The size of the market for “special enrollment period” (SEP) individual and family health insurance may be about 20 percent to 30 percent of the size of the regular open enrollment period market.
That estimate is based on analysis of individual “qualified health plan” (QHP) activity data from the state-based exchanges in Colorado and Minnesota.
The regular Patient Protection and Affordable Care Act (PPACA) exchange open enrollment period for individual QHP coverage started Oct. 1, 2013, and ended sometime from March 31 to mid-April in most of the country. Nevada extended its open enrollment period until May 30.
Regulators, exchange managers and insurers came up with the open enrollment system to keep consumers from waiting until they get sick to pay for coverage. To avoid risk management problems, insurers in the non-exchange individual market are using the same enrollment calendar.
To qualify for SEPs now, consumers must show that they have undergone a major life event, such as a divorce or a relocation, or qualify for an exemption from the usual calendar rules.
In some states with state-based exchange programs that had severe enrollment system problems, May has been an extension of the regular enrollment period, and enrollment activity has been much higher than the monthly average during the official open enrollment period.
In Nevada, for example, about 11,000 people have picked individual QHPs since March 31. The monthly average was about 2.5 times the open enrollment period average.
In Colorado, however — a state with an enrollment system that worked reasonably well — QHP selection volume has fallen to about 5,300, or about 30 percent of the open enrollment period average. In Minnesota, activity has fallen to about 1,600 QHP selections per month, or about 20 percent of the open-enrollment period average.
Charles Gaba, a PPACA supporter who has developed the widely watched ACASignups.net blog, has noted that he is also starting to see some non-exchange individual health market enrollment data.
Washington state, for example, has seen about 171,000 people enroll in PPACA-compliant coverage outside the exchange system.