Maps of 2015 Individual Exchange Enrollment by Zip Code

This report presents a tool to examine exchange enrollment information by zip code with additional geographic boundaries.

CRS Insights Maps of 2015 Individual Exchange Enrollment by Zip Code Namrata K. Uberoi, Analyst in Health Care Financing (nuberoi@crs.loc.gov, 7-0688) James C. Uzel, Geospatial Information Systems Analyst (juzel@crs.loc.gov, 7-6830) May 21, 2015 (IN10282) The 2010 Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) allows certain individuals to purchase health plans through health insurance exchanges (also known as marketplaces). According to April 2015 enrollment figures, 11.7 million individuals selected a health insurance plan between November 15, 2014, and February 22, 2015. This Insight presents a tool to examine exchange enrollment information by zip code with additional geographic boundaries. Table 1 presents data on exchange enrollment for all states and includes hyperlinks to maps of exchange enrollment by zip code for 37 states. Each map includes an option to overlay county and congressional district boundaries. The maps are not an aggregation of exchange enrollment by county or congressional district; rather, the maps present optional geographical boundaries over exchange enrollment by zip code. Exchanges Individual exchanges are marketplaces in which persons can shop for and purchase private health insurance coverage. Exchanges may be established either by the state itself as a state-based exchange (SBE) or by the Secretary of Health and Human Services (HHS) as a federally facilitated exchange (FFE). In states with FFEs, the exchange may be operated solely by the federal government or in conjunction with the state. For the 2015 coverage year, 34 states have FFEs, 13 states and the District of Columbia have SBEs, and 3 states have SBEs but use the federal IT platform (see Figure 1). The ACA requires that plans offered through an exchange are, for the most part, Qualified Health Plans (QHPs). In general, to be certified as a QHP a plan must offer the essential health benefits, comply with cost-sharing limits, and meet certain standards related to marketing, choice of providers, and plan networks. Each exchange is responsible for certifying the plans it offers. Figure 1. Health Insurance Exchange Types, 2015 Source: CRS illustration of HHS classification of health insurance exchange types. Enrollment Individuals are eligible to enroll in the exchanges during an Open Enrollment period. For the 2015 coverage year, the Open Enrollment period was November 15, 2014, to February 15, 2015. If an individual experiences a certain life change—such as having a baby—he or she may qualify for a Special Enrollment Period. Furthermore, states or the federal government may initiate a Special Enrollment Period for other circumstances. Enrollment Data Enrollment data are from HHS. The data represent pre-effectuated enrollment, which is the total number of unique individuals who selected a QHP or were automatically reenrolled in a QHP but may or may not have submitted the first premium payment for the 2015 coverage year. The data include enrollment during the 2015 Open Enrollment period as well as Special Enrollment Period activity through February 22, 2015. Exchange enrollment by state ranged from 12,625 enrollees in Hawaii to 1,596,296 enrollees in Florida (see Table 1). The most populous states (e.g., California, Texas, and Florida) had higher enrollee totals. Similarly, the least populous states (e.g., Wyoming, Vermont, and Alaska) had lower enrollee totals. HHS also provides exchange enrollment data by zip code for the 37 states using the federal IT platform (i.e., HealthCare.gov). These 37 states include the 34 states with FFEs and the 3 states with SBEs using the federal IT platform. Approximately 8.8 million individuals residing in these 37 states selected a QHP between November 15, 2014, and February 22, 2015. These QHP selections are tabulated by zip code using the home address provided by the exchange applicant. Zip code data were not available for approximately 2% of applicants. (Please contact the Congressional Research Service for tabular zip code data arranged by state.) Caveats Mapping of the data by zip code is subject to the following caveats: Zip code areas can cross counties, congressional districts, and/or states; thus, the distribution of enrolled individuals in these geographies cannot be determined. Because zip code geographic coverage areas are highly variable in size, the mapped data should not be viewed as displaying enrollee densities. Very small zip code areas displayed on the maps may be obscured due to scale or overlapping features or labels. Due to privacy concerns, zip code-level enrollment data are not available for zip codes with 50 or fewer eligible enrollees who have selected a QHP. As a result, the sum of QHP selections among zip codes within a state using this dataset may not be equal to state-level totals provided in Table 1. Table 1. Enrollment in Health Insurance Exchanges by State (2015 Open Enrollment Period and Special Enrollment Period activity through February 22, 2015) State Alabama Type of Exchangea Enrollmentb FFE 171,641 Alaska FFE 21,260 Arizona FFE 205,666 Arkansas FFE 65,684 Californiac SBE 1,412,200 Coloradoc SBE 140,327 Connecticutc SBE 109,839 Delaware FFE 25,036 District of Columbiac SBE 18,465 Florida FFE 1,596,296 Georgia FFE 541,080 Hawaiic SBE 12,625 Idahoc SBE 97,079 Illinois FFE 349,487 Indiana FFE 219,185 Iowa FFE 45,162 Kansas FFE 96,197 Kentuckyc 106,330 SBE Louisiana FFE 186,277 Maine FFE 74,805 Marylandc SBE 120,145 Massachusettsc SBE 140,540 Michigan FFE 341,183 Minnesotac SBE 59,704 Mississippi FFE 104,538 Missouri FFE 253,430 Montana FFE 54,266 Nebraska FFE 74,152 Nevadad SBE 73,596 New Hampshire FFE 53,005 New Jersey FFE 254,316 New Mexicod SBE 52,358 New Yorkc SBE 408,841 North Carolina FFE 560,357 North Dakota FFE 18,171 Ohio FFE 234,341 Oklahoma FFE 126,115 Oregond SBE 112,024 Pennsylvania FFE 472,697 Rhode Islandc SBE 31,337 South Carolina FFE 210,331 South Dakota FFE 21,393 Tennessee FFE 231,440 Texas FFE 1,205,174 Utah FFE 140,612 Vermontc SBE 31,619 Virginia FFE 385,154 Washingtonc SBE 160,732 West Virginia FFE 33,421 Wisconsin FFE 33,421 Wyoming FFE 21,092 Total   11,688,074 Source: HHS, Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report, March 10, 2015. a. State-based exchange (SBE) or federally facilitated exchange (FFE). b. Enrollment data represent pre-effectuated enrollment, which is the total number of unique individuals who selected or were automatically reenrolled in a qualified health plan but may or may not have submitted the first premium payment. c. Additional notes on this state's enrollment figures can be found in Appendix Table C1 of HHS's March enrollment report. d. State-based exchange that uses the federal IT platform.