Fewer people signed up for private insurance on Maryland’s health exchange for 2018 than last year, but officials said they were pleased with the results after a challenging year.
More than 153,500 people enrolled in private coverage for 2018, down nearly 2.5 percent from last year, when more than 157,500 people enrolled. But the Maryland Health Benefit Exchange, which administers Maryland’s health insurance marketplace, had estimated that only 148,000 people would sign up this year.
“Overall, we’re pretty delighted,” said Michelle Eberly, the exchange’s executive director. “(The numbers show) there really is a desire from Marylanders to have health insurance and to access health care.”
The exchanged faced a number of challenges for the 2018 enrollment period. The period was shortened from 90 days to 45 days — though the exchange extended it by another seven days during the enrollment period. Exchange premiums also increased significantly, and President Donald Trump’s administration cut cost-sharing reduction subsidies to insurance companies.
The tumultuous year had some predicting sharp declines in enrollment as uncertainty around the exchange increased. Maryland Insurance Commissioner Al Redmer said he was relieved by the numbers.
“I was pleased and relieved that we enrolled as many as we did,” he said. “You plan for the worst, hope for the best.”
While the numbers for the exchange were down, activity was high. The exchange noted that it recorded more daily activity, including enrollments, than it did last year. The final day of open enrollment, the marketplace received 15,000, up 25 percent from its top day last year.
The exchange managed to turn some of its challenges into wins. It carried the same marketing budget from 2017’s open enrollment period into the 2018 period, allowing for greater coverage during a shorter period of time.
The exchange targeted outreach to rural and minority consumers this year and saw results. African-American enrollment increased 12 percent. Hispanic enrollment increased 10 percent. Enrollment rose 11 percent in the state’s panhandle and 9 percent on the lower Eastern Shore.
The marketplace also used the loss of cost-sharing reduction subsidies to increase the Advanced Premium Tax Credits available to consumers. Redmer approved increased rates only on exchange Silver plans, the benchmark plan for the tax credits.
As a result, 20 percent of enrollees chose Gold plans, with lower deductibles. That represented around a 400 percent increase.
“That means there were people who got a better deal by signing up for Gold (which reduces their deductible substantially and also provides lower copayments/coinsurance) than they would have for Silver,” Dylan Roby, a professor in the University of Maryland’s School of Public Health, wrote in an email. “That is better for people’s access to health care, though it costs more federal money due to the increase in tax credits used by consumers.”
Those not eligible for tax credits were encouraged to choose off-exchange plans, because they would not have seen the additional premium increases that made up for the loss of subsidies. Those people would not have been included in the exchange’s enrollment numbers.
Based on who signed up for health care, the exchange pool could be about as stable as it was last year. Consumers age 18-34 represented about 30 percent of total enrollments, about the same percentage as last year.
Younger and healthier enrollees are important for the insurance pool because they represent premium payers who may not have as many medical bills. That medical loss ratio has been greater than 100 percent over the past couple of cycles, a driver of the premium increases.
“(This) is good news from a stability standpoint,” Roby wrote. “We would want to see more young people signing up to ensure younger, healthier people make up a larger part of the market to ensure premiums don’t rise substantially next year, but the premium increases we see for 2019 will be based more on insurer’s estimates of who will be in the risk pool once the individual mandate is no longer enforced and there is no monetary penalty for going without coverage.”
The numbers released Thursday by the exchange may not be the final numbers. The exchange typically auto-renews consumers for next year’s coverage, and numbers drop if those people do not continue to pay their premiums in 2018.
But Eberly does not anticipate a drop as significant as the exchange has seen in previous years. Activity from enrollees was higher this year, indicating that they took a more active role in changing their plan, she said.
“We’re pretty assured that most people that are coming through are there because they want insurance,” Eberly said. “Significant increase year over year of people that came back to make a change to their plan — that was in indicator to us that people are paying attention to their plan.”