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5 Reasons Why Open Enrollment Has Attracted Nearly 1 Million New Members

Analysis  |  By Laura Beerman  
   December 27, 2021

"With more insurers in almost every state exchange, there is less risk of getting hit with adverse selection like they did the first time. The volatility of the mid-2010s has gone away," says one industry analyst.

Before December 15, the first cut-off date for open enrollment, the Centers for Medicare & Medicaid Services (CMS) reported that close to 4.6 million people had signed up for marketplace coverage through either HealthCare.gov or a State exchange. This includes nearly 1 million new enrollees. These numbers are from CMS' National Marketplace Open Enrollment report. The agency has been providing weekly snapshots throughout open enrollment, with subsidies from the American Rescue Plan and increased plan participation continuing to boost numbers.

As open enrollment draws to a close, Bill Melville—principal analyst of Market Access Insights with Clarivate—identifies five key reasons for 2022 success compared to the early days of the exchanges:

1. The big players continue to come back

"Markets are essentially stable," says Melville "which is why the for-profit nationals have returned to the business." This includes UnitedHealth Group and Aetna, which can offer low-cost care options through its growing integration with CVS Health.

2. More options are available

In addition to 32 new insurers, Melville notes, "Centene has stepped into many places and boosted exchanges. Anthem widened its scope, and regional plans like Medica and CareSource stretched into new markets." Some states are seeing more options than ever before. "In 2022, Georgia has four new carriers, bringing the state to 11; this is more than any time since the exchanges began. That is a big turnaround."

3. New insurers are expanding

Startup health plans continue to earn their stripes and expand their business lines. "New for-profit companies like Oscar and Bright Health are continuing to expand, but their narrow, high-performing network models were built for exchange customers," notes Melville.

4. It's not the 2010s

"The risk is much lower for participation now, as payers have learned how to price for exchanges," adds Melville. "With more insurers in almost every state exchange, there is less risk of getting hit with adverse selection like they did the first time. The volatility of the mid-2010s has gone away. A few years ago, we were talking about the risk of 'bare counties'–counties with zero exchange options." Today, that's simply not the case.

5. Putting the affordable into the Affordable Care Act

CMS reports that $10 monthly premiums are available to 80% of enrollees. Says Melville, "For 2022 and 2023, consumers will pay no more than 8.5% of their income on premiums. It was previously 10% and was lowered through the coronavirus relief package passed in early 2021. But it addresses a longstanding issue—premiums were not affordable for people who earned too much for subsidies."

This is all great news as open enrollment extends through January 15 for coverage that starts February 1. CMS notes that HealthCare.gov will continue to offer help from more than 1,500 trained Navigators, thanks to a $10.2 million funding boost for the 2022 season.

Laura Beerman is a contributing writer for HealthLeaders.

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