Record-Breaking Enrollment Continues in 2023 ACA Marketplace

With 5.5 million sign-ups so far, this year's numbers are already outpacing 2022.

If the expanded Marketplace subsidies end after 2025, what will keep the new pool of pandemic participants cancelling their coverage? A better shopping experience, CMS hopes.

In the past two weeks, the agency has published two bellwethers of Marketplace improvement: an 18% increase in year-over-year (YOY) enrollment and its proposed annual Exchange rule that—in select scenarios—would limit plan choices to make the shopping experience easier.

Another banner year?

For healthcare nerds, this record-breaking performance is like the big streaming wins that Wednesday is delivering for Netflix—not a bad comparison given that the Addams Family daughter and the Exchanges, now in their 12th year, are both navigating puberty.

CMS' second Marketplace snapshot shows 5.5 million plan selections, up from 4.6 million YOY. This includes 1.2 million new enrollees and 4.3 million who have renewed coverage from both Healthcare.gov (through December 3) and the state-based Marketplaces (or SBMs, through November 26).

This continues the faster pace that kicked off the first few weeks of 2023 Open Enrollment Period (OEP)—17% higher YOY as reported by HealthLeaders based on HHS' first data release.

"The numbers prove that our focus is in the right place," stated CMS administrator Chiquita Brooks-LaSure in that release. "In the first weeks of Open Enrollment, we have seen an increase in plan selections and a significant increase in the number of new enrollees over the previous year."

As part of the latest Exchange data release, Brooks-LaSure added: "We are incredibly pleased to see continued strong enrollment numbers in this second snapshot report, especially the increase in new enrollees. We are going to keep our focus on ensuring that all who seek health care coverage get the affordable, quality coverage they need."

Aiding enrollment through regulatory changes

These numbers build on the 2022 plan year (PY), which also saw record growth: nearly 14.5 million enrollees with close to 3 million being first-time exchange customers. As HealthLeaders reported in October, other big moves in PY2022 included Aetna's return to the Marketplace and continued expansion from carriers such as Centene, Cigna, Molina Healthcare, and UnitedHealthcare.

With growth like this, it may seem counterintuitive to limit Exchange plan options as CMS proposed in its 2024 Notice of Benefit and Payment Parameters (the agency's annual Marketplace rule). CMS' goal, however, is part of the industry's overall effort to improve customer experience.

Attracting customers and making it easy for them to choose a plan are two different things. As such, the proposed rule would limit the number of non-standardized plans that carriers can offer on the Marketplace to two per product type (HMO, PPO) and metal level (gold, silver, bronze) for each of its service areas.

In its press release for the rule, CMS notes: "The average number of plans available to consumers on the Marketplace has increased from 25.9 in PY2019 to 113.6 in PY2023. Such plan choice overload limits consumers’ ability to make a meaningful selection when comparing plan offerings."

The proposed 2024 rule continues CMS efforts to simplify the shopping experience. This includes the new standardized plan listings on HealthCare.gov that the agency required via last year's rule.

Making it easier to choose

Even with these improvements, navigating the Marketplace alone can be daunting. To assist, the Biden-Harris Administration has increased funding for Navigators who help customers find coverage on HealthCare.gov.

In PY2022, 60 organizations received $80 million in grants to hire, certify, and train community-based Navigators. For PY203, the Administration increased funding to $98.9 million.

A press release publicizing the increase touted the program's results: "More than 1,500 certified Navigators held more than 1,800 outreach and education events at accessible areas—such as local libraries, vaccination clinics, food drives, county fairs, and job fairs."

In the release, CMS's Brooks-LaSure added: "Reaching people where they are is a key part of our strategy to connect people to health coverage. Navigators were incredibly effective during the last Open Enrollment period when a historic number of people signed up and now we are doubling down on investing in community Navigators who can help people find the coverage they need."

In addition to these community-based Navigators, HealthCare.gov offers 24/7 telephone assistance and can connect shoppers to local agents/brokers.

Two other ways for HealthCare.gov customer to enroll are through Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE). Through DE, Exchange carriers and third-party web brokers can enroll customers after they complete the eligibility portion of the application on HealthCare.gov. EDE adds the eligibility assistance component, side-stepping customer interaction with the federal exchange website completely.

Catch is one of these web brokers, drawing ACA plan customers in with a "hack your premium" message to "slash your premium payments in two minutes or less." What sounds like a simple discounting or coupon service (think GoodRx) is actually a web broker service that creates its own version of the Marketplace shopping experience, pulling in the premium subsidy eligibility from HealthCare.gov.

Tracking enrollment throughout 2023

CMS will continue to track Marketplace enrollment data as part of its biweekly commitment to enrollment reporting. It issued its first snapshot on November 22 and its second December 7. Expect the third around December 21, just under one week after OEP ends.

CMS will continue to report enrollment updates to include those eligible for a Special Enrollment Period (SEP). Extensive, complete-year data is available here.