Saturday, January 30, 2016

10% of Low-Income Enrollees Spend 18.5% of Income on Healthcare


The Urban Institute recently conducted an analysis of healthcare spending relative to income for marketplace enrollees. Here are some key findings from the report:

·         10% of enrollees with incomes below 200% of FPL will spend 18.5% of their income on healthcare.

·         1 in 10 enrollees with incomes 200-500% of FPL will spend 21% of their income on health costs.

·         At the 90th percentile, out-of-pocket expenses consume 13% for those with incomes below 300% of FPL.

·         Median financial burdens rise from 8.7 percent of income (excellent health) to 11.4% (fair/poor health).

·         Those with the most healthcare needs pay between 16.7% and 22.8% of income for their medical care.

·         Median financial burdens for age 45-64 are 9.6% and 12% for those ages 55-64.

Source: The Urban Institute, January 14, 2016

According to a recent survey of practice administrators, billing managers, practice executives, billers and coders, their healthcare organizations plan to focus on the following in 2016:


  • mproving revenue cycle management processes: 66%
  • working toward a value-based care model: 15%
  • automating patient collections strategies: 9%

Source: "Navicure Survey Reveals ICD-10 Readiness Post-Implementation," Navicure Press Release, January 19, 2016, http://www.navicure.com/documents/Navicure_ICD-10_post_transition.pdf

According to a recent study, single persons ages 85 and older ...

...  spent an average of about $13,355 on non-recurring health expenses such as home health care, nursing home stays, overnight hospital stays, and outpatient surgery, compared with only $8,530 for couples over the same two-year period.

Source: " Older Singles Face Higher Health Costs Than Couples," Employee Benefit Research Institute (EBRI), January 21, 2016, https://www.ebri.org/pdf/PR1153.OldSngls.21Jan16.pdf 

Seventeen states have state-based health insurance marketplaces in 2016. According to a recent analysis:


  • 9 have no net change in the number of insurers participating
  • 3 have a net gain
  • 5 have a small decrease

Source: "Insurer Participation in State-Based Marketplaces in 2016: A Closer Look," The Commonwealth Fund Blog, January 21, 2016, http://www.commonwealthfund.org/publications/blog/2016/jan/insurer-participation-in-state-based-marketplaces-in-2016

24% ...

... of data breaches are the result of employee error, followed by "inside jobs" (at 15%), according to a recent report from the Association of Corporate Counsel.

"From an employer perspective, one of the interesting things about the Cadillac tax ...

... being delayed for a couple of years is we are now going to see a lot of companies moving to full replacement, high-deductible plans in 2017. [In the] plan design survey [conducted by the National Business Group on Health this year we had something like 27% of companies considering moving to a full replacement high-deductible plan for 2017, really in anticipation of the Cadillac tax going into effect. But with a two-year delay I think we are going to see that level off.... [Employers] will look at ACOs, performance networks and centers of excellence and try to understand how these delivery models can perform versus the market from a cost, an outcomes and a patient experience perspective. And I would say that ACOs in particular are not very well understood."

— Brian Marcotte, president and CEO of NBGH, told AIS's Health Plan Week.

35% ...


... was the increase in adoption of private exchanges in 2015, fueled by midsize companies, according to a Jan. 20 report from Accenture.

"Should Obamacare critics come to control not only Congress but also the White House ...


... I doubt that they would actually 'repeal and replace.' Their pledge to do so would evaporate as quickly as did Kentucky Governor Bevin's promise to rescind his state's acceptance of the Medicaid expansion. Instead, recognizing that 'if you break it, you own it,' a Republican president would segue to a traditional Republican stance that states should be accorded greater authority than national legislation allows them."

— Henry Aaron, a senior fellow at The Brookings Institution, told AIS's Inside Health Insurance Exchanges.

Nearly 20% ...

... of public exchange options are compatible with health savings accounts, according to John Young, former Cigna Corp. exec who is now the CEO of Consumerdriven, LLC.

55 ...


... hospitals have sued CMS over the Medicare two-midnight rule and the reduction in inpatient prospective payment system payments (operating and capital) for fiscal years 2014-2018 to offset the rule's cost.

