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Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment.

Publication ,  Journal Article
Garabedian, LF; LeCates, R; Galbraith, A; Ross-Degnan, D; Wharam, JF
Published in: Health Aff (Millwood)
August 2020

More than 20 percent of Affordable Care Act (ACA) exchange market (Marketplace) members insured by a large national insurer in 2015 and 2016 enrolled during a special enrollment period (SEP), defined as any enrollment outside the annual open enrollment period. These members were younger and had approximately 34 percent higher average monthly total costs than members who enrolled during open enrollment. SEP members had 69-114 percent higher inpatient costs and 11-19 percent higher emergency department costs than open enrollment members. Higher costs, especially among a slightly younger population, may suggest potential adverse selection among SEP members, which could contribute to increased premiums and insurer exit from ACA Marketplaces. Although SEP members had a shorter average enrollment length per calendar year, they were more likely than open enrollment members to stay insured through the end of the calendar year and to renew in a Marketplace plan offered by the insurer in the following year. However, renewing SEP and open enrollment members were older, sicker, and costlier than nonrenewing members of both enrollee types, which suggests that healthier members are switching carriers or leaving the market over time. Additional research is urgently needed to inform evidence-based policy regarding Marketplace risk adjustment and SEP eligibility rules and to improve outreach to people who are eligible for SEP enrollment.

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Published In

Health Aff (Millwood)

DOI

EISSN

2694-233X

Publication Date

August 2020

Volume

39

Issue

8

Start / End Page

1354 / 1361

Location

United States

Related Subject Headings

  • United States
  • Patient Protection and Affordable Care Act
  • Insurance, Health
  • Insurance Coverage
  • Insurance Carriers
  • Humans
  • Health Policy & Services
  • Health Insurance Exchanges
  • Eligibility Determination
  • 4407 Policy and administration
 

Citation

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Garabedian, L. F., LeCates, R., Galbraith, A., Ross-Degnan, D., & Wharam, J. F. (2020). Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment. Health Aff (Millwood), 39(8), 1354–1361. https://doi.org/10.1377/hlthaff.2019.01155
Garabedian, Laura F., Robert LeCates, Alison Galbraith, Dennis Ross-Degnan, and J Frank Wharam. “Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment.Health Aff (Millwood) 39, no. 8 (August 2020): 1354–61. https://doi.org/10.1377/hlthaff.2019.01155.
Garabedian LF, LeCates R, Galbraith A, Ross-Degnan D, Wharam JF. Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment. Health Aff (Millwood). 2020 Aug;39(8):1354–61.
Garabedian, Laura F., et al. “Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment.Health Aff (Millwood), vol. 39, no. 8, Aug. 2020, pp. 1354–61. Pubmed, doi:10.1377/hlthaff.2019.01155.
Garabedian LF, LeCates R, Galbraith A, Ross-Degnan D, Wharam JF. Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment. Health Aff (Millwood). 2020 Aug;39(8):1354–1361.

Published In

Health Aff (Millwood)

DOI

EISSN

2694-233X

Publication Date

August 2020

Volume

39

Issue

8

Start / End Page

1354 / 1361

Location

United States

Related Subject Headings

  • United States
  • Patient Protection and Affordable Care Act
  • Insurance, Health
  • Insurance Coverage
  • Insurance Carriers
  • Humans
  • Health Policy & Services
  • Health Insurance Exchanges
  • Eligibility Determination
  • 4407 Policy and administration