HHS: ACA exchange enrollment reaches 12.2M thanks to enhanced subsidies

The COVID-19 special enrollment period increased enrollment in the Affordable Care Act’s federal and state-run insurance exchanges to 12.2 million people, as signups were buoyed by boosted tax credits, new federal data shows.

The Department of Health and Human Services released a report on Wednesday reporting that more than 2.8 million people signed up for coverage during the 2021 special enrollment period that ended last month. The report added that enrollment in Medicaid and the Children’s Health Insurance Program also reached more than 82.3 million people as of April.

“Thanks to the special enrollment period, we were able to help a record-breaking number of people across the country get covered, including those in rural and underserved communities,” said HHS Secretary Xavier Becerra in a statement.

HHS reported that 2.1 million people signed up for ACA coverage on HealthCare.gov, a website used by residents in 35 states to purchase coverage, during the special enrollment period that ran Feb. 15 to Aug. 15.

The 15 state-run exchanges signed up 738,000 people. There are six states and the District of Columbia that are continuing their special enrollment periods through the rest of 2021.

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Nearly half of the customers on HealthCare.gov that selected a new plan had a monthly premium of $10 or less, a sharp drop compared to the 25% during the same period in 2020, HHS’ report said.

The American Rescue Plan Act boosted income-based subsidies sold on the exchanges but only through the 2022 coverage year. Democrats are hoping to extend the subsidies as part of a $3.5 trillion infrastructure package being considered this month.

The boosted subsidies also helped changed the characteristics of who signed up for coverage.

For example, previously the income-based subsidies cut off at 400% above the federal poverty level (FPL), but the enhanced subsidies ensure that people who earn 400% above the level won’t have to pay more than 8.5% of their income on healthcare.

The percent of 2021 consumers that signed up during the special enrollment period who had an income above 400% of the FPL was 7%, up from 2% in 2020 and 1% in 2019.

This year 93% of consumers also had premiums reduced due to the boosted subsidies compared.

Consumers who got cost-sharing reduction payments, which are subsidies to help low-income customers with out-of-pocket costs, increased to 58% for 2021 compared to 54% in 2020 and 57% in 2019.

“It’s clear that when health coverage is accessible and affordable, people sign up,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure in a statement.

The 12.2 million people is still below the biggest high of enrollment in 2016 when 12.6 million people signed up, but it is above the 11.4 million who signed up for 2020 coverage, according to data from the Kaiser Family Foundation.

CMS also released a report that gave a snapshot of CHIP and Medicaid enrollment in April. The report showed that more than 82.3 million people enrolled in the programs, an increase of 580,591 individuals compared to the previous month.

“Since February 2020, the month before the COVID-19 public health emergency was declared, enrollment in Medicaid and CHIP increased by more than 11.6 million individuals or 16.4%,” HHS said in a release.