Marketplace Enrollment Surged in 2022 as Federal Subsidies Increased

Key Points

• During the open enrollment period that ended January 15, 2022, there were 107,784 Kansans who selected or were automatically re-enrolled in a health insurance plan for the 2022 plan year through the federally facilitated marketplace — a 21.6 percent increase compared to enrollment during the 2021 open enrollment period.
• The average monthly premium paid by Kansans selecting a plan during the 2022 plan year open enrollment decreased compared to 2021. Kansas enrollees receiving APTC on average paid $104 per month in 2022 compared to $116 in 2021. Enrollees without APTC paid $562 in 2022 compared to $567 in 2021.
• After taking into account APTC received, the average monthly premium paid by Kansas enrollees was 34.2 percent higher than the average monthly premium for enrollees across all 36 states (including Kansas) operating on the federally facilitated marketplace.
• Seven insurers combined offered 123 plans on the Kansas marketplace in 2022. All counties in Kansas had at least two insurers offering coverage.
• Nine in 10 (90.3 percent) marketplace enrollees took advantage of the enhanced Advance Premium Tax Credits (APTC) to reduce the cost of their monthly premium payments in 2022.

Introduction

During the 2022 plan year open enrollment period (OEP) that ended January 15, 2022, a record 107,784 Kansans selected or were automatically re-enrolled in a health insurance plan through the federally facilitated marketplace — an increase of 19,157 (21.6 percent) compared to last year’s enrollment. In the United States, 14.5 million consumers enrolled during the 2022 OEP, which is also about a 21 percent increase from 12 million the previous year and is a record enrollment for the marketplace nationally, surpassing the 12.7 million who enrolled in 2016. The 2022 OEP was the first OEP since the American Rescue Plan Act of 2021 (ARPA) increased the value of Advance Premium Tax Credits (APTC) and made them available to more enrollees.

This brief provides summary data from the 2022 OEP on enrollment, enrollee characteristics, plan selection, financial assistance, premiums, and stand-alone dental insurance in Kansas. Unlike last year, when the OEP lasted only 45 days, the 2022 OEP lasted 75 days from November 1, 2021, through January 15, 2022. Coverage began January 1, 2022, for those who enrolled on or before December 15 and began on February 1 those who enrolled after December 15.

Two in 10 (21.5 percent or 23,178) Kansas enrollees were new consumers who did not have marketplace coverage in 2021. The other 8 in 10 (78.5 percent or 84,606) were enrolled last year. Among returning enrollees, there were 60,899 active re-enrollees, and about half of those enrollees (50.0 percent or 30,441) switched plans. The remaining 23,707 returning enrollees were automatically re-enrolled by the marketplace in the same or a similar plan to the previous year.

CMS released an early snapshot showing that as of March 15, 2022, 102,303 Kansas enrollees had paid the first month’s premium.

Over half (55.3 percent) of Kansas enrollees reported their race as White and 6.9 percent reported Hispanic/Latino ethnicity. However, data on race were not reported for more than 1 in 4 (26.7 percent) Kansas enrollees and data on ethnicity was not reported for about 1 in 5 (18.6 percent) Kansas enrollees.

Plan Selection

Seven insurers offered a total of 123 bronze, expanded bronze, silver or gold plans for the 2022 plan year. Two insurers also offered catastrophic plans. For the sixth consecutive year, there were no platinum plans offered on the marketplace in Kansas. The companies and number of counties in which they offered plans include Medica Insurance Company (105 counties); Blue Cross and Blue Shield of Kansas (103 counties); Ambetter from Sunflower Health Plan (91 counties); Cigna Health and Life Insurance Company (eight counties); Oscar Insurance Company (two counties); Blue Cross and Blue Shield of Kansas City (two counties); and US Health and Life (seven counties), which newly offered coverage in Kansas in 2022. Like in 2021, all counties in Kansas have at least two insurers offering coverage in 2022.

During the 2022 OEP, 15.0 percent — or 16,191 Kansas enrollees — selected a higher premium gold plan, which covers about 80 percent of health care expenses for a typical population. Almost half (49.0 percent or 52,783) selected a silver plan, which covers about 70 percent of health care expenses. Over one-third (35.7 percent or 38,456) selected a bronze plan, which covers about 60 percent of health care expenses. As in previous years, relatively few (0.3 percent or 354) selected a catastrophic plan, which covers essential health benefits and has no out-of-pocket cost for certain preventive services. (Figure 3).

