Altarum's Private Insurance Research Collection

Commissioned Projects

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Performance of the “Off‐Exchange” Health Insurance Market: Implications for the Exchange Market, Kosali Simon and Dan Sacks, Indiana University, Jean Abraham, University of Minnesota

A key goal of the Affordable Care Act (ACA) was to increase coverage and institute minimum standards in the individual insurance market. To that end, the ACA created the Health Insurance Exchanges, centralized marketplaces for streamlined purchasing of subsidy-eligible health insurance. Despite close attention paid to the on-Exchange segment, little is known about the off-Exchange segment of the individual market. Roughly 30 percent of all individual market enrollment occurs off-Exchange and many insurers only offer policies in this segment. Studying this segment is especially important because off-Exchange coverage is a plausible option for medium- and higher-income persons, who may be most adversely affected by rapid premium growth in the individual market. We propose to fill the gap by providing data and analysis on the role and performance of the off-Exchange segment of the individual market. We will answer the following sets of research questions: 1. Performance: What are the patterns of enrollment in the off-Exchange market across time and geography? Are cross-state differences in the size of the off-Exchange market correlated with state policy choices such as Medicaid expansion or state-based marketplaces? How has the off-Exchange market changed over time? 2. Role: Who uses this market? What are the characteristics of off-Exchange enrollees and how do they compare to on-Exchange enrollees? 9/1/18 – 7/14/19