May 4, 2016

Study Reveals New Individual Plan Members Need More Care

Newly published results of a recent study by the Blue Cross Blue Shield Association (BCBSA) show that individuals who enrolled in Blue Cross and Blue Shield (BCBS) health plans after the Affordable Care Act (ACA) took effect had higher rates of disease and received significantly more medical care, on average, than those who enrolled in BCBS individual plans prior to 2014.

The report, “Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform: The Experience from 2014 and 2015,” represents a comprehensive, in-depth study of actual medical claims among those enrolled in individual coverage before and after the ACA took effect. The study also compares this group to those who receive insurance through their employers.

The study included individuals who purchased coverage from a BCBS company on a state-based or federally facilitated marketplace, as well as individual, ACA-compliant policies sold outside of the government marketplaces. It excluded Medicare and Medicaid enrollment. The data were collected from independent BCBS companies across the country and focused on members ages 21 through 64.

Comparing health status and use of medical services among these three groups, the study found that:

• Members who newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus (HIV) and Hepatitis C than individuals who had BCBS individual coverage prior to health-care reform.
• Consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as those with BCBS employer-based group health insurance.
• The new enrollees used more medical services across all sites of care — including inpatient admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.
• Medical costs of care for the new individual market members were, on average, 19 percent higher than employer-based group members in 2014 and 22 percent higher in 2015. For example, the average monthly medical spending per member was $559 for individual enrollees versus $457 for group members in 2015.

This report gives us the first comprehensive and in-depth look at the medical needs and costs of caring for individuals enrolled in health insurance coverage with the expanded access and benefits called for under the Affordable Care Act.

To see the full report, visit bcbs.com/healthofamerica.