Employee Benefits Compliance, Exchanges / Marketplaces / Subsidies

Exchange Enrollment: Oct 1, 2013 – April 19, 2014


PDF of this Article:  Exchange Enrollment thru April 19 2014 v 8-1-14

The information below is from Health Insurance Marketplace: Enrollment Report, issued by the Department of Health and Human Services (HHS)on May 1, 2014. (ASPE Issue Brief by the office of the Assistant Secretary for Planning and Education.)  Data on Exchange enrollment is for the period October 1, 2013 – April 19, 2014.


More than 8 million people nationwide enrolled in qualified health plans (QHPS) through both federal and state Exchanges between October 1, 2013 and April 19, 2014.  The open enrollment period was originally scheduled to end on March 31, but was extended through April 19th for individuals who had already begun the enrollment process.


By Age:
28%     18-34 year olds (exact percentage varies by state)

66%     Ages 35 and older

6%     Ages 0-17

By Gender:     54% female/ 46% male (same as the breakdown as of December 31)

By Race and Ethnicity:

Race and ethnicity data were requested only from enrollees in the Federal Exchange, not in State Exchanges, and only 69% of federal enrollees (approximately 3.8 million) provided information.  Of these 3.8 million:

  • 63% are White;
  • 17% are African-American
  • 11% are Latino; and
  • 8% are Asian.


Enrollment Outside the Exchanges:

The ASPE report did not include information about people who enrolled in individual plans outside the Exchanges, but a recent Congressional Budget Office (CBO) report estimated that 5 million people enrolled in PPACA-compliant plans outside the Exchanges. An unknown number of people also renewed coverage in non-PPACA compliant plans outside the Exchanges, since the federal government and some states allowed certain non-compliant individual policies to be extended. Those numbers could impact insurers’ risk pools and affect 2015 premium rates in the Exchanges.  People who would not qualify for a subsidy may have been more likely to enroll in an individual policy offered outside the Exchange because non-Exchange policies generally had larger provider networks.



Overall (both federal and state exchanges), for enrollment through April 19, 2014, the following percentages of enrollees bought policies at each of the “metal” levels.  Bronze policies (60% Actuarial Value) have the lowest premiums but highest cost-sharing (such as deductibles and copays), and platinum policies (90% Actuarial Value) have the highest premiums but lowest cost-sharing.

Enrollment                                Actuarial Value

Bronze             20%                                        60%

Silver               65%                                         70%

Gold                   9%                                         80%

Platinum          5%                                         90%

Catastrophic   2%                                      <60%

Lower-income individuals who enroll in Exchange coverage may be eligible for federal subsidies in the form of “cost-sharing reductions” and “premium tax credits.” The cost-sharing subsidies reduce deductible and co-payment amounts at the time of service. The premium tax credit reduces the monthly premium amount individuals must pay.

Of the total number of people who selected a Silver plan, 95% of them will receive a federal premium tax credit.

Of the total number of people who received a subsidy in the Federal Exchange, 76% of them selected a Silver level plan.

Silver level plans significantly reduce the deductibles, co-payments and coinsurance amounts for individuals with household incomes up to 200% of the federal poverty level (FPL), and marginally reduce these cost-sharing amounts for individuals with household income of 200% – 250% of the FPL.

Premium tax credit amounts are based on the cost of the second lowest-cost silver plan for each individual.  For enrollees in a silver plan, an individual with household income of 138% of FPL will pay no more than 2% of household income above the tax filing threshold; while an individual with household income of 400% of the FPL will pay 9.5% of household income above the tax filing threshold.



Data released by Covered California (the California Exchange) indicate that 1.4 million California residents enrolled through Covered California from Oct. 1, 2013, – April 19, 2014, and 1.5 million enrolled in Medi-Cal (the California Medicaid program). The 1.4 million enrollees in Covered California comprised 17.5% of total enrollments through all Exchanges nationwide, and more than 50% of the almost 2.6 million enrollees through all the state-run Exchanges.

Covered California data also indicated that 88% of the 1.4 million California enrollees were eligible for a subsidy. The California report also noted that 85% of total enrollments in Covered California health insurance plans had paid their first month’s premium for coverage starting May.  94% of enrollees in Covered California enrolled in the following four insurers.

  • 30.5%  enrolled in Anthem (425,058 people)
  • 27.3% enrolled in Blue Shield
  • 18.9% enrolled in Health Net third
  • 17.3% enrolled in Kaiser