HHS Estimates Modest Increase in Marketplace Enrollment to 10 Million by End of 2016

A Department of Health and Human Services (HHS) report estimated that 9.4 million to 11.4 million individuals will effectuate Marketplace coverage by the end of 2016, representing a potential modest increase from the most recent total of 9.9 million Marketplace enrollees. Built into this estimate was the following: (1) of the 9.1 million current enrollees, 7.3 million to 8.8 million will make re-enrollment plan selections during the upcoming open enrollment; (2) of the 10.5 million uninsured individuals who are likely eligible for QHP coverage, 2.8 million to 3.9 million will make plan selections; and (3) 0.9 million to 1.5 million individual market enrollees (currently off of the Marketplace) will make plan selections. While HHS estimates between 11 million and 14.1 million total plan selections in the 2016 open enrollment period, the effectuated enrollment estimate is approximately 10 million. Effectuated enrollment is expected to be lower than total open enrollment plan selections as some enrollees obtain coverage from other sources and others have their coverage terminated due to non-payment or data matching issues.

HHS Releases Report Detailing the Remaining QHP Eligible Uninsured

Separate from HHS’s Marketplace enrollment estimates, the agency released a report examining the composition of the 10.5 million uninsured individuals who may be eligible to purchase insurance coverage through a Qualified Health Plan. When analyzing income of the remaining QHP-eligible uninsured, the report found that 48% have incomes between 100% and 250% of the federal poverty level (FPL), 30% have incomes between 250% and 400% FPL, and 22% have incomes above 400% FPL. The agency’s estimate of approximately 8.2 million uninsured individuals who may be eligible for subsidies tracks closely to the Kaiser Family Foundation report also released this week, which estimates this population to be 7.1 million. The greatest barrier to obtaining health insurance for most of the uninsured QHP-eligible was affordability concerns. Nearly 80% of people without health insurance have less than $1,000 in savings and nearly 50% have less than $100 in savings. Approximately 3 in 5 of QHP-eligible uninsured individuals did not understand or were unaware of the premium tax credit.

Report Finds 15 Million Uninsured Individuals Likely Eligible for ACA Assistance

Of the 32.3 million total uninsured, 15.7 million may be eligible for either Medicaid or subsidized Marketplace coverage, according to a new report by the Kaiser Family Foundation. Of the total uninsured individuals eligible for ACA assistance: 7.1 million individuals are eligible for Marketplace premium tax credits, 5.4 million adults are eligible for Medicaid, and 3.2 million children are eligible for Medicaid or CHIP. The report estimates that of the remaining 16.6 million uninsured not eligible for ACA assistance: 4.9 million are undocumented immigrants ineligible for ACA coverage, 4.9 million are ineligible for financial assistance due to an offer of employer sponsored insurance, 3.7 million have an income above the limit for premium tax credits, and 3.1 million fall into the coverage gap.

72 Million Individuals Enrolled in Medicaid and CHIP

According to CMS's monthly Medicaid/CHIP eligibility and enrollment report, 72 million individuals were enrolled in Medicaid and CHIP in July 2015, an increase of just over 28,500 individuals since June 2015. Since October 2013, nearly 13.2 million additional individuals have enrolled in Medicaid and CHIP, an increase of almost 22.9% over the average monthly enrollment for July through September of 2013. Compared to this 2013 timeframe, Medicaid expansion states have seen an average increase in enrollment of 30%, while states that have not expanded reported an average increase of 9.9%.