8/18/23; updated 11/08/23

West Virginia is yet another state where I'm unable to acquire unredacted actuarial memos and/or filing summaries in order to run weighted average rate changes, so I have to settle for unweighted averages. On the other hand, on the individual market, at least, WV only has three carriers and their requested rate changes for 2024 are in a very narrow range anyway (from flat to a 2.1% increase), so it doesn't matter much.

The good news is that West Virginia's individual market rates are only increasing by around 1% next year, one of the lowest avg. rate increases in the country.

The bad news is that West Virginia already has by far the highest unsubsidized individual market rates in the nation, at nearly $1,200 per month (second highest this year is Wyoming at $965/month).

In any event, small group market carriers are requesting an unweighted average increase of 9.6% overall.

UPDATE 11/08/23: State regulators increased the rate h ikes from 1.1% to 3.0% for CareSource, but otherwise left the other carriers on both markets as is.

Originally posted 8/17/23; updated 11/08/23

As always, the Texas individual and small group markets are pretty messy. For starters, they have up to 20 individual market carriers depending on the year, along with over a dozen small group market carriers some years.

On top of that, as is also the case in some other states, some of the names of the insurance carriers can be confusing as hell. There's the "Insurance company of Scott & White" which seems to have changed its name to "Baylor Scott & White Insurance Co.," which isn't to be confused with "Scott & White Health Plans" and so on.

In addition, this year there seem to be a lot of carriers bailing on the Texas market altogether: Ambetter, Ascension and FirstCare appear to be pulling out of the states individual market, while Aetna (up to four different divisions?) along with Humana are leaving the small group market.

Originally posted 8/21/23; updated 11/08/23

Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (14) and small group (18) markets. They're losing two carriers in 2024 (WPS Health Plan in both markets and Humana in the small group market only), but it's still pretty robust.

The bad news is that it's once again extremely difficult to acquire Wisconsin's actual rate filings prior to the actual Open Enrollment Period launching, meaning I can only run unweighted average requested rate increases/decreases.

With that in mind, individual market carriers are requesting unweighted increases of around 6.8% (ranging from 1% - 15.7%), while small group carriers are seeking hikes of around 7% overall, ranging from a 25.9% reduction (wow!) to a 16.3% increase.

UPDATE 11/08/23: No changes to any of the individual market rate requests; a couple of slight changes to the small group carriers.

Originally posted 8/17/23; updated as of 11/08/23

Pretty straightforward in the Mount Rushmore state. Three carriers on the individual market; around 48,000 enrollees total; requested rate changes ranging from a slight drop to a 5.9% increase. The weighted average across all three is +2.5%. No one new seems to be entering the market and none of the current ones are pulling out.

For the small group market, there are six carriers (again, no one new, no one dropping). The requested rate increases for these range from 2.5% to 10.3%, with a weighted average increase of 5.2% statewide.

Update 11/08/23: No changes to any of the preliminary filings on either market.

Originally posted 8/14/23; updated 11/07/23

This one is particularly frustrating. In addition to the filings being listed at the federal Rate Review website, every individual & small group market carrier also has their filings listed via the SERFF database and via New Mexico's own internal, searchable rate filing database...and yet I still can't run a weighted average rate change for either market because almost none of the filings at any of these three databases includes the actual enrollment data (Presbyterian on the individual market is the exception).

As a result, I have to once again settle for unweighted averages, which come to +5.6% on the individual market and +7.7% for small group plans.

UPDATED 11/07/23: In the end there were only slight tweaks made to a few carrier requests in either market.

Originally posted 8/09/23; updated 11/07/23

Louisiana's rate filing database is frustrating, because it's both highly-detailed and confusing at the same time.

They break out the filings not between Individual and small group markets or on- vs. off-exchange policies, but between rate increases over and under 10%. Normally that would be fine, but they also have multiple listings within each market for several carriers; HMO Louisiana, in fact, has 11 entries, each for a different product line, making it tedious and difficult to piece together the weighted average rate change and current enrollment for the carrier as a whole.

