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ABSTRACT The individual health insurance market has grown significantly since the 2014 implementation of the Affordable Care Act's state-based and federally facilitated Marketplaces. During annual open enrollment periods, Marketplace enrollees can switch plans for the upcoming year. The percentage of reenrollees in California's state-based Marketplace, Covered California, who made changes to their coverage steadily increased between the 2014-15 and 2017-18 open enrollment periods. Following the implementation of "silver loading"-in which insurers raised 2018 silver-tier plan premiums to compensate for their loss of federal payments for cost-sharing reductions-the proportion of consumers who moved into gold plans during the 2017-18 open enrollment period dramatically increased, compared to previous years. Among bronze or silver plan enrollees who switched metal tiers during open enrollment, those who could enroll in gold plans that were no more than $49 per month more expensive than their initial bronze or silver plan had a significantly higher probability of switching to gold coverage than those who faced larger premium differences.
The Affordable Care Act (ACA) has changed the individual health insurance market in the United States by creating new coverage requirements for health plans; creating an easier, more streamlined shopping experience through the federally facilitated and state-based Marketplaces; and making individual-market coverage more affordable through premium subsidies to about 85 percent of Marketplace enrollees.1 These changes have also put millions more consumers into direct contact with the complicated process of selecting a health insurance plan. Before the ACA, individual-market enrollment had been decreasing, from nearly 17.0 million in 2008 to 15.6 million in 2012.2'3 Under the ACA, the number of Americans enrolled in an individual-market health plan increased from about 16.3 million in 2013, justbefore the implementation of the law's major coverage provisions, to 20.5 million in 2017, with 12.2 million enrolled through Marketplaces and the rest in off-exchange plans.4-6
Individual-market enrollees can change their coverage during annual open enrollment periods. Consumers' decisions to make such changes may reflect dissatisfaction with their plan in the prior year; a change in their plan's provider network or costs; a change in the health plans available to them; or a change in personal circumstances, such as income, family structure, or health status.
Shopping and switching coverage during open enrollment is an integral part of keeping insurance...