ACA Market Reflections on Retention and Yr-round Enrollment
– by Andrew Sprung
Writing in regards to the ACA market at this level has an elegiac really feel (as does writing about nearly any not-depraved or degraded side of American life). As of 2026, protection is more likely to be far much less reasonably priced, out of pocket prices will rise as extra enrollees fall again on bronze plans, and enrollment is more likely to drop precipitously. And that’s a near-best-case state of affairs, barring repeal or some sort of not absolutely possible regulatory assault (or judicial assault, e.g., on free preventive care).
That stated, I’ve been mulling this 12 months’s new peak in enrollment, pushed primarily by numerous renewals. That’s fueled not solely by the 31% year-over-year enrollment surge in OEP 2024 however by steady low season enrollment for candidates with revenue below 150% FPL (in place since early 2022) and by low season enrollment from these disenrolled from Medicaid throughout the unwinding, which was primarily completed by final summer season. (New enrollment dropped from 5.2 million in OEP 2024 to three.9 million in OEP 2025.)
All that stated, I needed to take a look at year-round enrollment patterns by means of the Trump and Biden eras. I not consult with the January-to-December enrollment fluctuations as a query of “retention,” as there was a lot low season enrollment since 2022; a slight drop and even improve from January to December doesn’t give a transparent image of how lengthy persons are remaining enrolled. Then again, one perhaps-obvious proven fact that jumps out from the desk beneath is that in all years, nearly everybody who’s enrolled as of December renews, actively or passively. And within the Biden years, thanks primarily to the ARPA subsidy boosts, fall-off from the top of OEP to “early effectuated enrollment in February is minimal – -that is, the auto-re-enrolled don’t drop protection in droves when the primary premium fee (typically $0, because of ARPA) is due (retention additionally improved by means of the Trump years, as cuts to outreach and advertising and marketing and a shortened OEP apparently culled extra marginal enrollees).
Beneath, I’ve charted enrollment renewals in every year (2017-2025) in opposition to numerous factors within the prior 12 months: finish of OEP, early effectuated enrollment (February within the Trump years, March within the Biden and Obama years), September (to seize a way of post-OEP enrollment in Biden years particularly) and December.
The sources are CMS’s annual early effectuated enrollment snapshots (hyperlinks beneath — so far as I do know they’re not listed on one web page) and enrollment public use information for end-of-OEP totals.
ACA market renewals as a proportion of prior-year enrollment factors
I’m undecided how illuminating that is, TBH. A number of observations beneath. Perhaps others will discover different figures within the carpet.
- The soar in percentages within the Biden displays not solely improved retention (as excessive percentages of enrollees have been paying both $0 premiums or lower than $10/month) but in addition full-year enrollment for a lot of potential enrollees (e.g., all enrollees throughout the emergency SEP of 2021, low-income enrollees from early 2022 ahead, and Medicaid “unwindees” in 2023-25).
- Since 2021, enrollment has both elevated or barely dropped from March to September (there was additionally excessive low season enrollment in 2020, because the state marketplaces opened emergency SEPs, HealthCare.gov streamlined particular person SEPs, and Covid led to mass if largely short-lived layoffs).
- In all years, nearly everybody who retains protection by means of December renews. And as I’ve famous beforehand, the drop in enrollment from the top of OEP to the primary effectuated enrollment snapshot can also be fairly excessive and has additionally fallen steadily since 2016 — indicating that those that are passively auto-renewed largely retain protection for at the very least some months within the new 12 months. Thus retention in addition to year-round new enrollment are a part of the year-long stability of enrollment totals in recent times.
What else?
Further time-related references will be discovered on the creator’s website. ACA market renewals: reflections on retention and year-round enrollment, xpostfactoid, Andrew Sprung
