Marketplace Enrollment Declined in Pre-COVID Early 2020

Plan selection has fallen from 101,555 in 2016 to 85,837 in 2020

Kansas map marketplace enrollment

Key Points

    • 85,837 Kansans enrolled in health insurance through the federally facilitated marketplace in early 2020. Increasing marketplace enrollment is likely, however, due to COVID-19 related losses of job-based insurance.
    • Five insurers offered 82 plans on the Kansas marketplace. All counties in Kansas had at least two insurers offering coverage.
    • A majority (85.5 percent) of Kansas enrollees received Advanced Premium Tax Credits (APTC) to reduce the cost of their monthly premium payments.
    • The average monthly premium for Kansas enrollees receiving APTC in 2020 rose to $101 per member per month compared to $76 in 2019. The average monthly premium for Kansas enrollees without APTC was $579 for the 2020 plan year, which was lower than the 2019 rate of $596.
    • Kansas enrollees generally had higher average monthly premiums compared to U.S. enrollees in the other 37 states operating on the federally facilitated marketplace in 2020.

Introduction

During the latest open enrollment period at the end of 2019, 85,837 Kansans selected or were automatically re-enrolled in a health insurance plan through the federally facilitated marketplace. That is 4,156 fewer than the previous year and a 15 percent drop from the 101,555 who selected a plan in 2016. Around the country, 11.4 million consumers selected a marketplace plan in 2020, the same as last year and a 10 percent drop from the 12.7 million in 2016. Enrollment is likely to increase during 2020 following large losses in the availability of job-based insurance due to the COVID-19 pandemic.

This brief, which is based on the latest available data from the Centers for Medicare and Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services (HHS), provides data on enrollment, enrollee characteristics, plan selection, financial assistance, premiums and stand-alone dental insurance in Kansas. CMS released its final summary enrollment data for the marketplaces created by the Affordable Care Act (ACA) on April 2, 2020, for plan year 2020. Like last year, the open enrollment period for the 2020 plan year lasted 45 days from November 1, 2019, through December 15, 2019, for coverage beginning on January 1, 2020. However, the enrollment period was extended until December 18, 2019, for consumers who could not sign up on December 15, which fell on a Sunday.

Kansas Enrollment

The data from CMS show that 111,789 Kansans applied for a marketplace plan for 2020 and 103,870 were determined eligible to enroll, but only 85,837 Kansans completed their enrollment by selecting a plan or were automatically re-enrolled (Figure 1). CMS has not yet released information on the percentage of enrollees who have “effectuated” their enrollment by paying their premiums. This year, 2 in 10 (20.8 percent or 17,877) Kansas enrollees were “new consumers” who did not have marketplace coverage in 2019. The other 8 in 10 (79.2 percent or 67,960) were returning enrollees who had marketplace coverage last year. Among the returning enrollees, there were 18,994 who were automatically re-enrolled by the marketplace in the same or a similar plan as the previous year. There were 48,966 returning who actively re-enrolled, and among this group more than half re-enrolled in the same plan (58.6 percent or 28,677) and 4 in 10 (41.4 percent or 20,289) switched plans.

Figure 1 Kansas Marketplace Enrollment 2020 Plan year

Enrollee Characteristics

It is important to the stability of the marketplace to enroll an adequate number of young persons who are generally healthy and reduce the average premium. About one in five (19.9 percent) Kansas enrollees were under age 26 and nearly one-third (32.8 percent) were age 26-44 (Figure 2). Another one-third (30.1 percent) of Kansas enrollees were age 55–64. Individuals in this age group are more likely to have a pre-existing or chronic health condition. The ACA-required comprehensive health benefits included in marketplace plans likely are very attractive to this age group.

Figure 2 Kansas Marketplace Enrollees by Age 2020 Plan Year

Two-thirds (66.1 percent) of Kansas enrollees reported their race as White and 7.1 percent reported Hispanic/Latino ethnicity. However, data on race were missing for one in five (20.7 percent) Kansas enrollees and on ethnicity for 13.6 percent.

Plan Selection

During the 2020 open enrollment period, five insurers offered 82 insurance plans in four “metal” levels (catastrophic, bronze, silver and gold) on the Kansas marketplace. For the third consecutive year, there were no platinum plans offered. Cigna and Oscar Insurance Company joined the three insurers who offered plans in 2019, Ambetter from Sunflower Health Plan, Blue Cross and Blue Shield of Kansas and Medica Insurance Company. All counties in Kansas had at least two insurers offering coverage.

