CMS Updates Affordable Care Act, Public Payer Enrollment Numbers


Affordable Care Act enrollment for 2022 and public payer enrollment midway through 2021 saw some record-breaking surges.

In 2020 and 2021, public payer and Affordable Care Act marketplaces experienced major disruptions and changes that continue to have ripple effects.

The year that the pandemic struck, Medicaid and CHIP enrollment escalated for the first time in two years. From 2017 to 2019, enrollment in these programs dropped 3.1 percent, according to Kaiser Family Foundation. But 2020 initiated a drastic shift that extended into 2021.

Meanwhile, the Affordable Care Act marketplaces received an injection of new enrollees in 2021 as the Biden administration opened up and prolonged a special enrollment period. Experts have projected that the influx of enrollees will create a higher demand for customer service and unanticipated shifts in risk adjustment and medical loss ratios.

As 2022 approaches, public payer and Affordable Care Act marketplace enrollment trends indicate that these surges in enrollment are ongoing.


There is still one month left in the Affordable Care Act marketplace open enrollment period. In September 2021, CMS announced that the marketplace’s open enrollment period would last until January 15, 2022.

A total of 13.6 million consumers have selected an Affordable Care Act marketplace plan, either through their state-based marketplace or through the federal health insurance marketplace,

Since the open enrollment period began on November 1, 2021 through December 15, 2021, a record-breaking 9.7 million consumers have selected federal health insurance marketplace plans. These enrollees come from 33 states that do not run a state-based marketplace.

As of December 11, 2021, the state-based health insurance marketplaces reported 3.9 million enrollees, including new plan selections, plan changes, and automatic re-enrollment.

The last time that federal health insurance marketplace enrollment came close to this level was under the Trump administration during the 2018 open enrollment period. At the time, six more states were using the federal health insurance marketplace than the current number of users. Still, 2021 enrollment exceeded that record by 900,000 enrollees.

State-based marketplace enrollment also is higher for the 2022 open enrollment season than for the 2021 open enrollment season, though this was to be expected with the addition of three states. Kentucky, Maine, and New Mexico all launched their state-based marketplaces at the start of the 2022 open enrollment season.


Medicaid and CHIP enrollment benefitted from a number of regulations that policymakers created or relaxed during the coronavirus pandemic.

Together, Medicaid and CHIP enrollment increased 17.7 percent from February 2020 to May 2021, in part demonstrating the impact of the coronavirus pandemic. More than 12.5 million individuals enrolled in either Medicaid or CHIP in that timeframe.

As of June 2021, Medicaid enrollment exceeded 76.3 million consumers. In just one month from May 2021 to June 2021, Medicaid gained over 413,600 new enrollees. The CHIP program gained more than 20,300 beneficiaries in the same timeframe, reaching a total enrollment of over 6.8 million.

With 2022 around the corner, policymakers have been debating whether or not to establish certain policies—such as continuous Medicaid enrollment—as a way to ensure more universal coverage.


Medicare enrollment in October 2021 encompassed a total of over 63.9 million individuals. Fee-for-service Medicare enrollment surpassed enrollment in Medicare Advantage and other health plans combined. These plans accumulated more than 27.9 million enrollees.

Meanwhile, Medicare Part D covered over 49.1 million Americans.

Few seniors decided to change health plans during the 2022 open enrollment season, according to As of mid-November 2021, only one out of ten seniors had changed their health plans.

While this reluctance to switch plans is not unusual, experts noted that it can be beneficial to consider alternative health plans due to annual changes in coverage and cost, particularly during the coronavirus pandemic.

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