Employee Benefits Compliance, Exchanges / Marketplaces / Subsidies

Exchange Enrollment October 1st – December 28, 2013


The information below is from Health Insurance Marketplace: January Enrollment Report, issued by the Department of Health and Human Services (HHS) on January 13, 2014. (ASPE Issue Brief by the office of the Assistant Secretary for Planning and Education.)  Data on Exchange enrollment is for the period October 1st – December 28th, 2013.

A printable version is in PDF format and attached at the end of this article.






 By Age:
24%    18-34 year olds  (exact percentage varies by state)
33%    55-64 year olds
State Variations in Young People as a Percentage of Total Enrolled

17%    in West Virginia and Arizona
44%    in Washington, D.C.
25%    in California

By Gender:  54% female/ 46% male


Overall (both federal and state exchanges), the following percentage of consumers 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             60%                                        70%
Gold               13%                                        80%
Platinum           7%                                        90%
Catastrophic    1%

Silver level plans offer dramatic cost-sharing reductions for individuals with household incomes up to 200% of the federal poverty level (FPL), and marginal reductions in cost-sharing for individuals above 200% but up to 250% of the FPL.  The cost-sharing subsidies  reduce deductible and co-payment amounts at time of service but do not affect premium tax credit amounts.  The premium tax credit reduces the premium amount for certain individuals.  For a silver plan, an individual with household income of 138% of FPL will not pay more than 2% of household income above the tax filing threshold; while an individual with household income of 400% of the FPL will not pay more than 9.5% of household income above the tax filing threshold.


The five states with the highest enrollment numbers, on both federal and state Exchanges, accounted for 1.0 million of the total 2.2 million enrollees.  These top five states were:

CA        498,794
FL         158,030
NY         156,902
TX         118,532
NC        107,778
Total    1,040336



The HHS report did not include information about people who enrolled in individual plans outside the Exchanges.  Those numbers could impact insurers’ risk pools and affect 2015 premium rates in the Exchanges.

A major concern has been getting young people to enroll, since their claims generally are lower than claims of older people.  As some commentators have pointed out, age is only a proxy for health status.  The real concern is getting enough healthy people to enroll, so the risk pool is not heavily comprised of unhealthy, costly people.  According to a November study by the Kaiser Family Foundation, even under a worst-case scenario where only 25% of enrollees are young people ages 18-34, insurers would have to increase premiums by only 2.4% in 2015 in order to cover projected expenses.


In addition to the 2.2 million enrollees in health insurance policies on the state and federal Exchanges, over 7 million US residents were determined eligible for Medicaid and the Children’s Health Insurance Program during the period October 1 – December 31, 2013.   According to an article in California Healthline (January 23, citing a CMS report issued January 22), more than 6.3 million US residents were determined eligible through state-run agencies and Exchanges, and an additional 750,000 were deemed eligible through the federal Exchange website.  The report did not break down how many renewed coverage, were previously eligible but had not enrolled, or were newly eligible due to Medicaid expansion.


Data released by Covered California (the California Exchange) also noted that of a total of 500,108 enrolled through December 31, 2014 (three days beyond the December 28 ending date of the HHS report), 424,936 (85%) were eligible for a subsidy and 75,172 (15%) were not. This is a higher subsidy-eligible percentage than the average percentages in the HHS report (which were 78% and 80%). The California report also noted that total enrollments in Covered California health insurance plans continued to increase after the end of the year, with a total of approximately 625,000 from October 1, 2013 through January 15, 2014 (18 days longer than the period reported in the HHS report).

The Covered California report also included data on the number of Medi-Cal applicants/enrollees through December 31, 2013.  Since there is no cost for Medi-Cal applicants, it is likely almost all of them will be enrollees.

584,000          Medi-Cal applicants, including individuals who are pending, eligible and
conditionally eligible coming in through Covered California.

630,000          Medi-Cal transitions from Low Income Health Program (LIHP)

The number of new Medi-Cal applicants is greater than the number of enrollees in Covered California health insurance (584,000 vs 500,108), and the total of 1,214,000 Medi-Cal enrollees is more than two times the number of enrollees in Covered California health insurance through the same time period.


PDF:  Exchange Enrollment Jan 27 2014