State-based public exchanges may have lower enrollee retention rates this year than the exchanges managed by the U.S. Department of Health and Human Services (HHS).
The latest exchange activity figures show that the HHS exchanges may be on track to retain 78 percent of their 2014 enrollees in 2015, according to analysts at Avalere Health. At the state-based exchanges that could provide comparable data, the projected 2015 retention rate was just 69 percent.
The regular 2015 open enrollment started Nov. 15, 2014, and ended in March. The Avalere analysts could get retention data from the managers of 11 state-based Patient Protection and Affordable Care Act (PPACA) exchanges, but not from the managers of the state-based PPACA exchanges in Idaho, Maryland, Massachusetts, Nevada and Oregon.
To become an “effectuated” qualified health plan (QHP) enrollee, a consumer must choose a QHP and also make at least one QHP premium payment.
For many of the consumers in the 2015 exchange activity data, the premium payment due date is still in the future, and the consumers have not necessarily made any payments. HHS classifies those consumers as plan selectors, not enrollees. In 2014, about 85 percent of the QHP selectors ended up paying for coverage and becoming effectuated QHP enrollees.
The Avalere analysts came up with their retention rate projections by dividing the 2015 numbers, which may include a mix of data on effectuated enrollees with data on selectors, with the 2014 numbers, which, apparently, may also a include a mix of data on effectuated enrollees and selectors.
The Avalere analysts divided PPACA exchanges into three categories: Those with projected retention rates over 85 percent, those with projected retention rates under 75 percent, and those with projected retention rates from 75 percent to 85 percent.
The HHS exchange managers, who use the HealthCare.gov exchange enrollment system, had high retention rates at nine of their 34 exchanges, or 26 percent of their exchanges, and low retention rates at seven, or about 20 percent.
In the HHS exchange system, North Dakota led with a 94 percent retention rate. Texas came in last, with a retention rate of 71 percent.
Florida, an HHS exchange state in which exchange plans have been popular, had a retention rate of just 73 percent.
At the state-based exchanges with complete activity data, two of the 11, or 18 percent, had high enrollee retention rates, and seven, or 64 percent, had low retention rates.
State-based exchange retention rates ranged from a high of 94 percent in Kentucky down to a low of 37 percent in Hawaii.
Avalere analysts said they were not sure why retention rates were higher at HHS exchanges than at the state-based exchanges.
The state-based exchange states accepted PPACA Medicaid eligibility expansion money, and many HHS exchange states did not. One explanation for the retention gap could be that state-based exchange users have any easier time moving from exchange plan coverage into Medicaid plans.