December 15, 2014 | Rosemarie Day

Open Enrollment #2 – One Month Update

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One month in, the second open enrollment for health insurance under the Affordable Care Act is working much better than it was one year ago.  Exchanges are functioning, people are shopping, and many are enrolling.  Can we relax?  Let’s take a deeper dive…


  • Federal Marketplace:  The website launched smoothly on November 15th and has handled the website traffic load so far.  One big improvement this fall is that shoppers can browse the website without having to create an account – this is a far more welcoming approach for consumers.
  • State Marketplaces:  There are now 17 state-based marketplaces (3 of which are supported by the federal IT platform).  Overall, their websites are going well – those states whose sites worked last year have had time to add features, including many customer-friendly enhancements.  Those that didn’t work have fixed their problems.  There were 5 troubled exchanges and they took different approaches to the fix:  Maryland and Massachusetts replaced their vendors, Oregon and Nevada migrated to the federal platform, and Hawaii fixed its current system.  All have re-launched successfully.

In spite of these gains, purchasing insurance on-line is still complicated with lots of insurance jargon. Consumers are experiencing some frustrations, particularly if they need to renew their coverage – this is explained more below.


  • Call Centers:  One of the big lessons learned for exchanges last year was that they needed to add staff to their call centers to handle all of their enrollment volume, particularly as they got closer to the deadlines.  Armed with this knowledge, the exchanges have been better able to predict how many staff they need to support open enrollment and they’ve reported few problems on this front.
  • Retail Sites:  Several states have opened retail (walk-in) centers where customers can get in-person help with enrolling.  Connecticut did this successfully last year and Colorado and Kentucky are among the states that are following suit.

A key challenge in either setting is to ensure that the customer service staff are well-informed and providing the information clearly and consistently.  This will be an ongoing issue and needs to be monitored.


  • Federal Marketplace:   CMS reports that more than 1.3 million people have selected plans as of December 5th.  Of these, about half were new enrollments and half were renewals.  Enrollments were picking up as today’s deadline for January 1st coverage approached.
  • State Marketplaces: The official state enrollment reports aren’t out yet.  But in taking a quick look at a few states, California (the largest state) is off to a strong start.  And two of the most troubled states, Maryland and Massachusetts, are also off to strong starts.  Both have reported tens of thousands of enrollments, compared to the handful they enrolled last year.  Another welcome enhancement is increased transparency:  Massachusetts has made a point of sharing its results every day.

Will the marketplaces reach CMS’s revised enrollment goal of 9 – 9.9 million?  If the states are doing as well as the federal marketplace for new enrollments, if the current rate of new enrollment continues, and if they are all able to capture a re-enrollment rate of 80% (which means picking up the pace), then they will.  As discussed in previous blogs, outreach and advertising will be critical to enrollment success.  We’re seeing positive results so far, and will continue to monitor this.


New in this open enrollment is the renewal process.  The marketplaces worked hard to develop this process, but often ended up prioritizing the development of processes for new enrollees.  This means that challenges remain with renewals.  To make things easier for existing customers, most of the marketplaces developed an automatic re-enrollment process.  But there are still some significant areas of confusion, including recalculation of subsidies (due to change in prices of silver plans upon which subsidies are based), and getting consumers to understand that. So even the states with an automatic re-enrollment (eg. CO, KY, and WA) are trying to encourage consumers to come back and shop, to ensure they are getting the best plan at the best price.1 And in states (eg. MA, MD and RI) that require enrollees to return to the marketplace and enroll, if the consumer forgets, they could lose their subsidy, their coverage, or both.1


Here are a few things to look for in this open enrollment and beyond:

  • Messaging the Mandate:  Not to be “Grinchy” during the holiday season, but we need to see more messaging about the tax penalties.  People need to know what will happen to them if they don’t sign up for health insurance coverage, or there will unpleasant surprises when they file their taxes.
  • Website Innovation:  Many of the state marketplace websites are becoming mature enough to experiment with consumer-friendly tools and messaging and measure their results.  The federal team can learn from that and make needed improvements for the next cycle.

1. Georgetown University, The Center on Health Insurance Reform. Marketplace Renewals: State Efforts to Maximize Enrollment into Affordable Health Plan Options, December 2014.