Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA.
Med Care. 2019 Jan;57(1):49-53. doi: 10.1097/MLR.0000000000001020.
Midyear disenrollment from Marketplace coverage may have detrimental effects on continuity of care and risk pool stability of individual health insurance markets.
The main objective of this study was to assess associations between insurance plan characteristics, individual and area-level demographics, and disenrollment from Marketplace coverage.
All payer claims data from individual market enrollees, 2014-2016.
We estimated Cox proportional hazards models to assess the relationship between plan actuarial value and Marketplace enrollment. The primary outcome was disenrollment from Marketplace coverage before the end of the year. We also calculated the proportion of enrollees who transitioned to other coverage after leaving the Marketplace, and identified demographic and area-level factors associated with early disenrollment. Finally, we compared monthly utilization rates between those who disenrolled early and those who maintained coverage.
Nearly 1 in 4 Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollment was 30% lower for individuals in plans receiving cost-sharing reductions and 21% lower for those enrolled in gold plans, compared with silver plans without cost-sharing subsidies. Young adults had a 70% increased hazard of disenrollment compared with older adults. Those who disenrolled midyear had greater hospital and emergency department utilization before disenrollment compared with those who maintained continuous coverage.
Plan generosity is significantly associated with lower disenrollment rates from Marketplace coverage. Reducing churning in Affordable Care Act Marketplaces may improve continuity of care and insurers' ability to accurately forecast the health care costs of their enrollees.
从医疗保险市场中期退出可能会对医疗保健的连续性和个人医疗保险市场的风险池稳定性产生不利影响。
本研究的主要目的是评估保险计划特征、个人和地区人口统计学特征与从医疗保险市场退保之间的关联。
2014-2016 年，来自个人市场参保者的所有支付方索赔数据。
我们使用 Cox 比例风险模型来评估计划精算价值与医疗保险市场参保之间的关系。主要结果是在年底前从医疗保险市场退保。我们还计算了离开医疗保险市场后转为其他保险的参保者比例，并确定了与早期退保相关的人口统计学和地区因素。最后，我们比较了早期退保者和持续参保者之间的每月利用率。
近四分之一的医疗保险市场受益人参保中途退保。与没有成本分担补贴的银质计划相比，接受成本分担减免的计划和参加金质计划的个人退保的风险率分别降低了 30%和 21%。与老年人相比，年轻人退保的风险增加了 70%。与持续参保者相比，中途退保者在退保前的住院和急诊就诊利用率更高。
计划的慷慨程度与从医疗保险市场退保的较低退保率显著相关。减少《平价医疗法案》市场中的“退保潮”可能会提高医疗保健的连续性，并提高保险公司准确预测参保者医疗保健成本的能力。
