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Avalere Analysis Projects Potential for Increased Subsidized Exchange Enrollment

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NEWS RELEASE -- A new Avalere Health analysis shows that, as of November 2, 30 percent of exchange applicants are eligible for federal subsidies to reduce their monthly insurance premiums and out-of-pocket costs for medical care, far below the 84 percent of enrollees who are ultimately expected to qualify for financial assistance.

Additionally, state-based exchanges (SBEs) are tracking behind states with federally run exchanges, with 23 percent of eligible applicants being subsidy-eligible in SBEs compared with 34 percent in federally run exchanges.

“The figures show the potential for increased exchange enrollment in the coming weeks as we get closer to the deadline for 2014 insurance,” said Dan Mendelson, CEO of Avalere Health. “As lower-income Americans determine that they have access to subsidized commercial insurance products, we can expect to see many enroll to save money.”

Low Rates of Subsidy Eligibles: On November 12, the Department of Health and Human Services released enrollment data for the health insurance exchanges from October 1 to November 2. The data showed that 106,000 people nationwide had enrolled in coverage and selected a health plan. However, nearly 1.1 million individuals had applied and been deemed eligible for coverage. Among those, 30 percent were eligible for subsidies, meaning they had incomes below 400 percent of the poverty line. By contrast, Avalere Health projects that 84 percent of final exchange enrollees are ultimately expected to qualify for subsidies.

State vs. Federally Run Exchanges: Surprisingly, rates of subsidized applicants in states with federally run exchanges are outpacing those in state-based exchanges. In the 15 state-based exchanges (including D.C.), 23 percent of applicants deemed eligible for exchanges were below 400 percent of the poverty line, whereas subsidized applicants constituted 34 percent in federally run states. By comparison, Avalere Health projects that state-run exchanges will ultimately have 88 percent of subsidized enrollees and federally run states will have 83 percent of subsidized enrollees.

For more information, contact Frank Walsh at or 202-745-5110.

Read the full analysis here.

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