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Avalere Analysis: State-Based Exchanges Average 3 Percent of Expected Enrollment

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An analysis from Avalere Health finds that 12 state-based exchanges1 have enrolled about 3 percent of their expected 2014 exchange participants. Together, the 12 states have enrolled 49,100 people in exchanges based on data released by the states, as of Nov. 10. By the end of 2014, Avalere projects these states will account for 1.4 million exchange enrollees.

The Department of Health and Human Services is expected to release initial exchange enrollment figures this week, which are anticipated to be very low given ongoing problems with the site.

“Enrollment in new programs begins slowly and often takes several months to build momentum,” said Dan Mendelson, CEO of Avalere Health. “While initial enrollment has been lagging, with aggressive marketing there is still time for awareness of the program to grow and participation to begin.”

By comparison, when Medicare Part D began, two-thirds of people who voluntarily enrolled in a plan did so after coverage began on Jan. 1.(2) As of one month before the deadline for coverage on Jan. 1, only 10 percent of voluntary Part D enrollees had signed up. Exchange enrollment is expected to fall behind the Part D experience initially given the prolonged problems that have plagued the web-based application infrastructure.

Methodology: Avalere Health monitored publicly available, state-based exchange enrollment figures. When possible, we removed Medicaid beneficiaries from the exchange data. Avalere then applied its proprietary state-based Health Insurance Enrollment Model to the administration’s estimate of 7 million exchange enrollees in 2014 to estimate the expected 2014 enrollment by state.

Avalere Health reviewed monthly enrollment numbers for individuals who voluntarily enrolled in Medicare stand-alone prescription drug plans (PDPs) and aligned the milestones of the Part D initial open enrollment period with those of the initial open enrollment period for exchanges. We then applied the trajectory of voluntary enrollment in Part D to the May 2013 Congressional Budget Office (CBO) estimate of 7 million total exchange enrollees for 2014. Medicare Part D open enrollment ran from Nov.15, 2005 to May 15, 2006. Exchange open enrollment runs from Oct. 1, 2013 to March 31, 2014.

1: The analysis includes Colorado, Connecticut, District of Columbia, Hawaii, Kentucky, Maryland, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington. It excludes California, which has only released the number of started applications, and Massachusetts, which is requiring current Connector participants to re-enroll.

2: Avalere Health analysis available at


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About Avalere Health

Avalere Health is an advisory services company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington DC, the firm delivers research, analysis, insight, and strategy for leaders in healthcare business and policy. Avalere’s experts span 170 staff drawn from the federal government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500 healthcare companies, top consultancies, and nonprofits. The firm offers deep substance in areas ranging from healthcare coverage and financing to the changing role of evidence in healthcare decision-making. Its focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications, and interactive programs, Avalere also translates real-time healthcare developments into actionable information. For more information, visit Follow Avalere Health on Twitter @avalerehealth.

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