Individual Health Sales Season (Mostly) Ends

The ordinary individual major medical insurance sales season ended Monday, sort of, in most of the United States. HealthCare.gov closed for open enrollment period sales Jan. 15. Most of the locally run "web-based supermarkets for health insurance" pulled up their welcome mats Jan. 15. Some locally run exchange programs, such as the exchange programs operated by Rhode Island and the District of Columbia, rolled down their open enrollment period shutters Monday. But some of the highest-population states have fuzzed the final enrollment picture by extending their individual health enrollment periods even past Jan. 31. In New York, for example, NY State of Health is keeping the open enrollment period lights on until at least March 31.

What It Means

Agents and brokers now have a better chance to sell "gap-filler" health insurance products, such as short-term health insurance, in most states. They also have a better chance to attract consumers with special situations, such as moves to new communities, that qualify them to apply for coverage through special enrollment period applications. In some cases, however, carriers avoid paying commissions for special enrollment period signups, because of concerns that enrollees who come in through special enrollment period applications will have higher claim costs than other enrollees.

The Basics

The Affordable Care Act public exchange system gives people way to use income-based federal subsidies to pay for individual health coverage from private health insurers. Health insurance regulators created the enrollment period calendar, or limits when people can buy individual health coverage without showing that they have a good reason to be shopping for health coverage, to shield health insurers from some of the effects of the ACA ban on medical underwriting. The idea is that enrollment period limits will push some young, healthy people to pay for coverage even when they feel great, to reduce the odds that they'll be stuck with a broken leg and no way to buy health coverage at some other time of the year.

The Numbers

The Centers for Medicare and Medicaid Services reported recently that, as of Jan. 15, it had recorded a total of 14.5 million ACA exchange plan signups, or about 14% of the 169 million U.S. residents under age 65 who have private health coverage. That was up 19% from the total for 2021 exchange plan coverage, and up 36% from the total for 2020, which was the last ACA exchange plan coverage year that was completely under the management of the administration of former President Donald Trump. HealthCare.gov increased its plan signup count to 10.3 million, from 8.3 million as of Dec. 21, 2020, when the original open enrollment period for 2021 coverage ended. The preliminary signup counts available from the locally run exchanges have increased 9.2%, to 4.2 million. The 2021 and 2022 coverage year figures are not directly comparable because of the effects of extended special enrollment period rules on final 2021 coverage year signup counts, and because of the effect of the current enrollment period extensions on the 2022 coverage year totals.

The Broker Numbers

The ACA exchange system gets about half of its enrollees from traditional agents, traditional brokers and web brokers. HealthSherpa, a company that helps agents and brokers with the ACA exchange plan signup process, says it has helped at least 3 million people get covered this year. Their median gross premium was $733, and their median net premium payment, after federal premium subsidies were applied, was $21. About 30% of the enrollees signed up for plans without having to pay for any cash for premiums out of pocket.

More Numbers

For a look at what has happened, so far, to signup counts in the three biggest ACA exchange markets, see the gallery above. For data for all 50 states and the District of Columbia, see the chart below.

Affordable Care Act Public Exchange Signups