Estimating Eligibility and Uptake of Federally Facilitated Marketplace Insurance in North Carolina in the Second Open Enrollment Period
Background
As the Federally Facilitated Marketplace (FFM) enters its third open enrollment period, focus is shifting toward examining which communities have lower uptake in coverage and how to increase enrollment. In national analysis of the first open enrollment period, Holmes and colleagues found that rural areas had lower rates of plan selections.1 However, these estimates are potentially misleading due to data suppression in smaller, isolated areas. Nationwide, 60% of all isolated ZIP codes were suppressed for having less than 50 enrollees per ZIP code; in North Carolina, 115 of the 807 ZIP codes were suppressed. This analysis estimates health insurance eligibility and enrollment among previously suppressed areas to help inform future outreach and enrollment assistance efforts throughout the state.
Results
We estimated that nearly 1.3 million residents of North Carolina were eligible to participate in the FFM during the 2015 open enrollment period. Statewide, 560,115 eligible persons selected a plan (43%). We explored how plan selection varied by geography and grouped ZIP codes by their Rural Urban Commuting Area (RUCA) classification,2 a more granular measure of rurality than more common county-based measures such as metropolitan statistical areas. Table 1 shows that 44% of eligible individuals living in urban areas selected a plan, while 38% of eligible individuals living in rural areas selected a plan. Partitioning rural areas into finer definitions, residents in large rural, small rural, and isolated areas, all had significantly lower plan selection rates (37.5%, 35.4%, and 39.2%, respectively) than urban.