"Although most do not expect biosimilars ...

... to mirror the generic market in price decrease, there is strong anticipation among payers that biosimilars will become a primary strategy to reduce specialty drug prices as 'lower-cost' branded options. Using the European market as a guide, payers are projecting pricing discounts within one to three years for biosimilar(s) and their originators of up to 20% to 30%. How large this discount turns out to be is dependent on the total market value that the biosimilar is competing in and the number of product competitors."

— Lynn Nishida, assistant vice president of pharmacy services at Solid Benefit Guidance, told AIS's Specialty Pharmacy News.

More than 80% ...


... of large employers use financial incentives to promote wellness in their benefit plans, but the effectiveness of these efforts is not certain, according to a study published in the January issue of Health Affairs.

"Our biggest challenge [at Minnesota's public exchange] ...

...  continues to be consumer education. There are still many Minnesotans out there who do not know the financial and comparative benefits of enrolling through MNsure. Spreading that message continues to be one of our main focuses in 2016."

— Allison O'Toole, CEO of MNsure, told AIS's Inside Health Insurance Exchanges

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available


CMS BLOG

http://blog.cms.gov/2016/01/29/in-these-last-days-of-open-enrollment-immigrant-families-need-to-know-affordable-coverage-options-are-available

FOR IMMEDIATE RELEASE

January 29, 2016

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

Affordable coverage options are available in the Health Insurance Marketplace for eligible immigrant families. In fact, most people shopping for coverage on the Marketplace can find a plan with monthly premiums of $75 or less. But, act soon:  January 31, 2016 is the final deadline for you to sign up at HealthCare.gov or CuidadodeSalud.gov for 2016 coverage.  Don’t miss out on getting coverage for 2016 and risk owing a fee of $695 or more.  

If you work with immigrant communities, we need your help to make sure people who are eligible for coverage understand that they should not be worried about applying for coverage if they have a family with mixed immigration status.

Here are 10 things immigrant families need to know about Marketplace coverage:

1.      To buy private health insurance through the Marketplace, you must be a U.S. citizen, a U.S. national, or be lawfully present in the United States. In addition, immigrants with certain other statuses are also eligible.  See a list of immigration statuses that qualify for Marketplace coverage.

2.      If you recently gained U.S. citizenship or had a change in your immigration status that makes you newly eligible to enroll in coverage through the Marketplace, you may qualify for a Special Enrollment Period. See if you can enroll in a Marketplace health plan outside Open Enrollment.

3.      Financial help is available. If you’re a lawfully present immigrant and meet other eligibility criteria, you can buy private health insurance through the Marketplace, and may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income. More than 8out of 10 people who have enrolled in a health insurance plan through the Marketplace have qualified for financial help. In fact, most people can find monthly premiums for $75 or less, after financial assistance. In general, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the premium tax credit or financial assistance to pay for your premium.  You can find the levels here based on the household size. If you make less than 100 percent of the federal poverty line, which is $11,770 for an individual or $24,250 for a family of 4 (higher in Alaska and Hawaii) and you aren’t eligible for Medicaid because of your immigration status, you may still qualify for lower costs on Marketplace coverage.

4.      If you’re a “qualified non-citizen” and meet your state’s income and other eligibility rules, you may be eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage. See a list of “qualified non-citizen” statuses and other important details.

5.      If you’re a “qualified non-citizen,” you may have a 5-year waiting period to get full Medicaid or CHIP coverage. This means you must wait 5 years after receiving “qualified” immigration status and meet all other eligibility rules in the state before being eligible for full Medicaid or CHIP. See a list of exceptions to the 5-year waiting period and other important details.

6.      Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for financial assistance for private insurance for their dependent family members who are eligible for coverage through the Marketplace, or for Medicaid and CHIP coverage. Family members who aren't applying for health coverage for themselves won't be asked if they have eligible immigration status.

7.      Federal and State Marketplaces, as well as state Medicaid and CHIP agencies, can’t require you to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage for themselves.

8.      States can’t deny you benefits because a family or household member who isn't applying has not provided his or her citizenship or immigration status.

