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A Retrospective on ACA Membership and Behavior Spanning November 2019 to August 2021 – and What it Could Mean for Your Plan Now

This report looks beyond enrollment and into billing and payment behavior and its impact on member abrasion, payment delays, and more.

Softheon wants to work with our health plan partners to create interventions that help the most vulnerable keep their insurance.

Out of the millions of people who enrolled in health insurance during the previous three enrollment periods through the Softheon retail platform, this data looks exclusively at those who signed up for Exchange individual or family plans, reflecting the 90+ health plans that Softheon serves.

Who Kept or Did Not Keep Their Health Insurance in Recent Enrollment Periods?

Softheon observed several themes while examining our large data set, revealing that some populations kept their insurance more than others.

Characteristics of Those Most
Likely to Keep Their Insurance
Characteristics of Those Most
Likely to Lapse in Coverage
State of the ACA Marketplace State of the ACA Marketplace
Has Family Coverage Has individual coverage
State of the ACA Marketplace State of the ACA Marketplace
At least 35 years old Between the ages of 18-34
State of the ACA Marketplace State of the ACA Marketplace
Receiving subsidies No subsides
State of the ACA Marketplace State of the ACA Marketplace
Paying by credit card Paying by bank accound online

Softheon clients have successfully conducted campaigns that increased auto-pay adoption, a factor that correlated positively with maintaining coverage.

State of the ACA Marketplace

16% of people paying electronically with their bank account let their coverage lapse compared to 7% of people paying by credit card.

How Did Subsidy Changes Impact Lapses?

Overall, the introduction of higher subsidies had a positive effect on the lapse rate. In general, those who receive subsidies on their insurance policy lapse at a lower rate, an effect exacerbated during the 2021 Special Enrollment Period.

No-subsidy Payee Lapse Rate


We can drill-down further by examining the effect of subsidies based on the percentage of the premium covered by the subsidy.

The data revealed a reversal of the higher lapse rates noticed in the period prior.

Subsidy Changes and Retention

Those new to a health plan were consistently more likely to let their insurance lapse.

State of the ACA Marketplace
Grace Periods and Their Relationship with Lapses

Members who experienced a grace period of longer than one month let their insurance lapse at a rate of 17%, whereas the lapse rate is typically 10% or less depending on the plan and/or population.

So how did grace periods change over the course of the last few enrollment periods?

After the Open Enrollment period that began in November 2019, the percentage of members who entered a grace period, no matter the length, decreased by 30% for individuals and 24% for families. Subsequent periods during the same time saw a significant increase in the length of time members spent in grace periods. Possibly, those who could pay on time were more motivated to do so during the pandemic, but the underlying reasons are unclear.

Grace Periods and Coverage Lapses

State of the ACA Marketplace

Note: The average grace period month metric was calculated only for those who didn’t lapse in their coverage.

State of the ACA Marketplace

While the youngest demographic of payees are most likely to term (18-34), the oldest demographic (payees 65+) are most likely to enter a grace period.