Just a couple of reminders on what to expect from the data during the 2015 Exchange open enrollment period as I have the kids home for a snow delay so I don’t think that I can think this morning.
1) Deadlines matter.
We saw this in 2014, we saw this in Massachusetts in 2007, we see this every year with Medicare open enrollment but deadlines matter. Most people will procrastinate until the end and they are forced to make a decision or send a check in. Last year we saw roughly half of the enrollment activity happen in the last six weeks.
2) Different deadlines are in play
There are three sets of deadlines; two major and one minor. The first major deadline is December 15th plan selection. This deadline will allow people to start their new policy on January 1, 2015. That will provide either continuous coverage from previous policies or start their new coverage as soon as possible. The other major deadline is February 15th. This will start coverage for March 1, 2015, and it is the last day that regular coverage can be bought for the year unless there is a special qualifying event. The minor deadline is January 15th as that will allow people to start coverage on February 1st.
3) Two different populations are in play.
2015 is very different than 2014 in that last year everything was brand new to everyone. This year, there are 7 million people who are looking to renew their coverage. I think we should see the vast majority of these people renew by December 15 as they want to keep their coverage. Losing coverage for a month would be a break from their new routine. The other population is far more similar to 2014’s general Exchange population in that they are switching from no coverage to coverage. Procrastination is more likely here, so I anticipate more people signing up after the New Year than before the New Year.
4) Self identified sick get covered earlier
People procrastinate unless they have a damn good reason not to. That is, to me, a reasonable assumption about life. The early renewers and the early new enrollees are statistically different than the entire population of renewers and new enrollees in that they are far more likely to be sick with chronic conditions. Insurance lets them knock a problem off their to do list. Relatively healthy people will delay. The take-away is that we can not make good population health guesses based on November enrollment activity.
5) Four steps of web activity
a) See the exchange
b) Log into the Exchange and look around
c) Put a health plan in the shopping cart and check-out.
d) Pay the premium
Right now we can track C as payment for January 1st coverage is not due until the week of Christmas. March 1st coverage won’t see payment due until February 21st. There is a big lag between choosing a plan and the last day possible to pay for that plan. There will be some drop-off. Charles Gaba used a 12% drop rate for his purposes.