9.      Information that you provide to the Marketplace won’t be used for immigration enforcement purposes.
If you’re not eligible for Marketplace coverage or you can't afford a health plan, you can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents in the health center’s service area. Find more information here. 

Friday, January 29, 2016

Be sure to check out the “Operational Tips for Agents/Brokers Assisting Consumers with Plan Year 2016 Enrollments in the Federally-facilitated Marketplaces (FFMs)”


Be sure to check out the “Operational Tips for Agents/Brokers Assisting Consumers with Plan Year 2016 Enrollments in the Federally-facilitated Marketplaces (FFMs)” resource now available on the Agents and Brokers Resources webpage. This document provides agents and brokers with answers to frequently asked questions about consumer enrollment, including:

·         How agents and brokers can assist with enrollments

·         The Marketplace 2.0 Application

·         The Direct Enrollment Pathway

·         Reenrollment

·         Capturing National Producer Numbers (NPNs) on applications

·         Registration

 

Stay informed and make the most of the last few days of the plan year 2016 Open Enrollment period!

 

Contact Us: 

·         For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.govor call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”

·         Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596. Direct questions about SHOP Marketplace coverage to the SHOP Marketplace Call Center at 1-800-706-7893.

CMS Releases Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries


CMS NEWS


 

FOR IMMEDIATE RELEASE

January 26, 2016                                                                                                                          

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

CMS Releases Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries

 

 

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH), released a new Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.

 

The Guide was developed in collaboration with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center (NORC) at the University of Chicago as part of the CMS Equity Plan for Improving Quality in Medicare, and is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign in identifying root causes and solutions for preventing avoidable readmissions among racially and ethnically diverse Medicare beneficiaries.

 

“CMS has an important opportunity and a critical role in preventing hospital readmissions while promoting health equity among diverse Medicare beneficiaries,” said Cara James, Director of CMS’s Office of Minority Health. “This Guide encourages action-oriented steps and solutions in achieving health equity, addresses reducing readmissions and focuses on our initiative of achieving better care, smarter spending, and healthier people throughout our health care system.”

 

Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions, such as heart failure, heart attack, and pneumonia, among others. Social, cultural, and linguistic barriers contribute to these higher readmission rates.

 

The Guide provides:

  • New, action-oriented guidance for addressing avoidable readmissions in this population by providing an overview of the issues related to readmissions for diverse Medicare beneficiaries;
  • A set of seven key recommendations that hospital leaders can take to prevent avoidable readmissions in this population;
  • Concrete examples of initiatives and strategies that may be applied to reduce readmissions in diverse populations.

 
To learn more about the Readmissions Guide and key recommendations, or visit https://www.cms.gov/About-CMS/Agency-information/OMH/Downloads/OMH_Readmissions_Guide.pdf

Make the most of these final days by using the following points to encourage consumers to complete enrollment at HealthCare.gov for coverage effective March 1.


 

·         Avoid the penalty: If your clients miss this deadline, they will likely have to wait another year to enroll, and may be required to pay a fee when filing their federal income taxes.

·         Financial help: Eight out of 10 people who sign up for coverage at HealthCare.gov qualify for financial help to lower the cost of their monthly premiums. After this financial assistance, seven out of 10 people can find plans with premiums for less than $75 per month.

·         Free enrollment assistance: If you or your clients have questions or want to talk through options, enrollment specialists are available 24 hours a day at 1-800-318-2596. To minimize wait times, avoid calling the Health Insurance Marketplace during the hours of 9:00 AM and 12:00 PM Eastern Time (ET), 4:00 PM and 6:00 PM ET.

·         Avoid the last minute rush: Expect longer wait times if you need to call the Marketplace Call Center January 29 through 31.

 

For more Open Enrollment resources, visit the Agents and Brokers Resources webpage

Open Enrollment ends on January 31.


Consumers who miss this deadline will likely have to wait another year to enroll and may be required to pay a fee when filing their federal income taxes. The Centers for Medicare & Medicaid thanks you for your continued partnership in helping consumers get covered.

