What kinds of health plans are unsubsidized buyers choosing? A hint from HealthSherpa

Recently, I posted a series of comparisons of the health insurance obtained in the ACA marketplace by enrollees who were a) unsubsidized, b) subsidized, and c) heavily subsidized (i.e. with access to strong Cost Sharing Reduction (CSR) subsidies). In brief, the weighted average actuarial value of plans obtained by subsidized buyers was 81.4%, compared to 68.9% for the unsubsidized.  The perhaps more significant contrast was between those with incomes under 200% of the Federal Poverty Level, where CSR is strong, and everyone else. Average AV for buyers below 200% FPL was 86.3%. Subsidized buyers over 200% FPL obtained coverage only marginally richer than did unsubsidized buyers.

In that post I posited, tentatively, that the 1.4 million unsubsidized buyers who obtained plans on HealthCare.gov might stand in as a proxy for the estimated 9.6 million out-of-marketplace buyers of ACA-compliant plans.  While every buyer on HealthCare.gov and in the 12 state-run marketplaces is tabulated, the out-of-marketplace market is something of a black box.

Now I have a sliver of corroboration from HealthSherpa, a commercial online broker with a sleek interface and easy enrollment process. HealthSherpa is one of dozens of e-brokers authorized to process subsidized marketplace applications, which it does via a dedicated interface on HealthCare.gov (as do other brokers). According to co-founder Ning Liang, HealthSherpa has enrolled some 500,000 people in marketplace plans to date (since 2014). HealthSherpa sells in the 38 states using HealthCare.gov,and recently added  Liang sent me metal level selection data from the most recent 100,000 enrollees, all for 2016.

One surprise is that the vast majority of the 100,000, 88%, are subsidized enrollees. Finding one's way to HealthSherpa implies a certain degree of web savvy, and probably also relative youth, and most young enrollees are subsidy-eligible. So we are dealing with an unsubsidized sample of just 11,812, and all are buying plans available in the ACA marketplace, as opposed to ACA-compliant plans offered exclusively outside the marketplace.

All that said, the metal level selections of the HealthSherpa sample are pretty close to those of the unsubsidized HealthCare.gov enrollees. Here are the numbers for unsubsidized buyers from HealthSherpa:

Bypassing healthcare.gov, revisited

Just a brief teaser here, as I work to finish a reported story about different approaches to improving the shopping experience at healthcare.gov and getting essential information to users.

I have caught up again with HealthSherpa, which began life as one of the first ACA comparison shopping sites to spring up while Healthcare.gov was dysfunctional last fall, then went on to become a licensed broker and go live last February as one of the first third-party sites to start enrolling people in subsidized ACA plans. As I reported at the time (or rather, added some explanation to an initial report by the Washington Post's Brian Fung), HHS licensed a number of brokers to develop "web-based entities" -- that is, their own dedicated interfaces on the government site -- and HealthSherpa did so.

Now, co-founder Ning Liang tells me that the company has completed almost 2,000 applications and  continues to streamline the process. Liang claims that a solo applicant can now complete an application in 3-5 minutes --  and a family plan applicant in 10-15 minutes.  HealthSherpa has made this possible partly by reducing the lag time following each completed question, and partly by eliminating redundancies. One key streamlining is that a user goes directly from the shop-around process, where one enters personal info and gets price quotes with plan summaries, to the application process, rather than starting over as on healthcare.gov. The info entered in the shop-around process is ported into the application process.