Subscriber continuity in health insurance plans: factors associated with reenrollment and coverage changes
Aims: In this study we examined the extent to which Marketplace health insurance subscribers reenroll a second year. Among reenrollees, we sought to examine movement to more and less generous insurance plans (based on actuarial value), and the extent to which adverse selection, adverse retention, and aging in place are evident from reenrollment choices made.
Methods: Reenrollment from 2015 to 2016 and 2016 to 2017 and movement to more and less generous insurance plans was examined using enrollment and insurance claims data from two U.S. Federally-facilitated Marketplace insurance carriers operating in the state of New Mexico for 2015 through 2017. Insurance plans are assigned to metal levels based on estimated plan actuarial value: Bronze (60%), Silver (70%), and Gold (80%). Odds ratios (ORs) and 95% confidence intervals (OR CI) were estimated using logistic regressions for subscribers with base year healthcare utilization. ORs were estimated for 1) reenrollment in the year following the base year, and 2) movement to a higher or lower actuarial value plan.
Results: Approximately 50% of subscribers reenrolled with the same carrier for 2016 and 60% for 2017. Being enrolled 12 months was the strongest predictor for second year reenrollment. Older individuals were more likely to reenroll. Reenrollment was lower for the insurance carrier with higher second year premium changes. Chronic condition utilization characteristics were positively associated with reenrollment. Approximately 12% of Bronze subscribers moved to Silver or Gold, and had higher utilization after reenrollment. Among Silver subscribers, 6% moved to Gold and 6% to Bronze. Approximately 37% of Gold subscribers moved to Silver or Bronze.
Discussion: Reenrollment was similar to published non-group insurance rates. Adverse selection and aging in place were observed. Evidence was weak for adverse retention. Some coverage change choices were rational, while others suggest subscribers may have difficulty making insurance choice decisions.