 

Looking for Open Enrollment resources? Visit the Agents and Brokers Resources webpage for guidance, tips, and additional resources.
 

By the Numbers: Open Enrollment


Since Open Enrollment for the Health Insurance Marketplace began on November 1, about 11.6 million people have signed up for or renewed a health plan (2.7 million through State-based Marketplaces through December 26 and over 8.9 million through HealthCare.gov or CuidadodeSalud.gov through January 23) that meets their needs and fits their budget.

 

People learned about HealthCare.gov by talking with friends, from their local news, from social media, from trusted leaders in their communities, and from TV and radio public awareness campaigns. When they needed advice about how to enroll, enrollment specialists and volunteers were #HereToHelp and ready to answer their questions. Text messages, emails, and phone calls provided important deadline reminders. And when they were ready to sign up, new tools and features on HealthCare.gov, the Marketplace Call Center, and in-person assistance have made it as easy as possible for them to do so.

 

This fact sheet provides a point-in-time estimate as of January 28, except where noted, of the many numbers behind the 2016 Open Enrollment period.

11.6 million
The number of Americans across the country who have signed up for or been automatically renewed for 2016 Marketplace coverage (through December 26 for State-based Marketplaces and January 23 for states using HealthCare.gov).
60 percent
The share of returning 2015 consumers who came back to HealthCare.gov and actively reenrolled and switched to a different plan for 2016 through December 26.
$516
The average savings per year for the 60 percent of all people who actively reenrolled in a Marketplace plan for 2016 through HealthCare.gov who switched to a different plan through December 26.
 
$294
In the 38 states using HealthCare.gov, the average monthly tax credit for people who qualify for financial assistance to lower the cost of their premiums through December 26.
83%
The percentage of Marketplace consumers who qualified for tax credits to make their monthly premiums more affordable through December 26 of open enrollment.
10
The number of issuers the average consumer has in their state, up from 9 in 2015 and 8 in 2014 in the states using HealthCare.gov.
50
The average number of plans consumers can choose from this year in the states using HealthCare.gov.
3.6 million
Consumers who have used HealthCare.gov’s new Doctor Lookup and Prescription Drug look up features to more easily search for the plan that matches their needs.
 
13.2 million
Total calls answered at the Marketplace call center through January 23 during this Open Enrollment season.
25.4 million
Unique users who visited HealthCare.gov.
 
250
Local television and radio interviews from the President, the First Lady, Secretary Burwell, and HHS and Administration officials.
48
Trips taken by Administration officials to visit local events and raise awareness about Open Enrollment.
 
37%
Consumers who visited HealthCare.gov through a mobile device or tablet.
73%
Consumers who visited CuidadodeSalud.gov through a mobile device or tablet.
1 billion+
Impressions from our television and radio campaigns through January 28. (Check out the TV ads here: See Your Savings; My Story, My Savings; Cuidado deSalud: Find Your Savings; Cuidado de Salud: La Mayoría).
 
3.49+ billion
Twitter impressions garnered by the #GetCovered social media campaign.
 
21.6+ million
Total text messages sent by HealthCare.gov to consumers interested in learning more about their health care options.
35
Average number of emails received per consumer with important reminders about their coverage, deadlines and financial help.
15,000+
Certified application counselors, navigators and in-person assisters on the ground in communities across the nation working to educate and enroll individuals in Marketplace coverage.
79,000
Agents and brokers on the ground in communities across the nation working to educate and enroll individuals in Marketplace coverage.
3,100+
National, state and local partners helping to communicate information about the Health Insurance Marketplace.
8,200+
Number of public enrollment events that have taken place in communities across the country.
 
22,300+
Number of letters written to the President through January 2016 thanking him for the Affordable Care Act since mid-2013 alone.

Health Insurance Marketplace Open Enrollment Snapshot Week 12: January 17, 2016 – January 23, 2016


With the final January 31 deadline just days away, about 8.9 million consumers have signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. This week’s snapshot includes weekly and cumulative data for enrollment through HealthCare.gov, a breakdown of cumulative data for 38 states using the HealthCare.gov platform, and cumulative data for local markets.

