HealthSherpa 2018 OEP Year-in-Review

We’re just three weeks away from the 2019 Open Enrollment Period (OEP) for individual Marketplace coverage and we here at HealthSherpa Research are excited to share insights culled from our thousands of enrollments nationwide over the past five OEPs. We’ll be sharing these insights leading up to and throughout OEP.

First up, we’re looking back to look forward by reviewing the highlights of OEP 2018 and what that data might tell us about 2019.

In spite of uncertainty leading into 2018 OEP — Would Congress succeed with repeal-and-replace? How would President Trump’s decision to discontinue CSR payments to carriers impact the market? — the individual market showed its resiliency and value to those who rely on it coverage. Enrollments in ACA-subsidized policies not only held relatively steady but “silver plan loading” ended up saving people money. As shown in the table 1, while the average gross premium rose by 35% from 2017 OEP, HealthSherpa shoppers on average spent 10% less per month on their health coverage.

Regionally, customers in the South had the lowest average net premium costs, while those in the Midwest spent the most per month. These differences can be attributed to multiple factors, from higher incomes leading to lower subsidies, to a higher average age leading to a higher average gross premium. In our next HealthSherpa Research article, we will dig deeper into the enrollment data at the state-level to explore the impact of these factors up close.

The effects of silver plan loading were seen in the metal level distribution changes from 2017 OEP. With health insurers “loading” costs into silver plans, the percentage share of all silver plans declined nearly 8 percent, while gold plans saw a threefold increase in enrollments and bronze plans increased by 4 percent.

Demographic Distribution

Who is shopping for plans? According to our data, more women (including single mothers) are enrolling as head-of-household than men — an 8-percent difference overall. Among all enrollees, more than 50 percent are aged 50-65. However, the share of enrollees in all other age brackets (18-49) increased more quickly from 2017 than the 50+ age group — e.g. there was an 86 percent year-over-year increase in enrollments by those 30 years old and younger.

Gender Distinctions in Costs and Choices

Finally, we saw small distinctions in the costs and choices among female and male customers. Women pay a bit less in monthly premium costs, in part because they have a slightly lower average number of covered lives per policy.

Conversely, men pay slightly more but also cover slightly more lives. Likewise, men were slightly more likely than women to opt for a bronze plan than a silver.

Implications for 2019 OEP

While each year brings its own opportunities and challenges, the data from 2018, along with what we’ve known about regulatory and market changes for 2019 OEP, lead us to the following initial thoughts:

• The individual, ACA-subsidized market is resilient and stabilizing. Early indications are that prices are holding steady or even dropping in some states. That’s a good sign for consumers.
• Silver plan loading will continue, which means gross premiums and gross subsidies will look similar in 2019 to how they looked this year, which in turn means net premiums will be lower for consumers.
• While last year there was concern about some counties having no available plans, there is much less concern this year. Several insurers have expanded their offerings or reentered the individual, subsidized market. Others have entered for the first time. More competition means better pricing for consumers. It also appears to mean more broker participation in the market — drawn by higher commissions offered by competing insurers. All of these factors are signs of an improving market and true to the intent of the Affordable Care Act.
• Coverage is high-quality and affordable. It’s providing health insurance for many who would have no other option — and it’s providing better coverage than the newly expanded short-term health plans. This is not just us being marketers — HealthSherpa has a Net Promoter Score (NPS) of 59, which is much higher than the industry average for health insurance and health care in general.
• A large segment of HealthSherpa’s customers learned about us through friends and family who received coverage. Other private and public Marketplaces have seen a similar pattern. That leads us to believe that enrollments will remain strong this year, in spite of the removal of the Individual Mandate and introduction of short-term health plans.

Stay tuned for more data analysis over the coming weeks and throughout OEP 2019. If you are a reporter or researcher, or are just curious and have more detailed questions, contact us to find out more.