Enrollment down in individual insurance, focused in off-exchange plans
The departure of many would-be customers is increasingly narrowing the client base for the individual market.
In the first quarter of 2018, enrollment in the individual insurance market continued its downward trend, with the drop concentrated in off-exchange plans where enrollees are not eligible for subsidies to help pay for coverage under the Affordable Care Act and are on the hook for the whole amount of premiums, including recent price hikes.
So reports the Kaiser Family Foundation, which says that the first-quarter decline compared with Q1 of 2017 totaled 12 percent. Still, it adds that enrollment in ACA exchange-sold plans increased by 3 percent in 2018 after receding from its peak of 11.1 million people in 2016.
Related: How ACA ‘dine and dashers’ affect the market
In Q1 2018, 10.6 million people had coverage through the ACA exchanges; that includes 9.2 million who receive federal premium subsidies.
Total enrollment in 2017 was down; that’s been followed by this latest loss of approximately two million people overall from the individual market in Q1 2018. Off-exchange enrollment took the hardest hit in both years, but in Q1 2018 it fell a shocking 38 percent compared with the same period in 2017.
The departure of many would-be customers is increasingly narrowing the client base to those who are eligible for premium subsidies and those who suffer from preexisting conditions.
According to the analysis, that trend is likely to continue in 2019, since in Q1 2018 almost two thirds of enrollees in the overall individual market were subsidized—and 2019 will further pressure premiums upward with the repeal of the individual mandate penalty and the likely spread of short-term health plans. Both factors will probably further discourage healthy people from buying coverage because of high premiums, which are expected to go even higher.
That said, the report finds 14.4 million people still enrolled as of Q1 2018, compared with just 10.6 million people in 2013; that’s the year before ACA provisions on subsidies and regulations to protect those with preexisting conditions kicked in. The biggest decline in individual market enrollment from 2015 to 2017 has been in non-ACA-compliant coverage, the report says.