 

“The clock is ticking with just four days left before January 31, the final enrollment deadline for 2016 health coverage,” said U.S. Secretary for Health and Human Services, Sylvia Burwell. “We are focused on making sure people know that financial help is available, the deadline is fast approaching and that we’re here to help them enroll – so that they don't risk having to pay a penalty of $695 or more for not having health insurance.”

 

Overall, net plan selections for Week 12 totaled 103,172. Over the same time period, net new plan selections totaled 144,971. Net new plan selections take into account new plan selections in the reporting week minus any consumer or insurer-initiated cancelations for new plan selections. As a reminder, this year the number of net plan selections accounts for both insurer and consumer-initiated cancellations that occur before the end of Open Enrollment. This is a change from last year, and it will result in a larger number of cancellations being accounted for during, rather than after, Open Enrollment. Last year, cancellations from insurers that happened during Open Enrollment were reflected only in reports on effectuated enrollment after the end of Open Enrollment. There will likely be a smaller difference this year between plan selection totals at the end of Open Enrollment and subsequent effectuated enrollment.

Similar to last year, each week, the Centers for Medicare & Medicaid Services (CMS) will release weekly Open Enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Marketplaces and State Partnership Marketplaces, as well as some State-based Marketplaces. These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity to date could fluctuate as plan changes or cancellations occur, such as in response to life changes like starting a new job or getting married. In addition, the weekly snapshot only looks at plan selections and does not include the number of consumers who paid their premiums to effectuate their enrollment.

HHS will continue to produce more detailed reports that look at plan selections across the Federally-facilitated Marketplace and State-based Marketplaces later in the Open Enrollment period.

 

Definitions and details on the data are included in the glossary.

 

Federal Marketplace Snapshot

 

Federal Marketplace Snapshot
Week 12
Jan 17 – Jan 23
Cumulative
Nov 1 – Jan 23
Plan Selections (net)
103,172
8,939,274
Applications Submitted (Number of Consumers)
*
*
Call Center Volume
918,603
12,454,334
Average Call Center Wait Time
4 minutes 25 seconds
9 minutes 48 seconds
Calls with Spanish Speaking Representative
73,956
774,588
Average Wait for Spanish Speaking Rep
14 seconds
21 seconds
HealthCare.gov Users
2,693,592
25,367,559
CuidadoDeSalud.gov Users
202,424
1,475,339
Window Shopping HealthCare.gov Users
492,562
8,390,521
Window Shopping CuidadoDeSalud.gov Users
11,311
168,101

* Applications submitted could not be validated this week.

 

HealthCare.gov State-by-State Snapshot

 

Consumers across the country continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visiting HealthCare.gov or CuidadoDeSalud.gov. Individual plan selections for the states using the HealthCare.gov platform include:

 

 

Week 12
Cumulative Plan Selections
Nov 1 – Jan 23
Alabama
182,895
Alaska
21,853
Arizona
185,459
Arkansas
68,622
Delaware
26,538
Florida
1,623,718
Georgia
543,142
Hawaii
13,194
Illinois
358,353
Indiana
185,710
Iowa
51,964
Kansas
93,852
Louisiana
198,511
Maine
80,399
Michigan
329,017
Mississippi
99,967
Missouri
268,445
Montana
55,891
Nebraska
82,884
Nevada
79,055
New Hampshire
52,331
New Jersey
268,847
New Mexico
50,603
North Carolina
575,374
North Dakota
20,393
Ohio
226,421
Oklahoma
135,448
Oregon
138,862
Pennsylvania
417,707
South Carolina
215,503
South Dakota
24,267
Tennessee
248,387
Texas
1,174,314
Utah
162,006
Virginia
394,896
West Virginia
35,217
Wisconsin
227,129
Wyoming
22,100

 

 

HealthCare.gov Local Market Snapshot

 

The Week 12 snapshot includes a look at plan section by Designated Market Areas (DMAs) which are local media markets. These data provides another level of detail to better understand total plan selections within local communities. Some DMAs include one or more counties in a state that is not using the HealthCare.gov platform in 2016. Plan selections for those DMAs only include data for the portions of these areas that are using the HealthCare.gov platform, so the cumulative totals in the snapshot do not represent plan selections for the entire DMA. In addition, some DMAs cross into multiple states that use the HealthCare.gov platform and those totals are cumulative for all HealthCare.gov states in that DMA. Because some communities do not fall into a DMA, cumulative plan selections for local markets will not total to the national cumulative plan selection number.