Figure 3 Kansas and US Marketplace Enrollment by Metal Level 2020 Plan Year

Almost half (44.5 percent or 38,189) of Kansas enrollees selected a silver plan, which covers about 70 percent of expected health care expenses for a typical population, and another one-quarter (25.4 percent or 21,790) selected a gold plan, which covers about 80 percent of expected health care expenses for a typical population (Figure 3). Similar to previous years, a small percentage (0.6 percent) of enrollees selected a catastrophic plan, which has low monthly premiums and very high deductibles, but covers essential health benefits and certain preventive services at no cost. These plans are available for anyone under age 30 and for those of any age with a hardship or affordability exemption.

In addition to standard bronze plans, companies also offered expanded bronze plans. The expanded bronze plans either cover and pay for at least one major service (e.g., primary care visits, specialist visits, emergency room services, generic drugs) other than preventive services before the deductible is applied, or they meet the requirements to be a high deductible health plan.

Plan selection in Kansas was similar to selections nationally for catastrophic and bronze plans but was lower for silver plans (44.5 percent compared to 57.0 percent; Figure 3) and much higher for gold plans (25.4 percent compared to 8.3 percent). This is similar to 2019 and might be due to a continuation of the “silver loading” that began last year when Kansas insurers were allowed to set higher premium rates for silver plans to offset the loss of federal funding for providing Cost-Sharing Reduction (CSR) subsidies. Under the ACA, individuals receiving Advanced Premium Tax Credits (APTC) are able to apply them to the purchase of a more benefit-rich gold plan, potentially at a cost to them that is less than, or close to, the cost of a silver plan.

Financial Assistance

Of the 85,837 Kansas marketplace enrollees, 9 in 10 (89.5 percent) had household incomes between 100 and 400 percent of the federal poverty level (FPL; $25,750 to $103,000 for a family of four in 2019) and may have been eligible for APTC to reduce the cost of their monthly premium payments. Two-thirds (67.2 percent) of Kansas enrollees had household incomes between 100 and 250 percent of FPL ($25,750 to $64,375 for a family of four in 2019) and also may have been eligible for CSR, which reduces out-of-pocket costs such as deductibles, co-payments and co-insurance.

Figure 4 Kansas Marketplace Enrollees by Financial Assistance Received 2020 Plan Year

Enrollees must request APTC and CSR during their application process, and if eligible, an estimate will be provided. APTC can be applied to the premium for any plan (except catastrophic plans), whereas CSR can be applied only to silver plans. A majority (85.5 percent or 73,372) of the Kansas enrollees received APTC, which was similar to the U.S. rate (84.1 percent). Also, 4 in 10 (40.1 percent or 34,423) Kansas enrollees received CSR compared to 48.8 percent nationally.

Premiums

While the average monthly premiums for Kansas enrollees without APTCs decreased slightly for the 2020 plan year The average monthly premium for those receiving APTC rose to $101 per month in 2020 from $76 in 2019 (Figure 5). The impact of the APTC on the cost to consumers is demonstrated in that the average premium for Kansas enrollees without APTC was 5.5 times higher than for those receiving APTC ($579 compared to $101). Figures 6 and 7 provide information on average monthly premiums in the seven rating areas across Kansas. Generally, enrollees in Kansas saw average monthly premiums higher than enrollees in the other 37 states operating on the federally facilitated marketplace.

Figure 5 Average Monthly Marketplace Premium Per Enrollee in Kansas and the US 2019 and 2020 Plan Years
Figure 6 Kansas Marketplace Enrollment and Average Premium by Rating Area 2020 Plan Year
Figure 7 Marketplace Financial Assistance Enrollment and Average Premium by Rating Area in Kansas 2020 Plan Year

Stand-Alone Dental Insurance

For the 2020 plan year, there were 12 stand-alone dental plans offered by four insurers on the Kansas marketplace, and 13,007 Kansans selected a standalone dental plan.

Looking Ahead

While enrollment in the Kansas marketplace has steadily declined in recent years, that could change later this year or in 2021 due to the disruption in the economy caused by COVID-19. Most Kansans receive health insurance through their employers and the recent rise in unemployment could lead to an uptick in marketplace enrollment throughout 2020 and beyond. Losing employment is a qualifying life event that creates a special enrollment period.

Additionally, for many individuals the pandemic has led to increased health care needs. Many Kansans, especially those with non-ACA compliant insurance plans, may decide to change their health insurance coverage as a result. However, Kansans who do not have a qualifying life event, such as job loss, can no longer purchase a marketplace plan for the 2020 plan year. As of June 1, 2020, only 11 states and Washington, D.C., have opened a special enrollment period for new enrollees on their own state-based exchanges. Kansans do not have this opportunity on the federally facilitated marketplace and will have to wait until the next open enrollment period if they want to purchase a marketplace plan. The open enrollment period for plan year 2021 is expected to begin on November 1, 2020.

About Kansas Health Institute

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.

Learn More About KHI