By Sam Melamed
ACA sales continue to be way down this year compared to last and the numbers are fun to dig into for a data nerd like me. Some interesting angles emerge when analyzing the data that tell a pretty powerful broker story. The dataset compares FFM ACA sales and State based exchange enrollments this year vs last year and the data comes directly from CMS.
Some of the clues point to the significant role of brokers, marketers, fraud and enforcement in impacting these numbers, playing a much larger role than many carriers, state regulators and CMS thought they would. I am surprised to not see this yet in the The Wall Street Journal or any of the health insurance focused publications.
Headline numbers:
Healthcare.gov totals down 27.75% year over year
State based exchanges up 32.44%
Healthcare.gov new consumers- down 47.12%
State based exchange new consumers up 64.29%
The most interesting angle is that enrollments in Georgia are down by 79.75%! Georgia is the only state to move off the FFM and onto their own state exchange this year and my guess is the shocking drop is likely to do with the fact that almost every scaled ACA distributor focuses mainly on FFM states. There may be other small factors, but having the largest ACA agencies in the country suddenly drop Georgia is a big deal.
The next big thing to jump out is that sales are actually up year over year in state based exchanges and down significantly in FFM. Here we see the same forces at play, but from a different angle. The big ACA shops are all way down on volume because of the three way calling, enforcement of fraud and broker switching prevention, and a crackdown on shady marketing. That had much less impact on state exchanges as the fraudsters stayed away for the most part.
Even though the big ACA shops and volume are way down from last year, they still trump the state exchanges because of the scalability of selling with one certification, platform and compliance regime.
Data is rarely about the answers and mostly about asking the right questions of it. One fun thing about having really smart and quick data analysts on our team is their ability to enhance the data questions too, while cranking out great analysis. Awesome work by Cooper Tretter
Lots of other shocking swings of 40% plus and minus in various states. If you want the full data set from CMS, state year over year analysis and data walkthrough, feel free to email me sam@ncd.com
*The dataset for the 2024 OEP reporting periods were 25 days for SBMs and 32 days for FFMs, while the dataset for the 2025 OEP reporting periods were 23 days for SBMs 30 days for FFMs. To account for the difference in lengths of the periods, we calculated the average number of selections per day for the 2024 OEP and the 2025 OEP, and then calculated the percent change based on those figures.
