Massachusetts Health Insurance Enrollment: March 2019 through January 2021

To provide more rapid insight into the impact of COVID-19 on insurance coverage in the Commonwealth, CHIA is producing monthly enrollment data summaries by key market sectors, in addition to its biannual Enrollment Trends reports.This publication includes enrollment figures through January 2021.During the pandemic, overall insurance coverage has remained relatively stable, with over 6.4 million Massachusetts residents receiving coverage from private commercial plans, MassHealth, or Medicare. 1 However, trends through January 2021 varied across these insurance categories.Private commercial insurance plans, which cover approximately 3.9 million Massachusetts residents, declined by 3.5% between March 2020 and January 2021.This decline occurred within both employersponsored insurance (ESI), where membership has contracted by 112,000 (-3.0%) since March, as well as individual purchasers, where enrollment decreased by 29,000 (-8.4%) over the same timeframe.However, in January 2021, ESI coverage experienced only its second (and largest) increase in membership (+7,300) since the pandemic began.Among individual purchasers, enrollment in unsubsidized plans increased 5.8% during this period, while ConnectorCare enrollment declined in large part due to a 9.2% drop from December 2020 to January 2021. 2,3 Between March 2020 and January 2021, the number of individuals with primary MassHealth coverage grew by approximately 170,000, or 14.5%.During this period, the Families First Coronavirus Response Act (FFCRA) mandated Medicaid programs continue coverage for all beneficiaries enrolled on or after March 18, 2020 regardless of changes in beneficiary circumstances or scheduled redetermination assessments. 4 Medicare coverage, 5 which experienced a pause in growth in the second quarter of 2020, grew at more usual levels during the summer and fall of 2020.An enrollment decline in January 2021 was concentrated within Medicare fee-for-service and is consistent with other states for this month, due to the annual open enrollment period.Enrollment in SCO, One Care, and PACE programs for dually-eligible members had a similar pause in growth in the second quarter of 2020, but has rebounded for an overall increase of 7.2% between the start of the pandemic and January 2021.While unemployment claims increased dramatically in the early months of the pandemic, 6 ESI coverage in Massachusetts did not decline at a correspondingly high rate.This is consistent with findings nationally 7,8 and a number of factors could explain this apparent disconnect.For one, not all those claiming unemployment benefits had coverage through their employer, and for those that did, some were furloughed and may have maintained their coverage.Some already had (or could shift to) coverage h gh a fa i e be a .O he a ha e ig ed f c e age h gh COBRA. 9 Despite these mitigating factors, disruptions to economic activity may impact subsectors of ESI to different degrees, particularly as distinctions emerge between temporary and permanent job losses across industries. 10CHIA is continuing to monitor these developments to better understand the extent to which ESI and other insurance coverage may be impacted by the COVID-19 pandemic. Massachusetts Enrollment by Health Insurance Category, December 2019 through January 20211 Coverage is defined by unique Massachusetts residents in primary, medical membership within the top 12 commercial payers by enrollment, MassHealth (Medicaid), and Medicare.These counts reflect enrollment for Massachusetts residents and may differ from other sources that report enrollment by Massachusetts contract situs.Membership counts are not exhaustive for Massachusetts; excluded populations may include commercial payers and third party administrators with a small Massachusetts presence, the Federal Employees Health Benefits Program (FEHBP), TRICARE, Veterans Affairs Healthcare, the Indian Health Service, other federal programs, and prisons.This d ata should not be used to calculate a statewide insurance rate.2 Per the Massachusetts Health Connector: In response to the COVID pandemic, between March 15th and August 2020, the Health Connector did not terminate or downgrade anyone for failure to respond to a Request for Information; however, in late August and early September, overdue requests were closed out in advance of annual processes that create renewal year applications.Further, this annual redetermination process encourages members to update their applications.As a result, Health Connector membership shows more volatility in recent months than earlier this year.3 Per the Massachusetts Health Connector: The Health Connector often observes shifts in unsubsidized and subsidized coverage in January for two main reasons: 1) When the Connector is not able to confirm through electronic data sources that a member continues to qualify for help paying for coverage, the Connector renews them without subsidies.Those members need to provide updated income information to regain subsidies.2) Opportunities to enroll in unsubsidized coverage are more limited during the year, so open enrollment serves as an opportunity for many to get coverage, whereas ConnectorCare members may have an easier time joining during the rest of the year.4 Medicaid.gov,6/30/2020: https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf 5 Medicare coverage here refers to Fee-for-Service (traditional) and Medicare Advantage plans.See data tables for additional information on these breakouts.

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