This week, the Centers for Medicare and Medicaid Services (CMS) released 2018 enrollment data for the Affordable Care Act (ACA) marketplaces, easing fears that enrollment would drop significantly because of federal legislative and administrative efforts to undermine the ACA.
Enrollment was down just four percent nationwide, and 2018 enrollment in California remained stable.
2018 Open Enrollment – The Numbers
- 3.7 million individuals submitted applications to Covered California, 2.1 million eligible to enroll in an exchange plan.
- Of those eligible, 1.5 million consumers (71 percent) ultimately selected a plan in Covered California, including 1.1 million renewals (re-enrollees). Almost 400,000 California consumers, or 25 percent, and 27 percent nationally, are new to the exchanges. The 2018 open enrollment period closely matched the results from 2017 when 1.5 million enrolled in Covered California, including 368,000 new enrollments and 1.2 million re-enrollees.
- In 2018, the average premium for consumers selecting a Covered California plan is $540, 13 percent lower than the national average premium of $621 in states without a state-based exchange.
- Nationally, most exchange enrollees are eligible for federal premium assistance, including 1.3 million (86 percent) in Covered California. Premium assistance reduces the average monthly premium to $114. Nationally, 85 percent of consumers in states without state-based exchanges receive premium assistance, reducing the average premium to $89 per month.
- Over 900,000 Covered California enrollees also qualify for lower deductibles, copayments and total out-of-pocket costs if they choose a silver plan (plan descriptions below). Cost-sharing reductions are available to those under 250 percent of the Federal Poverty Level ($30,350 per individual).
- For 2018, Covered California consumers that selected a plan chose the following plan options:
- Silver plan — 853,787 (a silver plan covers 70 percent of the costs of covered benefits),
- Bronze — 444,974 (covers 60 percent of costs),
- Gold — 152,215 (covers 80 percent of costs),
- Platinum — 53,662 (covers 90 percent of costs), and
- Catastrophic — 16,886 (a high-deductible health plan only available for people under 30 or those specifically exempt from the individual mandate under the ACA, such as those qualifying for a hardship exemption).
In 2017, California took several steps to insulate the 2018 open enrollment period from adverse federal actions, including extending the open enrollment period and allocating additional state funds for marketing and outreach.
It is not clear whether California will be able to maintain enrollment in future years since Congress eliminated the federal tax penalty for not having adequate coverage starting in 2019. Estimates indicate enrollment could drop with the elimination of the tax penalty. (See ITUP blog post on the Vulnerability of the Individual Market in California.) In 2018, California lawmakers are considering additional actions to stabilize the individual market. (See ITUP blog post on Stabilizing the Individual Market in California.) Time will tell.