News Release

Date Posted

Individual Market Enrollment Report - October 16, 2014

Covered California

Individual Market Enrollment Report
October 16, 2014

How many individuals currently have coverage in Covered California?
Today, 1,120,000 individuals have coverage in a Covered California qualified health plan.
How many individuals will be participating in the renewal process for the upcoming open enrollment period?
All individuals who currently have coverage as well as those who recently selected or will select a health plan for the duration of the coverage year will be eligible to renew their coverage. Up to 1,300,000 individuals will be able to renew for 2015 health insurance coverage.
For Covered California’s initial open enrollment period — from October 2013 through March 2014 — how many consumers actually began their coverage?
At the end of the first open enrollment period, which ran from October 1, 2013 to March 31, 2014, Covered California reported 1,395,929 individuals who selected a health insurance plan.1 Of those who selected a plan, about 1,140,000 had their coverage take effect (an effectuation rate of about 81%).2 As outlined in the May 2014 Enrollment Forecast Brief, Covered California anticipated having 1,190,000 individuals with coverage by the end of the first open enrollment period and the open enrollment effectuation rate was slightly less than originally estimated but in the range that Covered California has consistently reported.3
The effectuation rate accounts for every individual who paid for their first month of coverage divided by the total number of individuals who selected a health insurance plan. Due to the time needed for individuals to receive their invoice and pay their first bill, special enrollment effectuations will be ready in subsequent months.
During the special enrollment period, how many individuals have enrolled?
Covered California continues to enroll individuals who experience a qualifying life event outside of the open enrollment. Individuals who enroll begin coverage either the following month, or the month thereafter, depending on the date of plan selection. From June to September, over 200,000 individuals completed applications and selected a health plan.
The special enrollment monthly average enrollment for this period of 50,000 is slightly less than originally projected enrollment of nearly 60,000 per month. Covered California believes the primary reason for this is that Medi-Cal redeterminations have not occurred in the timeline that we expected, which partly explains the lower special enrollment numbers.
How many consumers did not continue their coverage after starting payments?
Of the 1,140,000 who enrolled in the open enrollment period and effectuated coverage, 150,000 subsequently disenrolled from their coverage. This is an average monthly disenrollment rate of 1.6% (or a retention rate of 98.4%). In addition to the monthly disenrollment rate, we forecast that an additional 15% will not renew during the upcoming open enrollment period.
If present monthly disenrollment trends continue, and 15% do not renew during open enrollment, the annual disenrollment rate would be 30%.4 Based on industry standards, Covered California projected that 2.5% of those with active coverage would stop coverage each month and that 15% of those eligible for renewal would not continue their coverage (for an annual “disenrollment rate” of 37%).5 Covered California’s retention rates are better than initial forecasts. There are multiple reasons a consumer may not continue their coverage, the biggest of which is that many consumers get individual insurance through the Exchange while between jobs. Historically, the individual market has relatively high turnover.
What is the difference between “enrolled” and “effectuated” coverage?
Covered California has been enrolling consumers in coverage since the beginning of the first open enrollment, which started in October 2013, for coverage that could take effect January 2014. The relatively easy to report figure is “enrollment” — the information that is based on when a consumer is determined eligible for coverage and selects a health plan. Covered California reported on enrollment figures during the initial open enrollment period that include coverage that took effect from January through May 2014.
For coverage to take effect and be maintained, consumers must both pay their initial premium (to be effectuated) and continue to pay their premium on an ongoing basis to maintain their coverage. There are many reasons individuals may sign up for coverage, but not pay their first months premium, including getting coverage outside of the Exchange if they are not subsidy eligible, getting coverage through a job or being subsequently determined eligible for another program, or deciding that they could not afford the coverage. 
What periods are covered by this data and why are there time lags in reporting data?
This report covers all individuals who have coverage from January to August 2014. Covered California’s data base shows those who enrolled and selected a plan in September or October, but does not yet show how many have paid for coverage, because the health insurance companies must return payment and effectuation data to Covered California for reconciliation. As such, data on plan selections is quickly available, but effectuation data requires a longer time lag.
Lastly, Covered California plans to analyze the effectuated population by subsidy status, federal poverty level, age, race, ethnicity, and more in future reports.

1  Updated data shows that 1,414,668 individuals selected a health plan during the first open enrollment period for coverage starting January to May. Many individuals finished their open enrollment application by April 15th, which resulted in May coverage.
2 Due to regular data reconciliation, numbers fluctuate, which is why all effectuation and special enrollment numbers are rounded to the nearest ten thousandth.
The estimated annual disenrollment rate of 30% is based on 1.6% per month for the duration of the special enrollment period, plus additional disenrollment before the next coverage year as individuals experience redetermination for subsidies.