Not that any of that matters this year, as they don't appear to have posted any of the ACA-compliant individual market filings there anyway. I had to rely entirely on the federal Rate Review site, and the filings there still don't include enrollment data for most carriers, so the averages below are all unweighted only:

• Individual Market: Around 1.7% higher
• Small Group Market: 9.4% higher

It's worth noting, however that Humana is, once again, dropping out of the states' small group market, while Vantage Health Plan appears to be pulling out of both the individual and small group markets in Louisiana.

UPDATE 11/07/23: In the end, every requested rate change was approved as is in both markets.

Originally posted 8/10/23; updated 11/07/23

The good news about the Montana Insurance Dept. is that once the final, approved annual rate changes for the individual and small group markets are released, they're pretty good about posting them in a clear, transparent manner.

The bad news is that they only do so for the final rates, not the preliminary/requested rate filings.

For that, I have to yet again rely on an unweighted average of the rate filings from the federal Rate Review website.

Montana only has three carriers on the indy market and four on the small group market. Of these, Montana Health Co-Op is providing their actual enrollment numbers for both, although one is in a roundabout way. For their individual market filing they state that:

via the Centers for Medicare & Medicaid Services (CMS):

In July 2023, 91,521,722 individuals were enrolled in Medicaid and CHIP.

• In July 2023, 91,521,722 individuals were enrolled in Medicaid and CHIP.
  • 84,504,888 individuals were enrolled in Medicaid in July 2023, a decrease of 1,106,693 individuals (1.3%) from June 2023.
  • 7,016,834 individuals were enrolled in CHIP in July 2023, an increase of 17,565 individuals (0.3%) from June 2023.
• As of July 2023, enrollment in Medicaid and CHIP has decreased by 2,396,487 individuals since March
  2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
  • Medicaid enrollment has decreased by 2,284,727 individuals (2.6%).
  • CHIP enrollment has decreased by 111,760 individuals (1.6%).
• Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,043,140 individuals (32.5%) to 93,918,209.
  • Medicaid enrollment increased by 22,709,822 individuals (35.4%).
  • CHIP enrollment increased by 333,318 individuals (4.9%).

As long-time readers know, every year during the ACA Open Enrollment Period (OEP) I have a tradition of regularly updating a graph tracking how many Americans have enrolled in on-exchange Qualified Health Plan (QHP) policies nationally. The Graph®, as I've come to call it, is how this entire website got started; the logo for ACA Signups even consists of a stylized version of the original version from the 2013 - 2014 OEP.

That first year I attempted to track every conceivable population--on-exchange QHPs, off-exchange QHPs, Medicaid expansion enrollment, SHOP (ACA small business exchange) enrollees) and even the amorphous "sub-26er" populations of young adults enrolled in their parents employer plans thanks to ACA provisions. Some of these were nearly impossible to accurately estimate, but I really tried my best.

Over the next year or two, I not only dropped the categories which I wasn't able to track properly, my tracking of the remaining ones became much more streamlined and sophisticated. Eventually I decided to stick with just two categories: On-exchange QHPs and those enrolled in the Basic Health Plan (BHP) programs in Minnesota and New York.

Originally posted 8/08/23; updated 11/03/23

Here's the preliminary 2024 rate filings for Iowa's individual & small-group markets. Unfortunately, I only have the enrollment data for the two smaller carriers on the individual market (and for only one carrier on the small group market). Oddly, while the Iowa Insurance Dept. has detailed rate filings for Medica and Oscar, it doesn't have one for Wellmark posted...and on the small group market, they only have publicly-available filing documentation for two of the eleven carriers.

Interestingly, CareSource Iowa, which only joined the state's individual market this year, appears to be dropping out of it again in 2024...or at least they don't have a listing showing up at RateReview.HealthCare.Gov as of this writing. Similarly, Aetna seems to be dropping out of the small group market as well.