For most Kansas marketplace consumers, bronze plans have the lowest monthly premium. Kansans can choose a standard or expanded bronze plan. Standard bronze plans offer a lower monthly premium but higher out-of-pocket cost when enrollees seek care. The expanded bronze plans either meet the requirements to be a high-deductible health plan or cover and pay for at least one major service (e.g., primary care visits, specialist visits, emergency room services, generic drugs) in addition to preventive services before the deductible begins. Catastrophic plans have the lowest monthly premiums and much higher deductibles, but the plans are only available for people under age 30 or of any age with a hardship or affordability exemption.

Plan selection in Kansas during the 2022 OEP was like plan selection nationally for catastrophic and bronze plans but was lower for silver plans (49.0 percent in Kansas compared to 56.4 percent nationally; Figure 3) and higher for gold plans (15.0 percent in Kansas compared to 9.7 percent nationally). The number of Kansans selecting a gold plan declined for the second year. Gold plan selections decreased by nearly one-fourth (5,324 consumers) in Kansas between the 2020 and 2021 OEP and again decreased slightly (275 consumers) between the 2021 and 2022 OEP. The total decrease in gold plan selections between the 2020 and 2022 OEP corresponds with a 52.0 percent increase in bronze plan selections (13,153 consumers) and a 38.2 percent increase in silver plan selections (14,594 consumers). This change suggests that both current and new Kansas marketplace consumers are finding more value in plans that have lower monthly premiums but that potentially will require higher out-of-pocket spending if they seek care.

Kansas enrollees with income between 100 and 250 percent of FPL ($26,500 to $66,250 for a family of four in 2021) also may be eligible for CSR subsidies, which reduce out-of-pocket costs such as deductibles, co-payments and co-insurance. More than 4 in 10 (46.3 percent or 49,878) Kansas enrollees received CSR subsidies during the 2022 plan year.

Lawfully present immigrants with annual household income below 100 percent FPL may also be qualified for APTC and CSR subsidies if they are not otherwise eligible for Medicaid and meet other eligibility requirements. U.S. citizens with family income under 100 percent FPL and undocumented immigrants are generally not eligible for financial assistance on the marketplace.

Premiums

The average monthly premium paid by Kansas enrollees receiving APTC decreased from $116 per member per month in 2021 to $104 in 2022. The average monthly premium paid by enrollees receiving APTC was higher in 2022 than in 2019 ($76) and 2020 ($101), despite increased subsidies in 2022 from ARPA and more enrollees selecting lower-cost silver and bronze plans (Figure 5). The average monthly premium paid by Kansas enrollees without APTC was $562, which was lower than the amount paid in 2019, 2020 and 2021 ($596, $579 and $567 respectively). The APTC greatly reduces the cost of marketplace plans to consumers. The average premium for Kansas enrollees without APTC was 5.4 times higher than for those receiving APTC ($562 compared to $104). Overall, Kansas enrollees paid $149 in monthly premiums on average (including any APTC amount) — 34.2 percent more than the $111 paid per month on average by enrollees across all 36 states (including Kansas) operating on the federally facilitated marketplace.

Figure 6  provides information on average monthly premiums paid by enrollees in each of the seven rating areas across Kansas and the growth in enrollment between 2021 and 2022. Enrollees living in Northeast Kansas (excluding Johnson, Wyandotte, Leavenworth and Miami counties) paid the highest monthly premium on average, $171, which was 72.7 percent higher than enrollees living in Southwest Kansas, who paid the lowest monthly premium on average, $99. Enrollment increased the most between 2021 and 2022 in South Central Kansas (including Wichita), 26.0 percent, and increased the least in Northwest Kansas, 7.7 percent.

Stand-Alone Dental Insurance

For the 2022 plan year, there were 16 stand-alone dental plans offered by five insurers on the Kansas marketplace, and 13,210 Kansans selected a standalone dental plan — a 6.9 percent increase compared to 2021.

Looking Ahead

The increase in enrollment in 2022 was widespread. Under ARPA, the tax subsidies that incentivized consumers to select a marketplace plan were scheduled to sunset at the end of 2022, and in March 2022 the Assistant Secretary for Planning and Evaluation estimated that of the 107,784 Kansans who enrolled during the 2022 OEP, 22,000 — or 20.4 percent — would disenroll and become uninsured. However, on August 16, 2022, President Biden signed the Inflation Reduction Act (IRA) of 2022, which extends the expanded subsidies provided under ARPA to January 1, 2026.

The Open Enrollment Period for the 2023 Plan Year began on November 1, 2022, and runs through January 15, 2023. It is possible that the number of Kansans who enroll for the 2023 plan year will remain steady or rise as those Kansans who took advantage of the ARPA-expanded subsidies in 2022 continue their enrollment, along with new enrollees who may have missed the opportunity in 2022 but may apply for the subsidies now provided in the IRA.

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