The Affordable Care Act (ACA) established marketplaces for consumers to purchase and enroll in Qualified Health Plans (QHPs) , referred to here as “plans”. Plans are sorted into categories to help consumers differentiate plans by their cost and benefits. Certain low-income consumers may also be able to receive financial assistance provided under the ACA to help subsidize the cost of a plan.
Since 2013, consumers have been able to purchase and enroll in plans offered through the marketplaces during each year’s open enrollment period. In the most recent open enrollment period (November 1st 2015 to January 31st 2016), about 12.7 million first-time and renewing consumers purchased and enrolled in a plan. This Spotlight highlights a subset of consumers’ choices during this enrollment period by illustrating available data on consumers’ selected plan category, age, and financial assistance.
|State||Marketplace Type*||Enrollment Website**||Implemented Expanded Medicaid as of February 2016***|
|District of Columbia||State-based Marketplace||dchealthlink.com||Yes|
|Hawaii||Federally-supported State-based Marketplace||healthcare.gov||Yes|
|Montana||Federally-facilitated Marketplace||healthcare.gov||Yes (Effective 1/1/2016)|
|Nevada||Federally-supported State-based Marketplace||healthcare.gov||Yes|
|New Hampshire||State-Partnership Marketplace||healthcare.gov||Yes|
|New Jersey||Federally-facilitated Marketplace||healthcare.gov||Yes|
|New Mexico||Federally-supported State-based Marketplace||healthcare.gov||Yes|
|New York||State-based Marketplace||healthcare.gov||Yes|
|North Carolina||Federally-facilitated Marketplace||healthcare.gov||No|
|North Dakota||Federally-facilitated Marketplace||healthcare.gov||Yes|
|Oregon||Federally-supported State-based Marketplace||healthcare.gov||Yes|
|Rhode Island||State-based Marketplace||healthsourceri.com||Yes|
|South Carolina||Federally-facilitated Marketplace||healthcare.gov||No|
|South Dakota||Federally-facilitated Marketplace||healthcare.gov||No|
|West Virginia||State-Partnership Marketplace||healthcare.gov||Yes|
* See Kaiser Family Foundation here.
** See healthcare.gov here.
*** See Kaiser Family Foundation here.
The Affordable Care Act (ACA) established marketplaces for consumers to purchase and enroll in Qualified Health Plans (QHPs). States can choose to create a state-based marketplace or to opt into the federally-facilitated marketplace accessible through Healthcare.gov. States also have the option under the ACA to expand Medicaid eligibility for certain low-income adults.
Consumers can enroll in marketplace plans during the annual open enrollment period. During the most recent open enrollment period (November 1st 2015 to January 31st 2016), 12.7 million first-time and renewing consumers purchased and enrolled in a plan offered through a marketplace. This Spotlight highlights a subset of consumers’ choices during this enrollment period by illustrating available data on consumers’ selected plan category, age, and financial assistance. Due to differences in data reporting, certain data may not be available in every state. More details about the subset of consumers’ choices illustrated in this Spotlight are below:
Plans offered through marketplaces are categorized into four “metal tiers” – platinum, gold, silver, and bronze. These plan categories are meant to help consumers differentiate between plans by their cost and benefits. All of these plan categories are eligible for some form of financial assistance, but only silver plans are eligible for all available forms of financial assistance.
Catastrophic plans are an additional plan category meant for certain low-income consumers. They are available to consumers under 30 years old, but those over age 30 must first apply and be granted a hardship exemption. Catastrophic plans are not eligible for any forms of financial assistance. Additionally, platinum and catastrophic plans are not offered in all areas.
Generally, most consumers enrolling in plans offered through a marketplace are between the ages of 19 to 64. Uninsured children under 19 may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), and most adults over 65 years old qualify for Medicare. A state’s decision to expand Medicaid eligibility to certain low-income adults can also have an impact. In states that have done so, certain low-income consumers under age 65 are eligible to enroll in Medicaid rather than purchase and enroll in a marketplace plan.
