3 Fast Facts From a Record-Breaking Marketplace Open Enrollment

"The risk is much lower for participation now, as payers have learned how to price for exchanges," says one industry analyst.

Marketplace Open Enrollment, aided by a Special Enrollment Period (SEP) in early 2021, has reached its highest numbers since the Affordable Care Act (ACA) launched health insurance exchanges in 2013. CMS reports that 13.6 million people have signed up through HealthCare.gov or State-based Marketplaces (SBM). This surpasses numbers from the final year of the Obama administration and includes additional records for the traditional Open Enrollment period and the number of people with first-time marketplace coverage.

A breakdown of the nearly 14 million now enrolled includes:

1. 9.7 million people selected plans on HealthCare.gov during Open Enrollment (November 1–December 15, 2021).
    
2. Of these, more than 1.6 million represents new consumers.
    
3. An additional 3.9 million enrolled via SBMs, which operate in 18 states.
    

CMS published these numbers in its Marketplace Weekly Enrollment Snapshot and will provide a final update that includes a one-month extension (December 16–January 15, 2022), with coverage on those plan choices beginning February 1, 2022.

The impacts of COVID-19—including unemployment and the Great Resignation—as well as new marketplace supports and increased health plan participation have combined to boost enrollment. Subsidies from the American Rescue Plan have helped make coverage more affordable and for a larger group of people. Commercials for HealthCare.gov returned to the airwaves during the SEP and Open Enrollment, and $10.2 million in new funding for enrollment navigators was designed to improve the HealthCare.gov experience.

This is in stark contrast to the Trump administration, during which enrollment declined by more than 1.2 million. Additionally, in 2020, the federal government did not create a COVID-driven marketplace SEP as it did for Medicare Advantage. It should be noted, however, that enrollment dips did grow smaller between 2017–2020, with the pandemic driving the lowest declines.

The question now is whether the temporary marketplace subsidies will continue, to what degree, and the impact of the mid-term 2022 elections. The good news is today's marketplace is far more stable. As Clarivate principal analyst Bill Melville noted in a prior HealthLeaders article: "The risk is much lower for participation now, as payers have learned how to price for exchanges." If Congressional support wanes, overall marketplace health may provide a critical counterbalance for steady enrollment or continued growth—particularly if COVID's impacts on the economy and workforce continue throughout 2022.