For the first time since 2020, ACA marketplace enrollment is down – from 24.3 million to 22.8 million. Enhanced premium subsidies expired January 1, and the average subsidized enrollee saw their annual cost jump from $888 to $1,904 😲
An estimated 4.8 million people will drop coverage entirely this year 🤯
But the bigger story is the millions who stayed and downgraded their plan ↘️.
Bronze plan selection jumped from 49% to 59%, but it’s not a preference, rather a distress signal.
These members now carry ~$7,500 deductibles. Technically, they have insurance, but with cost-sharing that high, many will skip care and delay treatment until something becomes an emergency.
That’s the engagement gap no one’s talking about.
A member with three chronic conditions who can’t afford a specialist visit doesn’t show up in your disenrollment data. They show up 18 months later in your ER and hospitalization costs.
They’re covered, but they’re not engaged.
And if no one reaches out to help them understand what’s still available at no cost – preventive screenings, wellness visits, chronic care management – they’ll fall through the cracks quietly.
This is where proactive, continuous outreach changes the math. Not a portal notification. Not a mailer. A real conversation with a real person that helps them navigate their coverage and stay connected to care.
The subsidy debate will play out in Washington. But for health plans serving these members right now, the question is operational: are you reaching the members who stayed but checked out?