By Sandy Ahn, Jack Hoadley and Sabrina Corlette

Today we released a report that helps shed light on a critical element of the state-based health insurance marketplaces’ long-term sustainability: their ability to retain customers and re-enroll them as simply and efficiently as possible. Our study, conducted in partnership with the Urban Institute as part of the Robert Wood Johnson Foundation’s project to monitor and track state-level implementation of the Affordable Care Act (ACA), revisited six state-based marketplaces (SBMs) to better understand their experiences with first year renewals and how the state’s choice of a renewal process – automatic renewal or active re-enrollment – affected overall enrollment and the consumer experience.

We found that, in general, the study SBMs: California, Colorado, Kentucky, Maryland, Rhode Island and Washington, re-enrolled marketplace customers in large numbers in spite of some challenges, and that an active renewal process, if effectively managed and communicated to consumers, can support significant retention of enrollees.

Some major challenges

One major challenge for the SBMs was to redetermine consumers’ eligibility for premium tax credits. Some SBMS also struggled with messaging how changes to plan prices affected the value of premium tax credits for consumers eligible for auto-renewal. Other challenges include the capacity of information technology systems to simultaneously re-enroll and enroll consumers and the confusing nature of the renewal notices consumers received from the marketplace and insurers.

Despite these challenges and the added pressure of signing up new enrollees, the authors note that states were largely successful in retaining consumers from 2014, and that many consumers shopped or switched plans or insurers to get the best deal. SBMs will need to continue to improve their renewal processes in order to meet their long-term enrollment goals. You can read the full issue brief here.