Under the ACA, consumers purchasing and enrolling in a plan offered through a marketplace may qualify based on their income for two types of financial assistance: the Advanced Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSRs). In general, a consumer is eligible for financial assistance if he or she has a household income below 400% FPL and is not eligible for other health coverage options through either an employer or a public health coverage program like CHIP, Medicaid, Medicare, or a Basic Health Program.
Consumers may qualify for the APTC if their annual household income is between 100-400% of the federal poverty level (FPL). The amount of the tax credit is based on the consumer’s income and the cost of the second lowest cost silver plan available to the consumer through his or her marketplace.
Consumers who have selected a silver plan and have an annual household income between 100-250% of the FPL may also qualify for a CSR. CSRs lower eligible consumers’ out-of-pocket costs for healthcare. See ACA Spotlight 5, Medical Deductibles and Out-of-Pocket Limits, to learn more about CSRs.
The infographics in this ACA Spotlight illustrate a subset of consumers’ choices in marketplace plans during the open enrollment period that took place between November 1st 2015 and January 31st 2016. The data used in these infographics are based on the most current data available from the U.S. Office of the Assistant Secretary for Planning and Evaluation’s (ASPE) Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report.
This Spotlight highlights a subset of consumers’ choices in both state-based and federally facilitated marketplaces during this enrollment period by illustrating available data on consumers’ selected plan category, age, and financial assistance. Two of these factors can be compared using the selection criteria in the drop down menus at the top of the Spotlight. The data point selected in the second drop-down menu will be a sub-set of the data point selected in the first drop-down menu. After selecting a data point in each drop down menu, a user clicks the “See Result” button to initiate the calculation and comparison. The resulting infographic illustrates in every state the number enrolled in the second data point (numerator) as a percentage of the first data point (denominator). When a user clicks on a state, a pie chart reflecting a further breakdown of the first data point selected will appear in a separate window.
There are some limitations to the infographics:
- In 2015, Minnesota and New York began Basic Health Programs (BHPs). Since BHP enrollment data is reported separately, BHP enrollment data is not included with QHP enrollment data for Minnesota and New York.
- This infographic does not include enrollment data for the District of Columbia’s marketplace.
- States that do not offer platinum or catastrophic plans will show zero enrollees in those plan categories.
- The ASPE report does not have certain data from state-based marketplaces. The drop-down menus indicate which criteria is available only for states that use Healthcare.gov platform. Infographics with this limitation show states that do not use Healthcare.gov as gray.
- The ASPE report does not have certain data for some states due to differences in data reporting. The infographics show states lacking certain data as gray.
- The ASPE report does not distinguish between the APTC and CSRs when describing financial assistance for silver plans (which can be eligible for both). Therefore, infographics on financial assistance for silver plans may mean that the consumer received only an APTC or a combination of an APTC and CSR.
- Due to rounding of percentages in the ASPE report, some breakdowns of numbers and percentages may not add up to totals.
Due to differences in the collection and reporting of enrollment data both by states and by ASPE, the total number of enrollees in
one data point may not match the total number of enrollees in a similar data point.
- For example, the original data may have reported that 100 enrollees selected a silver plan in a certain state, but additional data on financial assistance was available for only 99 of those 100 silver plan enrollees. Therefore the percent breakdown of those in a silver plan is based on a total of 100 enrollees, while the percent breakdown of those with or without financial assistance who chose a silver plan is based on a total of 99 enrollees.
Data used in this Spotlight is available for download by clicking the download button directly beneath an infographic. Social Interest Solutions (SIS) produced the infographics using the available enrollment data in the ASPE report and the MAGI Cloud platform. To learn more about the MAGI Cloud platform, click here.
You may email questions or additional requests for information to firstname.lastname@example.org.
- Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
- Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services
- The Henry J. Kaiser Family Foundation
- U.S. Department of Health and Human Services