 

Local Markets in HealthCare.gov States
State
Cumulative Plan Selections
Nov 1 – Jan 23
Abilene-Sweetwater
Texas
9,923
Albany
Georgia
15,854
Albuquerque-Santa Fe
New Mexico
43,245
Alexandria
Louisiana
9,252
Alpena
Michigan
1,954*
Amarillo
Texas
14,024
Anchorage
Alaska
14,141
Atlanta
Georgia
410,182
Augusta
Georgia
31,166
Austin
Texas
115,970
Bangor
Maine
22,631
Baton Rouge
Louisiana
42,225
Beaumont-Port Arthur
Texas
14,249
Bend
Oregon
10,216
Billings
Montana
15,916
Biloxi-Gulfport
Mississippi
9,385
Birmingham (Ann and Tusc)
Alabama
72,619
Bluefield-Beckley-Oak Hill
West Virginia
7,458
Boise
Idaho
875**
Boston (Manchester)
Massachusetts
41,806
Buffalo
New York
1,258
Burlington-Plattsburgh
Vermont
4,906
Butte-Bozeman
Montana
9,354
Casper-Riverton
Wyoming
4,883
Cedar Rapids-Wtrlo-Iwc & Dub
Iowa
15,848
Champaign & Sprngfld-Decatur
Illinois
23,447
Charleston
South Carolina
44,225
Charleston-Huntington
West Virginia
15,967
Charlotte
North Carolina
195,030
Charlottesville
Virginia
15,543
Chattanooga
Tennessee
37,347
Cheyenne-Scottsbluf
Wyoming
6,292
Chicago
Illinois
286,011
Cincinnati
Ohio
46,006
Clarksburg-Weston
West Virginia
5,849
Cleveland-Akron (Canton)
Ohio
81,049
Columbia
South Carolina
41,711
Columbia-Jefferson City
Missouri
21,359
Columbus
Georgia
19,364
Columbus
Ohio
44,444
Columbus-Tupelo-West Point
Mississippi
13,348
Corpus Christi
Texas
18,690
Dallas-Ft. Worth
Texas
346,817
Davenport-R. Island-Moline
Iowa/Illinois
16,769
Dayton
Ohio
22,059
Denver
Colorado
6,946
Des Moines-Ames
Iowa
19,288
Detroit
Michigan
170,893
Dothan
Alabama
9,173
Duluth-Superior
Minnesota
6,582
El Paso (Las Cruces)
Texas
60,860
Elmira (Corning)
New York
1,187
Erie
New York
8,643
Eugene
Oregon
19,368
Evansville
Indiana
14,072
Fairbanks
Alaska
2,655
Fargo-Valley City
North Dakota
10,618
Flint-Saginaw-Bay City
Michigan
30,024
Ft. Myers-Naples
Florida
86,868
Ft. Smith-Fay-Sprngdl-Rgrs
Arkansas
22,230
Ft. Wayne
Indiana
21,615*
Gainesville
Florida
18,852
Glendive
Montana
530*
Grand Rapids-Kalmzoo-B.Crk
Michigan
66,611
Great Falls
Montana
7,763*
Green Bay-Appleton
Wisconsin
50,190
Greensboro-H.Point-W.Salem
North Carolina
103,011
Greenville-N.Bern-Washngtn
North Carolina
41,674
Greenvll-Spart-Ashevll-And
North Carolina
113,433
Greenwood-Greenville
Mississippi
6,979
Harlingen-Wslco-Brnsvl-Mca
Texas
52,106
Harrisburg-Lncstr-Leb-York
Pennsylvania
61,620
Harrisonburg
Virginia
11,910
Hattiesburg-Laurel
Mississippi
10,947
Helena
Montana
2,608
Honolulu
Hawaii
13,194
Houston
Texas
313,740
Huntsville-Decatur
Alabama
36,575
Idaho Falls-Pocatello
Idaho
2,735*
Indianapolis
Indiana
85,176
Jackson
Mississippi
39,189
Jackson
Tennessee
11,238
Jacksonville
Florida
97,240
Johnstown-Altoona
