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Here's how many households in the 5 top HealthCare.gov markets have signed up for 2019 exchange plans, as of Nov. 24...

5. Pennsylvania

2019 Signups: 92,775

Year-Over-Year Change: -25%

4. Georgia

2019 Signups: 139,645

Year-Over-Year Change: -4.9%

3. North Carolina

2019 Signups: 140,741

Year-Over-Year Change: -14%

2. Texas

2019 Signups: 311,489

Year-Over-Year Change: -6.8%


1. Florida

2019 Signups: 622,664

Year-Over-Year Change: -0.6%

(Related: HealthCare.gov Application Activity Improves)

More HealthCare.gov users are renewing their health coverage.

Managers of the federal Affordable Care Act public exchange system say 369,213 people renewed their coverage during the fourth week of the open enrollment period for 2019.

The number of people renewing their HealthCare.gov coverage was 4.9% higher than in the fourth week of the open enrollment period for 2018 coverage.

The fourth week of the open enrollment period ended on Nov. 24 this year, and on Nov. 23 in 2017. The Thanksgiving holiday interrupted the week both years.

The number of people selecting new coverage through HealthCare.gov during the fourth week fell to 131,224 this year, down about 14% from the year-earlier total.

The Season

HealthCare.gov got off to a slow start, but volume has improved steadily both for new business and for renewal business.

Although new signup activity was down 14% in the fourth week, year-over-over, that’s an improvement from a 17% drop in the third week, and an 18% drop for all four weeks.

The 4.9% year-over-year increase in renewal activity in the fourth week compares with a drop of 2.1% in renewal activity in the third week, and an 11% drop for all four weeks.


The Centers for Medicare and Medicaid Services (CMS), the federal agency that runs HealthCare.gov, counts a transaction as a sale only when a consumer has “effectuated” the coverage by making at least one premium payment.

The consumers who are renewing their coverage are already making premium payments. Their renewals represent effectuated sales.

The consumers who have signed up for the new coverage will not have to make their first payments for several weeks. Because, officially, many of the new customers have not yet bought their coverage, mid-season HealthCare.gov signup activity reports refer to “plan selection” activity, rather than to sales.

The “open enrollment period,” or time when people can buy individual major medical coverage without showing they have what the government classifies as a good excuse to be shopping for coverage, began Nov. 1 in most of the country and is set to run until Dec. 15 in most of the country.

Beyond HealthCare.gov

HealthCare.gov runs what amounts to a family of web-based supermarkets for health insurance. The program helps consumers buy individual major medical coverage from commercial insurers, and use Affordable Care Act premium tax credit subsidies, in states that are unwilling or unable to handle all ACA exchange program operations.

HealthCare.gov provides exchange enrollment and account administration services in 39 states.

The District of Columbia and 11 states operate locally run exchanges.

ACASignups.net is estimating that about 570,000 people had signed up for exchange plan coverage through state-based exchange programs by Nov. 24.


HealthSherpa — which is formally known as Geozoning Inc. — helps other agents and brokers sign people up for ACA exchange plan coverage, and it also helps its own retail clients sign up for coverage.

HealthSherpa says its signup activity for the week that ended on Nov. 24 was 72% higher than its level of signup activity for the comparable week in 2017.

The company helped 78,684 people sign up for coverage in the latest enrollment period week.

For the entire enrollment period, the company’s activity is up 48%.

HealthSherpa says it believes its exchange plan signup activity has been strong partly because, after taking premium subsidies into account, the median net premium payment has fallen about 34%, to about $30 per month.

— Read ACA Public Exchanges Lurch Back Openon ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on LinkedIn and Twitter.

Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at abell@alm.com or on Twitter at @Think_Allison.

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