Early numbers for 2015 health insurance enrollment are starting to filter in.

It’s hard to know whether the numbers are actually good, bad or indifferent, but there are numbers.

The Patient Protection and Affordable Care Act (PPACA) public exchange system, for example, is reporting much higher application totals now than it was at this time a year ago, but it has a shorter open enrollment period this time around, and its qualified health plan (QHP) issuers have to try to hang on to existing business as well as attract new enrollees.

The state-based exchanges may be getting a different mix of business because they work better, or because the nature of the people who still need to get covered has changed.

The policymakers who created PPACA World hoped to increase the level of competition between health insurers in the traditional insurance market as well as in the public exchange system, but the buyers might have different ideas.

For a look at some of the first pixels, read on.

 

HealthCare.gov

1. About half of the HealthCare.gov plan selection volume is coming from consumers renewing exchange plan coverage that’s already in force.

The public exchange individual QHP open enrollment period started Nov. 15 and is set to end Feb. 15. The deadline for coverage that starts Jan. 1, 2015, is Dec. 15.

Officials at the U.S. Department of Health and Human Services (HHS) say the HHS-run exchanges received coverage applications for 1.6 million people and QHP selection information for 765,135 people as of Nov. 28.

One question is how well the QHPs at the HHS-run and state-based exchanges will retain the 6.7 million 2014 coverage enrollees they had this summer.

So far, HHS officials say, about half of the HealthCare.gov business is coming from consumers who have exchange QHP coverage and want to continue the coverage.

If business volume stays at current levels, the public exchange system could end up with about 10 million enrollees, including about 5 million returning enrollees and 5 million new enrollees.

During the 2014 open enrollment period, coverage was much stronger around the deadline for applying for coverage with a Jan. 1 start date and at the end of the open enrollment period. If that pattern repeats this year, the public exchange QHPs might end up with more than 15 million enrollees. 

 

Four different metals

2. Early 2015 exchange plan buyers seem to be more likely than the early 2014 exchange plan buyers to pick bronze or silver plans.

Some state-based exchanges release information about the metal levels of the QHPs selected, or other information that gives clues about metal level preferences.

In Colorado, for example, the early 2014 open enrollment period saw buyers purchasing coverage with a net average out-of-of-pocket monthly premium of $181, meaning that many were buying gold or platinum coverage, rather than silver or bronze coverage. The net monthly premium for silver coverage was less than $125, and, net of subsidies, the monthly premium for bronze coverage was about $99.

This year, the average net monthly premium level for the coverage purchased has increased sharply. The net cost of bronze coverage has increased about 28 percent, to almost $128. The net cost of platinum coverage has jumped to $512, from $252.

But the average net cost of all coverage purchased this year has fallen to $152, meaning that many enrollees must be buying silver, bronze or catastrophic coverage.

In Minnesota, where MNsure has posted 2015 metal level selection numbers, only 30 percent of the buyers are purchasing gold or platinum coverage, down from 48 percent early in the 2014 open enrollment period. The median enrollee age was 50 early last year and is about 50 this year.

The tilt toward leaner benefits could be the result of consumers trying to cope with premium increases, but it’s also possible that the first QHP buyers were people with serious health problems who had been shut out of the ordinary commercial health insurance market before 2014 by pre-existing conditions. The consumers getting QHP coverage for the first time this year might be healthier, and more interested in minimizing premiums than in minimizing out-of-pocket costs. 

 

Gorilla

3. The big gorillas still look good.

Mark Farrah Associates crunched second-quarter enrollment numbers for the seven biggest health insurers — Aetna, Anthem, Cigna, Health Care Service Corp., Humana, Kaiser Permanente and UnitedHealth.

Farrah found that the companies ended the quarter administering or providing coverage for 143 million people in commercial and government plans of all kinds. Total enrollment was up from 136 million people at the end of 2012, before many of the PPACA commercial health provisions had started to take effect.

 

Image: U.S. Fish and Wildlife Service photo.