Pennsylvania
19,149
Jonesboro
Arkansas
5,573
Joplin-Pittsburg
Missouri
15,192
Juneau
Alaska
2,999
Kansas City
Kansas/Missouri
102,165
Knoxville
Tennessee
49,472
La Crosse-Eau Claire
Wisconsin
23,394
Lafayette
Indiana
3,151*
Lafayette
Louisiana
24,803
Lake Charles
Louisiana
6,701
Lansing
Michigan
14,636
Laredo
Texas
14,130
Las Vegas
Nevada
55,675
Lima
Ohio
1,589*
Lincoln & Hastings-Krny
Nebraska
36,979
Little Rock-Pine Bluff
Arkansas
33,191
Louisville
Kentucky
8,495
Lubbock
Texas
12,814
Macon
Georgia
22,036
Madison
Wisconsin
33,477
Marquette
Michigan
9,444
Medford-Klamath Falls
Oregon
14,035
Memphis
Tennessee
59,942
Meridian
Mississippi
3,969
Miami-Ft. Lauderdale
Florida
605,675
Milwaukee
Wisconsin
83,503
Minneapolis-St. Paul
Minnesota
11,063
Minot-Bismarck-Dickinson
North Dakota
11,450*
Missoula
Montana
19,735
Mobile-Pensacola (Ft Walt)
Alabama
62,880
Monroe-El Dorado
Louisiana/Arkansas
20,332
Montgomery-Selma
Alabama
19,309
Myrtle Beach-Florence
Florida
39,504
Nashville
Tennessee
98,484
New Orleans
Louisiana
81,849
New York
New York
212,643
Norfolk-Portsmth-Newpt News
Virginia
77,841
North Platte
Nebraska
1,679
Odessa-Midland
Texas
12,088
Oklahoma City
Oklahoma
68,484
Omaha
Nebraska
37,084
Orlando-Daytona Bch-Melbrn
Florida
303,271
Ottumwa-Kirksville
Missouri
3,655
Paducah-Cape Girard-Harsbg
Illinois/Kentucky/Missouri
20,633
Panama City
Florida
21,073
Parkersburg
West Virginia
2,815*
Peoria-Bloomington
Illinois
13,024
Philadelphia
Pennsylvania
276,400
Phoenix (Prescott)
Arizona
131,758
Pittsburgh
Pennsylvania
78,170
Portland
Oregon
90,737
Portland-Auburn
Maine
58,899
Presque Isle
Maine
4,092
Quincy-Hannibal-Keokuk
Illinois/Missouri/Iowa
7,213
Raleigh-Durham (Fayetvlle)
North Carolina
154,176
Rapid City
South Dakota
7,484
Reno
Nevada
21,744
Richmond-Petersburg
Virginia
75,163
Roanoke-Lynchburg
Virginia
48,356
Rochestr-Mason City-Austin
Minnesota/Iowa
1,337*
Rockford
Illinois
12,599
Salisbury
Maryland
6,834
Salt Lake City
Utah
162,482
San Angelo
Texas
4,524
San Antonio
Texas
105,952
Savannah
Georgia
45,169
Sherman-Ada
Texas
9,193
Shreveport
Louisiana
34,951
Sioux City
Iowa
10,084
Sioux Falls(Mitchell)
South Dakota
18,105
South Bend-Elkhart
Indiana
24,034
Spokane
Washington
1,269*
Springfield
Missouri
53,145
St. Joseph
Missouri
3,756
St. Louis
Missouri
123,916
Tallahassee-Thomasville
Florida
25,995
Tampa-St. Pete (Sarasota)
Florida
261,849
Terre Haute
Indiana
9,629
Toledo
Ohio
17,831
Topeka
Kansas
11,830
Traverse City-Cadillac
Michigan
25,248
Tri-Cities
Tennessee
24,835
Tucson (Sierra Vista)
Arizona
31,478
Tulsa
Oklahoma
46,872
Tyler-Longview(Lfkn&Ncgd)
Texas
22,969
Victoria
Texas
2,140
Waco-Temple-Bryan
Texas
25,744
Washington, DC (Hagerstown)
 
