If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.
Next up: Age brackets, gender, racial/ethnic groups and urban/rural communities. I'm also throwing in the stand-alone Dental Plan table for the heck of it since I don't know where else to include it.
I don't have a ton to say about any of these, really. It's always interesting to me to see that nearly 2% of ACA exchange enrollees are 65 or older. Not sure why they aren't on Medicare but I'm sure there are logical reasons.
Now it's time to move on to the actual demographic breakout of the 2023 Open Enrollment Period (OEP) Qualified Health Plan (QHP) enrollees.
First up is breaking out new enrollees vs. existing enrollees who either actively re-enroll in an exchange plan for another year or who passively allow themselves to be automatically renewed into their current plan (or to be "mapped" to a similar plan if the current one is no longer available).
Now that the official press release is out of the way, it's time to dig into the actual final, official state-level data. The table below has the final, official 2023 Open Enrollment Period (OEP) numbers for both Qualified Health Plans (QHPs) in all 50 states + DC as well as Basic Health Plan (BHP) enrollment in Minnesota and New York only, compared to the 2022 OEP.
According to the essential Louise Norris, there are currently just six states where being pregnant in and of itself makes someone eligible for a Special Enrollment Period outside of the official Open Enrollment Period:
In most states, pregnancy does not trigger a special enrollment period. HHS considered this, but clarified in 2015 that they had decided not to include pregnancy as a qualifying event. This means that in most states, the special enrollment period tied to having a baby does not begin until the baby is born.
But state-run exchanges (there are 18 of them as of 2022) can set their own rules for qualifying events and special enrollment periods. Some of them do allow a special enrollment period triggered by pregnancy. This gives a pregnant person access to health coverage during the pregnancy, rather than having to wait until the baby is born to obtain coverage. As of 2022, pregnancy is a qualifying event in the following state-run exchanges:
Requires an insurer or health maintenance organization that provides coverage under an Affordable Care Act Marketplace (Marketplace) plan to provide to each individual covered under the Marketplace plan, not more than two months before the birthday on which the individual will become 65 years of age, a written message that includes: (1) a statement that the individual will be eligible to enroll in Medicare during the individual's initial enrollment period, which begins three months before the individual becomes 65 years of age; (2) a statement advising the individual that, in most cases, someone covered by a Marketplace plan will want to end their Marketplace coverage upon becoming eligible for Medicare; and (3) detailed instructions that the individual may follow to cancel the individual's Marketplace plan.
I've grown to absolutely love the way Hawaii state legislation summarizes the situation being addressed by the bill in question; they don't hold any punches in explaining why the bill is necessary:
The legislature finds that obstacles to access to health care based solely on immigration status prevent many low-income immigrants and immigrants' families from obtaining affordable health care coverage through medicaid, the Children's Health Insurance Program (CHIP), and health insurance exchanges established under part II of the Patient Protection and Affordable Care Act.
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:
Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.
