State-based marketplace sees rise in enrollment of “young invincibles”

• In Rhode Island, individual and family paid enrollments increased by five percent in 2018, among the largest increases in the country.

• The marketplace saw over 8,000 new enrollees, over 40 percent more than the previous year. About 35 percent of new 2018 customers were “young invincibles” age 18-34, up from approximately 25 percent compared to HealthSource RI’s 2017 population.

• HealthSource RI’s competitive marketplace offers the lowest cost benchmark plan nationwide in 2018.

• The amount of financial assistance brought into Rhode Island to make health coverage more affordable increased by 46 percent, to $7.4 million, in January 2018, compared to January 2017.

• The average subsidized customer saw steady rates in 2018 due to the protective effect of their subsidies rising to offset premium increases.

• HealthSource RI’s targeted customer education and new Savings Tool helped shoppers make wise decisions in 2018, leveraging their increased financial assistance and opting for Gold plans in many cases.

EAST PROVIDENCE, R.I. (March 19, 2018) — HealthSource RI today announced a 5 percent increase in individual and family customers at the end of the 2018 Open Enrollment period. As of January 31, 2018, 30,637 individuals enrolled and paid for 2018 health coverage through HealthSource RI, compared to 29,224 in 2017 (see Figure 1).

HealthSource RI saw a 45 percent increase in new customers to the state-based marketplace this year, up from 5,543 individuals in 2017 to 8,038 in 2018. About 35 percent of new 2018 customers were “young invincibles” age 18-34, up from approximately 25 percent compared to HealthSource RI’s 2017 population.

“Young invincibles are good for the overall stability of the market as they are typically healthier and therefore utilize less medical services,” said HealthSource RI Director Zachary W. Sherman. “I am encouraged we saw a big jump in overall new customers this year and that so many younger Rhode Islanders decided to enroll in high-quality, affordable HealthSource RI coverage for the first time.”

Rhode Islanders younger than 45 years old makeup about half of 2018 customers, as shown in Figure 2. Enrollment by gender remains fairly consistent in 2018. As of January 31, the gender breakdown was 54 percent (16,513 individuals) female and 46 percent (14,124 individuals) male.

There was a notable shift in plan enrollment towards Neighborhood Health Plan of Rhode Island (NHPRI), with market share rising from about 50 percent in 2017 to 70 percent (21,525 individuals) this year. This trend was most pronounced in new customers, who chose NHPRI over 80 percent of the time. The other 30 percent (9,112 individuals) of 2018 HealthSource RI customers enrolled in health coverage from Blue Cross & Blue Shield of Rhode Island (BCBSRI). The shift was primarily driven by NHPRI’s lower prices.

In response to the federal administration’s decision to end Cost Sharing Reduction (CSR) payments to insurers, BCBSRI and NHPRI were asked to focus their premium rate increases on Silver-level plans sold on HealthSource RI’s individual market. Because the cost of these plans determines the dollar amount of federal tax credits relative to consumers’ income, the premium rate increases on these plans were absorbed by the tax credit for most customers. Due to HealthSource RI and the Office of the Health Insurance Commissioner’s protective state-based actions, considerably more federal financial assistance will be provided to Rhode Island marketplace customers. In January 2018, $7.5 million in financial assistance was provided to HealthSource RI customers to make their premiums more affordable,compared to $5.1 million in January 2017, a 46 percent increase.

“The Affordable Care Act is working in Rhode Island. Nearly every person in the state now has health insurance, and the premiums on HealthSource RI are among the lowest in the country,” said Governor Gina M. Raimondo. “Washington’s recent actions will undermine our great progress, putting us at risk of unnecessary price increases, instability and fewer plan choices. It is our responsibility to look for ways for the state to protect against federal threats to coverage and affordability.”

Despite increases in Silver plan premiums, HealthSource RI has the lowest benchmark plan nationwide in 2018. The benchmark plan is the second-lowest cost Silver plan available, and determines the amount of financial assistance customers receive. However, the phenomena of many Silver plans costing more than Gold led to a shift in 2018 enrollment by metal levels (Figure 3). HealthSource RI saw a significant reduction in unsubsidized Silver customers, as well as a drop in Silver customers who only receive tax credits. Ninety-two percent of unsubsidized 2017 Silver-level customers, who actively selected a 2018 plan, chose a different metal level this year. Most CSR eligible customers stayed in Silver plans since their tax credit absorbed most of the premium increase. Most significantly, 22 percent of HealthSource RI customers selected a Gold plan for 2018, up from 12 percent in 2017.

To mitigate customer confusion and ensure customers picked the best plan for them, HealthSource RI introduced a new Savings Tool to make it easier to understand health coverage options. This quick quote tool helped Rhode Islanders consider their total health needs, from premium price and financial assistance to maximum out-of-pocket cost and provider networks. During Open Enrollment, over 60,000 sessions from more than 40,000 unique users took place on the Savings Tool. HealthSource RI also rolled-out a series of educational videos aimed to simplify the decision making process.

“In a year of uncertainty, state-based marketplaces like HealthSource RI saw higher enrollment and retention than HealthCare.Gov states due to our ability to nimbly adapt and serve our local communities,” Sherman added.  “By enabling and educating our customers, many made the informed decision to leverage their increased purchasing power which led to higher enrollment in richer benefit plans at no additional cost.”

Eighty-two percent of HealthSource RI customers received financial assistance in 2018, which is essentially unchanged from 2017. Of those receiving financial help, 50 percent (15,349 individuals) received both tax credits and CSRs and 32 percent (9,810 individuals) received only tax credits, while the remaining 18 percent (5,478 individuals) did not receive financial help.

Though Open Enrollment for 2018 health coverage has ended, HealthSource RI may be able to offer a Special Enrollment Period to individuals and families who go through life changes that affect their ability to get healthcare coverage. Those who experience a qualifying life event, like moving to Rhode Island or losing employer sponsored coverage, should contact HealthSource RI at 1-855-840-4774 or in-person at 401 Wampanoag Trail in East Providence. A full list of qualifying events and hours of operation can be found at www.HealthSourceRI.com/sep.

Small employers who purchase coverage through HealthSource RI for Employers may enroll in health insurance coverage throughout the year at their regular renewal date.