In any event, based on my estimate of Iowa's total ACA-compliant individual market, I can make an educated guess as to the former's weighted average, which should be roughly a 5.7% drop in premiums.

via Pennie, Pennsylvania's state-based ACA exchange:

Harrisburg, PA – November 1, 2023, marks the beginning of Pennie’s 2024 Open Enrollment Period, which is the annual time when Pennsylvanians who need health coverage can find high-quality health plans at the lowest costs.

Pennie is Pennsylvania’s official health insurance marketplace, and the only source for financial savings to lower monthly premium payments or out-of-pocket costs. Nine out of 10 Pennie customers qualify for financial savings.

Pennie ensures that all plans available provide access to a wide range of medical services, including hospitalization, prescription drugs, maternity care, mental health services, and much more. Health plans through Pennie must cover care for pre-existing conditions, offer free preventive services, and provide important financial protections.

via DC Health Link:

Wednesday, November 1, 2023

DC Health Link Open Enrollment Begins Today, Runs Through January 31, 2024; Monthly Premiums Start as Low as $13/Month

Washington, DC–Today, as the 2024 Open Enrollment period begins, Mayor Muriel Bowser and DC Health Link encourage residents to sign up for high-quality, affordable health insurance at DCHealthLink.com, the District’s online state-based health insurance marketplace. Open Enrollment for DC individuals and families begins today, November 1, 2023, and runs through January 31, 2024.

“Making sure everyone in DC has access to comprehensive, affordable health insurance is one of the many ways we are working to keep DC healthy and our residents’ healthcare costs down,” said Mayor Bowser. “Whether you are uninsured and need a policy or are looking for a more affordable way to keep you and your family covered, there is a plan for you at DCHealthLink.com.”

Originally posted 8/07/23; updated 11/02/23

Hawaii only has two health insurance carriers serving the individual market, Hawaii Medical Service Assocation and Kaiser Foundation Health Plan. Both of them have submitted their proposed premium rate filings for 2024; HMSA is asking for a dramatic 12.2% rate hike while Kaiser Foundation is seeking a more modest 3% increase.

From the HMSA filing summary:

Our requested rates include only the amounts needed to cover the expected health care benefits of our members, the cost of administering their benefits, expected Affordable Care Act (ACA) fees, a small charge to help manage the risk of offering benefits to this population, and a small margin that will allow us to continue replenishing HMSA’s reserves.

Originally posted 08/07/2023; updated 11/02/23

Florida state law gives private corporations wide berth as to what sort of information, which is easily available in some other states, they get to hide from the public under the guise of it being a "trade secret."

In the case of health insurance premium rate filing data, that even extends to basic information like "how many customers they have."

If you think I'm being sarcastic, this is literally a screenshot of what you get if you attempt to use the Florida Office of Insurance Regulation's filing search:

In August I posted the average rate changes being requested for 2024 by New Jersey insurance carriers on the individual & small group markets; it came in at ~6.6% for the indy market and 12.2% for the small group market...but those was unweighted by carrier market share.

Yesterday, with the launch of the 2024 Open Enrollment Period, the New Jersey Insurance Dept. has posted the final/approved rate filings...and while they don't appear to have made any changes to the preliminary requested rate changes, they do include the overall weighted rate increases (unfortunately I still don't know how many enrollees each carrier has).

The weighted rate hikes are just 4.4% on the individual market and 7.3% for small group plans. It's also worth noting that UnitedHealthcare is newly joining the NJ individual market:

Originally posted 8/08/23; updated 11/02/23

A few months ago, the Illinois legislature passed, and IL Gov. Pritzker signed, a new law which made my healthcare wonk heart sing, including:

• Provides that beginning before or on May 1, 2026, and each May 1 thereafter, the Department of Insurance shall report to the Governor and the General Assembly on health insurance coverage, affordability, and cost trends.
• Amends the Illinois Insurance Code.
• Provides that any forms and rates filed for large employer group accident and health insurance shall be automatically deemed approved after 90 days after filing.
• Provides that beginning plan year 2026, rate increases for all individual and small group accident and health insurance policies must be filed with the Department for approval.
• Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
• Provides that beginning plan year 2025, the Department shall post all insurers' rate filings and summaries on the Department's website.

