The ACA's open enrollment tally is in—and it's below HHS' projections

CMS on Wednesday announced about 12 million U.S. residents signed up for health plans through the federal and state-run exchanges during the Affordable Care Act's (ACA) latest open enrollment period—far below HHS' projected enrollment number.

The ACA's latest open enrollment period started Nov. 1, 2016, and ended Jan. 31. The numbers are in line with an Associated Press analysis released last month, as well as  preliminary findings from CMS that showed the number of people signing up for federal health plans declined for the first time since the exchanges opened.

Enrollment number details

CMS' latest enrollment snapshot accounts for individuals who selected a plan in all 50 states and the District of Columbia. The data do not include figures on how many individuals paid their first month's premiums, which effectively ends the enrollment process.

CMS said a total of 12.2 million U.S. residents signed up for coverage, down from the 12.7 million who selected plans during the ACA's previous open enrollment period and far below the 13.8 million individuals HHS projected would select plans during the latest open enrollment period.

According to CMS:

  • 9.2 million individuals signed up for plans in the 39 states that use the federal exchange, down 400,000 from the previous open enrollment period; and
  • 3 million people signed up for plans in the remaining states, down 100,000 from the previous open enrollment period.

According to the Washington Post's "To Your Health," the pace of sign-ups slowed significantly toward the end of the open enrollment period, after the Trump administration temporarily suspended federal enrollment outreach.

Of the 12.2 million signups, the data show:

  • 66 percent were returning customers, of whom 23 percent were automatically re-enrolled in coverage;
  • 31 percent were new enrollees; and
  • 3 percent were unknown.

The percentage of signups by individuals 34 years of age or younger—who experts say are needed to balance the exchange risk pool and offset the cost of older, sicker enrollees—was unchanged from the last open enrollment period at 36 percent. Thirty-seven percent of customers were between ages 35 and 54, and 28 percent were 55 and older, according to the data.

About 10 million people who signed up for coverage—about 84 percent—were eligible for federal subsidies to help pay for coverage. Subsidies averaged $383 per month and covered 73 percent of the price of their insurance premiums, according to CMS. CMS said the average silver plan after subsidies was $101.

CMS said the most popular plan by metal tier was silver, which accounted for 71 percent of plan selections, followed by:

  • Bronze, at 23 percent;
  • Gold, at 4 percent; and
  • Catastrophic and platinum, at 1 percent each (Small, FierceHealthcare, 3/15; Goldstein, "To Your Health," Washington Post, 3/15; CMS release, 3/15).

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