167,140
Wausau-Rhinelander
Wisconsin
20,580
West Palm Beach-Ft. Pierce
Florida
180,674
Wheeling-Steubenville
Ohio
6,285
Wichita Falls & Lawton
Texas
10,142
Wichita-Hutchinson Plus
Kansas
35,925
Wilkes Barre-Scranton
Pennsylvania
45,274
Wilmington
Delaware
31,982
Yakima-Pasco-Rchlnd-Knnwck
Oregon
1,741*
Youngstown
Ohio
13,031
Yuma-El Centro
Arizona
3,706
Zanesville
Ohio
1,242

*Because there was a change of 11 or fewer enrollments for Week 12, data for Week 11 was used as a placeholder to adhere to privacy standards.

 

**Because there was a change of 11 or fewer enrollments for Week 11 and 12, data for Week 10 was used as a placeholder to adhere to privacy standards.

 

 

Glossary

Plan Selections: The weekly and cumulative metrics provide a preliminary total of those who have submitted an application and selected a plan. Each week’s plan selections reflect the total number of plan selections for the week and cumulatively from the beginning of Open Enrollment to the end of the reporting period, net of any cancellations from a consumer or cancellations from an insurer during that time.

 

Because of further automation in communication with insurers, the number of net plan selections reported this year account for insurer-initiated plan cancellations that occur before the end of Open Enrollment for reasons such as non-payment of premiums. This change will result in a larger number of cancellations being accounted for during Open Enrollment than last year. Last year, these cancellations were reflected only in reports on effectuated enrollment after the end of Open Enrollment. As a result, there may also be a smaller difference this year between plan selections at the end of Open Enrollment and subsequent effectuated enrollment, although some difference will remain because plan cancellations related to non-payment of premium will frequently occur after the end of Open Enrollment.

 

Plan selections include those consumers who are automatically re-enrolled into their current plan or another plan with similar benefits, which occurs at the end of December.

 

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not include totals for effectuated enrollments.

 

Net New Plan Selections: Weekly net new plan selections take into account new plan selections minus any consumer or insurer-initiated cancelations for new plan selections.

 

Marketplace: Generally, references to the Health Insurance Marketplace in this report refer to 38 states that use the HealthCare.gov platform. The states using the HealthCare.gov platform are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

 

HealthCare.gov States: The 38 states that use the HealthCare.gov platform for the 2016 benefit year, including the Federally-facilitated Marketplace, State Partnership Marketplaces and State-based Marketplaces.

 

Local Markets: Cumulative plan selections for local markets are based on Designated Market Areas (DMAs) which are media markets. Some DMAs include one or more counties in a state that is not using the HealthCare.gov platform in 2016. Plan selections for those DMAs only include data for the portions of these areas that are using the HealthCare.gov platform, so the cumulative totals in the snapshot do not represent plan selections for the entire DMA.

 

Applications Submitted: This includes a consumer who is on a completed and submitted application or who, through the automatic re-enrollment process, which occurs at the end of December, had an application submitted to a Marketplace using the HealthCare.gov platform. If determined eligible for Marketplace coverage, a new consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

 

Call Center Volume: The total number of calls received by the Federally-facilitated Marketplace call center over the course of the week covered by the snapshot or from the start of Open Enrollment. Calls with Spanish speaking representatives are not included.

 

Calls with Spanish Speaking Representative: The total number of calls received by the Federally-facilitated Marketplace call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

 

Average Call Center Wait Time: The average amount of time a consumer waited before reaching a customer service representative. The cumulative total averages wait time over the course of the extended time period.

 

HealthCare.gov or CuidadodeSalud.gov  Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadodeSalud.gov , respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

 

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.