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You are here: Home / Anderson On Health Insurance / The Gold Rush

The Gold Rush

by David Anderson|  November 17, 20176:40 am| 10 Comments

This post is in: Anderson On Health Insurance

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Covered California released their enrollment data for the first two weeks of their extended open enrollment period. The Gold Rush is on:

From Nov. 1 through Nov. 14, more than 48,000 new consumers signed up for coverage through Covered California, which is slightly ahead of last year’s pace when more than 39,000 consumers selected a plan during the first two weeks of November 2016….

In addition to the enrollment data, Covered California announced that its data shows that consumers are using their increased tax credit money to purchase more-comprehensive coverage with richer benefits. The percentage of new subsidy-eligible consumers selecting a Gold-tier plan has increased from 4 percent during the first two weeks of 2016 to 12 percent during the same time this year. Silver continues to be the most-selected tier, which is good news because that is the level at which consumers receive the best value due to cost-sharing reduction benefits.

The shift out of Silver looks to be two thirds towards Gold. Maybe a quarter of the people who bought Silver last year are buying far less expensive after subsidy Bronze plans and a few more folks are buying Platinum plans. The work that Andrew Sprung, Louise Norris, Charles Gaba and I had done this Fall led us to believe that a lot more people would be choosing Gold plans because of CSR costs were being Silver Loaded. One of our worries was that people who were eligible for CSR Silver plans would choose the low to no premium Bronze plans instead.

That bargain remains in place. But silver plans can be quite expensive for low income enrollees. The premium for a benchmark silver plan ranges from 2% of income for those in the 100-138% FPL income bracket to 6.3% for enrollees at 200% FPL. The benchmark premium at 200% FPL comes to $127 per month in 2018.

Will the outsized bronze plan discounts available in many places this year tempt a lot CSR-eligible buyers into bronze plans?**

Right now the California data suggests that this is not the predominant case for new enrollees. The Bronze uptake percentage may have increased by no more than 4% while Gold’s uptake percentage was 8%. This is early data but promising data that shows this worry is not the dominant pathway.

Finally, California is running their own exchange. Covered California is running their own massive marketing campaign and they are running their own open enrollment period. They are outpacing their 2017 enrollment on an apples to apples basis. We can not extrapolate California’s experience nationally as there are too many differences but again, this is promising.

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Reader Interactions

10Comments

  1. 1.

    NobodySpecial

    November 17, 2017 at 6:49 am

    I found a Silver plan for 18 cents here in non-Chicago northern Illinois. That would have been fine, but the Gold was 12 bucks a month. The expected savings was worth the $120 extra a year.

  2. 2.

    p.a.

    November 17, 2017 at 6:57 am

    As TNC used to say to his online community, “talk to me like I’m stupid”, i.e. if the end of CSR cash is ‘fixed’ by insurance companies by Silver loading, and there is statistically significant movement out of Silver, where does the cash necessary for the insurers successful operation come from? A cut in the hookers and blow budget? I realize you’ve covered this ad nauseam, but “talk to me like I’m stupid.”

  3. 3.

    Xentik

    November 17, 2017 at 7:24 am

    People who could not normally afford a silver plan even with standard subsidies are given further assistance (Cost Sharing Reductions). Normally that gap between what the plan costs and what the insurance company is on the hook for is covered by the government’s CSR payments. In the absence of those payments the insurers are legally still required to provide the reduction in cost. To counteract that, the base price of the silver plans now has the cost of CSRs folded into it. Instead of the CSR’s being paid directly through CSR payments from the government, it is now paid for by the general subsidies, which are determined by the price of the second cheapest silver plan. Someone who gets CSRs *still* gets CSRs, but now they are paid for by all the other people who have silver plans. This caused a situation where silver plans are now more expensive than gold in many cases, meaning that people with subsidies can now buy better plans with those (significantly more generous) subsidies.

    To Recap:
    1. Gov’t refuses to pay CSRs.
    2. Ins. Companies bake CSR cost into silver pricing.
    3. Subsidies (non-CSR) are set based on new silver pricing
    4. Gov’t now is paying more in subsidies total than what they would’ve paid for subsidies + CSRs before choosing to drop CSR payments.
    5. More people have better insurance, i.e. Democrats win.

  4. 4.

    dr. bloor

    November 17, 2017 at 7:37 am

    @

  5. 5.

    p.a.

    November 17, 2017 at 8:03 am

    @Xentik: tks.

  6. 6.

    satby

    November 17, 2017 at 8:04 am

    @Xentik: thank you!

  7. 7.

    guachi

    November 17, 2017 at 8:43 am

    I would think a smart state would want to do what California has done. More subsidy eligible people getting insurance means more tax dollar flowing into the state.

    More people on insurance means cheaper overall rates.

  8. 8.

    kindness

    November 17, 2017 at 8:45 am

    We have fires, we have floods, we have earthquakes and we have nut job Republicans (in the minority thank the FSM) but God I love California.

  9. 9.

    JustRuss

    November 17, 2017 at 10:44 am

    Weird that they call a bump of 20% “slightly ahead of last year’s pace.” Why the hedging?

  10. 10.

    Kelly

    November 17, 2017 at 11:38 am

    I think we’re gonna go with a Bronze HSA. The family deductible is $13,100 but monthly payment is so low we’d save $7,000 in a worst case both of us hit by a truck scenario. We’ll probably save $4,000 if the year is typical. The HSA contribution will reduce our MAGA by $8900 which bumps our subsidy up a little or gives us a bunch of room from the subsidy cliff.

    Oh all this is over the cost of our cheapest Gold and all of our Silver options.

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