Originally posted 8/09/23; updated 11/02/23

Kansas is yet another state where the actuarial memos are heavily redacted, making it extremely difficult to get ahold of the actual enrollment numbers for the individual or small group markets. Once again, without knowing how many Kansans are enrolled in each carriers insurance policies, I have no way of running a weighted average, and therefore can only provide an unweighted average.

With that in mind, for 2024 Kansas individual market carriers are requesting an unweighted average rate increase of 4.5%. One carrier (US Health & Life) does provide an unredacted summary with enrollment, but they're a tiny part of the market which doesn't help much. The small group market carriers are likewise asking for a 4.7% unweighted average rate hike.

It's worth noting that Cigna appears to be leaving the states individual market, while Humana is leaving the small group market...which I've noticed is happening in several other states that Humana currently offers small group plans in as well.

UPDATE 11/02/23: The final/approved rates have been posted to the Kansas Insurance Dept. website; it looks like everything was approved pretty much as is on the individual market, and there was only one carrier request modified on the small group market (UnitedHealthcare was reduced from a 6.1% increase to 3.9%).

via Covered California:

Los Angeles, Calif. — Covered California kicked off its 2024 open-enrollment period at the iconic Los Angeles State Historic Park and Roundhouse Bridge, a public space that serves some of the most vulnerable communities in the state, with roots that connect back to the early history of the city and region…

Covered California Executive Director Jessica Altman was joined by California Health and Human Services Secretary Dr. Mark Ghaly and Assemblymember Miguel Santiago of California’s 54th district to launch open enrollment. They highlighted how record financial help — through enhanced federal premium support and a new program in California that will reduce out-of-pocket costs for over 650,000 consumers — is bridging the gap between uninsured Californians and access to affordable coverage and quality care.

via the Massachusetts Health Connector:

• The deadline for coverage beginning January 1 is December 23, 2023, but residents have until January 23 to apply for 2024 coverage

BOSTON, November 1, 2023 – Open Enrollment for 2024 health plans through the Massachusetts Health Connector starts today, with expanded access for tens of thousands of newly-eligible Massachusetts residents to the landmark ConnectorCare program that already helps 156,000 people access more affordable coverage.

Open Enrollment is when anyone who needs health insurance can find coverage through the Health Connector, the Commonwealth’s official health insurance Marketplace. Open Enrollment runs through Jan. 23, but the deadline to start the New Year with coverage is Dec. 23. People who need health insurance can go to MAhealthconnector.org to apply and enroll in coverage. They can also find community-based support in dozens of languages to assist with completing an application.

via the Washington HealthPlan Finder:

From Nov. 1, 2023 – Jan. 15, 2024, Washingtonians can shop for and purchase qualified health and dental plans and secure insurance for 2024. Olympia

Today, Washington Health Benefit Exchange (Exchange) is launching the annual WA HealthPlanFinder open enrollment period, with an offering of 82 health care plans and 12 dental plans that comply with the requirements of the Affordable Care Act. When people shop WA HealthPlanFinder , federal and state subsidies based on income are automatically applied.

via Access Health CT:

Connecticut residents can shop, compare and enroll in quality health insurance plans from Nov. 1, 2023 through Jan. 15, 2024

HARTFORD, Conn. (Nov. 1, 2023) — Access Health CT (AHCT) today announced the Open Enrollment period will take place Nov. 1, 2023 to Jan. 15, 2024 for health insurance plans for 2024. Connecticut residents can shop, compare, and enroll or renew their health insurance plans with coverage beginning in the 2024 plan year.

Customers must enroll on or before Dec. 15, 2023 for coverage to begin Jan. 1, 2024. Customers who enroll between Dec. 16, 2023 and Jan. 15, 2024 will have coverage starting Feb. 1, 2024.

AHCT is the only place Connecticut residents can qualify for financial help to lower health insurance costs. Open Enrollment gives customers the opportunity to review health coverage options to ensure they are making the best choice that meets their individual needs and budgets.