Final HealthCare.gov Totals: Enrollment down just ~4% overall, because more people kept their coverage than ever before

Today, CMS released the final enrollment totals for the 2019 federal Open Enrollment period. The total number of people enrolling in a health plan is down about 4% compared to last year and the number of people signing up for coverage this year who are new to HealthCare.gov is down almost 19% during that same period. In contrast, 4.2% more people kept their health coverage compared to last year. This increase in retention is largely responsible for the strong final enrollment totals we saw this year.

The final numbers released today are similar to the Week 7 totals, so our analysis from last week about what the enrollment totals mean and why is still accurate. But in addition to being final numbers, this release gives us one additional data point that gives us a lot more insight into retention. With today’s release, we can compare how many people renewed their coverage at the end of OE compared to previous years. The table below shows the percentage of people who selected a plan during the previous open enrollment and kept their coverage through the end of the following Open Enrollment.

Customer retention is important to the long term stability of HealthCare.gov. Since the third Open Enrollment period, customer retention has increased each year, but this year’s increase from 68.3% to 72.5% represents the largest single-year increase to date. Hypothetically, had retention stayed the same, 370,000 fewer people would have enrolled this year. In this same hypothetical scenario, the final enrollment total would have been just over 8 million people this year. We saw a significant increase in retention last year too, so this same factor played an important role then as well. There are multiple factors leading to the higher retention rate, but fundamentally a higher retention rate shows us that demand for quality, comprehensive coverage remains strong and that the federal Marketplace is meeting the needs of consumers.

This increase in retention sharply contrasts with the fall in new enrollment that we’ve seen at HealthCare.gov. But given the low levels of awareness about Open Enrollment deadlines this year, it’s no surprise to see these numbers. People who have coverage are keeping it and people who don’t hear about it aren’t signing up.

State-by-State Comparison

This year five HealthCare.gov states grew: Oklahoma, Mississippi, Florida, Hawaii, Wyoming, and Utah. Enrollment in twenty HealthCare.gov states shrunk by more than 5%: Virginia (due to the state expanding Medicaid), West Virginia, Louisiana, Indiana, Ohio, New Hampshire, New Mexico, Missouri, Wisconsin, Kansas, Nevada, Delaware, Iowa, New Jersey, Illinois, Michigan, Maine, Pennsylvania, Kentucky, and Oregon.