Findings from University of Pittsburgh Update Understanding of Health and Medicine (Coverage Retention and Plan Switching Following Switches From a Zero- To a Positive-premium Plan): Health and Medicine

2025 JUN 12 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Current study results on Health and Medicine have been published. According to news reporting originating from Pittsburgh, Pennsylvania, by NewsRx correspondents, research stated, “<bold>Importance Millions of lower-income Health Insurance Marketplace enrollees were defaulted from zero-premium to positive-premium health plans in 2022, 2023, and 2024. This turnover in zero-premium plans may cause coverage losses by creating administrative burdens that complicate enrollees’ ability to maintain coverage. <bold >Objective To determine how turnover affected Marketplace reenrollment. <bold >Design, Setting, and Participants This cross-sectional study used log-linear fixed-effects models including counties in 29 states that used the HealthCare.gov platform from 2022 through 2024. <bold >Exposure HealthCare.gov enrollees living in a county that experienced turnover that year. <bold >Main Outcomes and Measures County-year-level counts of overall reenrollment, automatic and active enrollment, and active reenrollment split by whether enrollees stayed with or switched from their previous plan.”

Financial supporters for this research include Commonwealth Fund, Agency for Healthcare Research & Quality.

Our news editors obtained a quote from the research from the University of Pittsburgh, “We controlled for premium affordability, insurer competition, other county characteristics, and state-by-year policy changes. <bold >Results The sample consisted of 2159 counties representing roughly 10 million HealthCare.gov enrollees annually in 29 states that used the HealthCare.gov platform from 2022 through 2024. The share of enrollees living in counties exposed to turnover increased from 10.3% to 93.9% from 2021 to 2022 as the American Rescue Plan Act subsidies were implemented. These increases have persisted into 2024. Turnover across insurers was associated with a 7.0% (95% CI, -12.7 to -1.3) decrease in automatic reenrollment. Any turnover was not associated with changes in active enrollment, though it was associated with a 13.4% decrease (95% CI, -17.7 to -9.1) in enrollees choosing to stay with their previous, default plan and a roughly equivalent 15.0% increase (95% CI, 11.5-18.5) in enrollees choosing to switch plans. <bold >Conclusions Turnover affects coverage losses by decreasing automatic, passive reenrollment among lower-income enrollees that may not realize they need to start paying premiums to retain coverage that previously did not have a premium. Turnover also nudges returning enrollees to select new plans rather than selecting their previous plans. This likely increases insurer price competition but also may create hassles for enrollees.”

According to the news editors, the research concluded: “These findings suggest that coverage losses from turnover in 2026 among lower-income Marketplace enrollees may be particularly large if enhanced subsidies from the Inflation Reduction Act expire.”

For more information on this research see: Coverage Retention and Plan Switching Following Switches From a Zero- To a Positive-premium Plan. Jama Health Forum, 2025;6(5). Jama Health Forum can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

The news editors report that additional information may be obtained by contacting Coleman Drake, University of Pittsburgh, Dept. of Health Policy and Management, Pittsburgh, PA 15261, United States. Additional authors for this research include Dylan Nagy, Sarah Avina, Daniel Ludwinski and David M. Anderson.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamahealthforum.2025.1424. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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