Enrollment in the new health exchanges has exceeded the expectations of supporters and disproven predictions of naysayers, but how many have actually paid their premiums, and which health plans are getting the lion's share of those enrollees?
About 73 percent have paid premiums, according to an analysis just released by Decision Resources Group, based on a multi-demographic regression and consumer behavior model. And of those, WellPoint has gotten the most enrollees, at more than 778,000.
The numbers are changing every day, and it may be that when DRG updates the data, a higher percentage will have paid. (An individual is not officially insured until he or she has made an initial premium payment, and applicants have 90 days to pay their initial premium.) But in the meantime, having about a quarter of that 8 million without paid premiums means that only 5.8 million actually have insurance now, which has broad implications for the actuarial soundness and viability of the exchange plans.
DRG based its numbers on publicly available information from the Department of Health and Human Services, which breaks out enrollment by state as of April 19, the final date applications were processed for 2014. DRG layered over that data information from individual states on what percentage of enrollees have paid their premiums, as well as data from congressional reports and statements from insurance commissioners. DRG also factored in data provided directly by companies or reported by companies.
About half of WellPoint's enrollment is in California, according to DRG's calculations not surprising, since it is the largest insurer in that state, and has excellent brand recognition and attractive premium prices. Its next-biggest states are Virginia (81,000) and Indiana (69,000). Other than WellPoint, the plans with the highest amount of enrollment nationally were Humana (397,000), Florida Blue (390,000), and Health Care Service Corp. (353,000). Again, DRG's numbers include only members who have paid premiums, not all who have filled out applications.
Those numbers reflect the brand recognition and experience of Blue Cross Blue Shield plans, which have long dominated the individual and small-group market, as well as Humana's strategy to be in 14 states with many low-priced plans while other national insurers were much more cautious. The country's largest insurer, UnitedHealthcare, only participated in four state exchanges for individuals, and its total paid enrollment is about 15,000, with most of that in Nevada, where it has a strong brand in the vertically integrated Health Plan of Nevada. In Colorado, where it attracted only 369 members, it sold under the less-familiar All Savers Insurance Co. brand and had the market's highest premiums, pretty much a deliberate effort to make a soft entrance in the market. Next year will be different, though: United plans to enter a dozen or more additional states.
In quarterly earning calls, national insurers have indicated that 80 to 85 percent of their members are paying premiums, about what they expected. It may be that the Blue Cross Blue Shield plans have ended up with a higher percentage of non-payers, and they may not view that as an entirely bad thing; a non-paying customer is likely not a good risk.
But to function over the long haul, the exchanges will need more than 73 percent of members to pay their premiums. Over the next few months, everyone with a stake in the healthcare business will be watching closely to see how many of those early enrollees pay up and make themselves officially insured individuals.
Follow Sheri Sellmeyer on Twitter @SheriSellmeyer