After more than five weeks of sign-ups for Affordable Care Act health insurance, enrollment through Maine’s ACA marketplace remained down significantly from the same period last year.

From Nov. 1 to Dec. 8, roughly 32,275 Mainers either signed up for individual ACA insurance or actively renewed their policies, down 21 percent from 40,600 Mainers the previous year. Saturday is the deadline for 2019 enrollment in Maine.

Health care analysts have said the drop may be a sign that the move last year by congressional Republicans to eliminate the federal income tax penalty for those without coverage is contributing to a decline in sign-ups. Other factors also may be at play, including the Trump administration’s unwillingness to promote ACA insurance.

But data from Maine’s largest ACA coverage provider suggest an alternative theory: More Mainers may be sticking with their current health plans next year – including a popular version with no premiums for eligible policyholders – which does not require active renewal and is not counted in the total number of new sign-ups. If true, the apparent decline in net enrollment is merely an illusion based on how the numbers are counted.

Nationally, individual sign-ups for the first month of ACA enrollment totaled 4.1 million, down 12 percent from 4.7 million a year earlier, according to the U.S. Centers for Medicare and Medicaid Services, or CMS. Its net enrollment figures include both new sign-ups and active plan renewals but do not include automatic renewals.

Kevin Lewis, president and CEO of Lewiston-based ACA insurer Community Health Options, said his organization’s data contradicts the notion that young people are dropping out of the ACA insurance market because of the elimination of the so-called individual mandate.

In fact, the average age of Community Health policyholders has been trending downward for several years, from 44 to 42, he said. Based on data collected so far, Lewis said, the age of the cooperative’s average policyholder appears unlikely to change much from this year to next.

A more likely explanation for the lower enrollment this year is that a relatively high percentage of Maine policyholders switched plans for 2018, which required active renewal and created a spike in CMS enrollment data.

The primary reason was a change in the pricing structure for medium-coverage “silver” plans for 2018, Lewis said.

Maine saw a record 72 percent jump in the early weeks of enrollment in 2017, with many ACA policyholders actively switching their plans from silver to bronze.

In 2017, ACA insurers responded to the Trump administration’s elimination of so-called cost-sharing reduction subsidies by dramatically increasing the price of their silver plans, which generally cover about 70 percent of a patient’s costs.

Before that tactic, which has become known as “silver-loading,” silver plans had been the most popular among consumers because they were the most highly subsidized.

Through silver-loading, insurers were able to keep prices relatively stable for plans in the other tiers: bronze, gold and platinum. When prices for silver plans spiked, many consumers shifted to the lower-cost bronze plans for 2018.

“It made bronze plans very affordable, if not without any premium payment at all,” Lewis said.

A recent report by the Kaiser Family Foundation, a nonprofit health care research group, found that roughly 19,000 Mainers – about one-third of potential ACA marketplace shoppers in the state – are eligible to pay no premiums in 2019, after factoring in tax credits, if they purchase bronze plans.

Ed Kane, Harvard Pilgrim Health Care’s regional vice president for the Maine market, agreed with Lewis that bronze plans continue to be extremely popular with Mainers this year.

“The strong interest that we have seen from consumers during this open enrollment period includes active interest in our bronze plans,” Kane said.

Lewis said it’s likely that many Community Health policyholders who switched to bronze plans in 2018 plan to keep them in 2019, which does not require active plan renewal and will not be counted by CMS until early next year.

Community Health always sees a certain number of members drop their plans each year following open enrollment, he said, but it is unclear how many will do so in 2019. The answer generally comes in January when a certain number of automatically renewed members fail to pay their January premiums, according to Lewis.

“Almost half of our membership right now haven’t engaged (in active renewal) as far as we can tell thus far,” Lewis said. “And that’s not necessarily surprising if they like the plan that they’re in and intend to stay with that plan.”

J. Craig Anderson can be contacted at 791-6390 or at:

[email protected]

Twitter: jcraiganderson

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