CMS Reports 11.8 Million People Signed Up for Health Insurance Using Exchanges in 2018


May 30, 2018

CMS Reports 11.8 Million People Signed Up for Health Insurance Using Exchanges in 2018

Final numbers for the 2018 open enrollment period indicate that about 11.8 million people used federal or state marketplaces to sign up for health insurance. The Centers for Medicare and Medicaid Services (CMS) released a final report in April tallying the total number of signups. Enrollment lasted just six weeks during the most recent open enrollment period, about half the time allotted in previous years.

In an effort to cut costs and – some argue – undermine the Affordable Care Act, the Trump administration cut the enrollment period and reduced advertising funding by 90 percent during the 2018 signup season. Despite these measures, nearly 12 million people still chose plans using or state-based exchanges.

Last year, enrollment lasted three months and resulted in 12.2 million people getting coverage through the marketplaces. Enrollment topped 12.7 million in 2016. The trend downward reflects an increasingly doubtful mentality about the ACA exchanges and Obamacare itself in light of efforts by the current administration and Republican lawmakers to weaken and eventually replace the law.

The CMS report also highlights how little things have changed in terms of the demographic makeup of exchange customers. Despite an overall decrease in marketplace enrollment of approximately 3 percent between 2017 and 2018, customer information remains about the same. In 2017 and 2018, more women (54%) than men (46%) signed up for health insurance using an exchange. Notably:

  • In 2018, 27 percent of exchange customers were new to the marketplace; that’s a decrease of 6 percent since 2017, when 33 percent of marketplace customers were new.
  • Adults aged 35 to 54 accounted for the highest percentage of enrollment in 2017 (37%) and in 2018 (36%).
  • Silver plans remain the most popular choice on Obamacare exchanges, representing 63 percent of plans in 2018 and 71 percent of plans in 2017.

The number of exchange customers who get subsidies to offset premium costs (advance premium tax credits) remained unchanged from 2017 to this year. During both signup seasons, 83 percent of marketplace customers qualified for tax credits. A slightly lower number of consumers qualified for cost-sharing reduction payments (CSRs). These payments reduce out-of-pocket costs, such as deductibles and copayments, for enrollees who earn between 100 and 250 percent of the federal poverty level. In 2018, 54 percent of exchange customers qualified for CSRs, a decrease of 4 percent over last year.

Tax credits and CSRs help to make health insurance more affordable for millions of Americans each year. Cost-sharing reduction payments made to insurers to offset the cost of cutting out-of-pocket expenses to lower-income families have been a thorn in the side of conservative lawmakers and the Trump administration. Last fall, President Trump announced that his administration would not renew these payments to insurers. By law, consumers will still receive the benefits of these payments even if insurers don’t get compensated by the federal government.

The result was a significant increase in silver-level premiums for 2018. Silver plans are used as benchmarks for determining subsidies. In 2018, tax credits helped bring down the average premium price of $639 a month for individuals who qualified for subsidies to just $89 a month, a savings of $550 or over $6,000 for the year.

Heading into the latter half of 2018, it’s unclear how insurers on the Obamacare exchanges will adjust for further changes proposed by the Trump administration, such as greater flexibility and longer time periods for short-term, limited-duration health plans. Elimination of the individual mandate starting in 2019 may also encourage younger, healthier enrollees to stay off the exchanges and out of the nongroup health insurance market altogether during the next enrollment period. Participation is already on the decline among young adults. In 2018, the 18 to 34 demographic represented just 26 percent of the final tally, down a percentage point from 2017.