Number of HIX enrollees who paid first premium in dispute

How many individuals and families that selected a health plan in the federally facilitated health insurance marketplace have paid their first month’s premium? Depends on whom you ask.

A House Committee reported Wednesday that, according to insurers, 67% of individuals and families that had selected a health plan in the federally facilitated health insurance marketplace had paid their first month’s premium and completed the enrollment process as of April 15.

However, the U.S. Centers for Medicare and Medicaid Services dispute that figure, saying insurance companies themselves indicate that 80% to 90% of enrolled individuals and families have submitted their insurance payments.

The Republican majority of the House Energy and Commerce Committee sent letters to every insurance provider operating in the marketplace, the committee reported, requesting specific enrollment data. The committee, however, did note that due to the extension of open enrollment and the fact that many insurers say individuals still have time to pay their first month’s premium, the numbers might change and the committee expects to request an update around May 20.

Mark Gaunya, principal and employee benefit adviser at Methuen, Mass.-based Borislow Insurance, and an EBA Advisory Board member, said that based on what he has heard the 67% paid figure sounds accurate to him.

For its part, a CMS official said in an e-mail the 67% figure the House committee reported is based on only about half of the approximately 300 issuers in the federally facilitated marketplace and “they do not match up with public comments from insurance companies themselves, most of which indicate that 80 to 90% of enrollees have paid their premium.” In various media reports, insurers at Aetna, Cigna and WellPoint have been quoted as saying in recent weeks the percentage of enrollees who paid their premiums was in the 80-90% range.

CMS adds that given the surge in enrollments at the end of March, “it stands to reason that not all enrollees would have paid by [April 15] of this so-called report since many people’s bills were not even due yet.”

A spokeswoman for insurance trade group America’s Health Insurance Plans, says the group does not keep its own data. 

The committee’s Subcommittee on Oversight and Investigations has asked the leaders of some of the nation’s largest insurance providers and their trade groups to testify at a hearing on May 7 to further understand the numbers.

See related: Kaiser Permanente extends premium deadline

See related: 1 in 5 Wis. ACA applicants have not paid premium

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