CHARLESTON, W.Va. — Enrollments out of West Virginia on the health insurance exchange created in the federal Affordable Care Act continue to decline.

During the open enrollment period for coverage to start on Jan. 1, 2020, a total of 20,066 Mountain State residents signed up for or were automatically re-enrolled in health insurance plans from Highmark Blue Cross Blue Shield or CareSource, enrollment numbers showed.

For 2019, the Centers for Medicare and Medicaid Services reported 22,599 total enrollments, a number that was down from the 27,000 West Virginians enrolled in exchange health insurance plans for 2018 which was also a reduced number from previous years.

However, Ellen Potter, health policy director for the West Virginia Offices of the Insurance Commissioner, said there was reason for optimism.

“At least it seems like it’s somewhat stable. It’s changed the least between these years than any years so maybe we’re starting to have a more stable market,” she said.

“Some of these people have gotten — probably — jobs with group benefits or some people have aged into Medicare. A lot of West Virginians, we are an older state, so that does happen also.”

Transitions to Medicaid were also possible due to job losses.

Others may be going uninsured.

There is no longer a tax penalty for not having health insurance in the United States, a change from the original ACA language.

Of those enrolled for 2019, data from the Centers for Medicare and Medicaid showed an average of 19,615 effectuated their enrollment. In other words, they paid their premiums for coverage for at least the first six months of 2019.

A total of 90 percent of those people received subsidies, CMS reported.

For the other ten percent, “The plans are expensive and they also have the higher deductibles to pay,” Potter said.

“The ones that receive the subsidies, their actual payment does not change much from year to year unless they change the plan that they have.”

In 2019, the average monthly premium in West Virginia for health insurance purchased through the exchange was $931.02 per enrollee while the average subsidy, or advanced premium tax credit, per enrollee was $765.06.

“The subsidy is based off of our premiums. Each area in the state, there’s eleven rating areas, and the subsidy is based on the second-lowest silver cost plan so, throughout the United States, these would all be different,” Potter explained.

“So our rates are a little bit higher, but then our subsidies are higher also.”

Nationally, average monthly premiums on exchanges were $593.29 per month while average subsidies were $513.91.

West Virginia is one of 38 states utilizing healthcare.gov as the enrollment platform.

Other states have state-based exchanges.

For 2020, CareSource offered plans in 44 Mountain State counties while Highmark was in every county.

Nationwide, the enrollment number for 2020 was nearly 8.3 million which was a little bit lower than 2019 enrollment. In general, there were more new enrollees and fewer renewals, enrollment figures showed.

A more detailed 2020 enrollment report was due out in March.

The enrollment period on exchanges, originally scheduled to run from Nov. 1 to Dec. 15, 2019, was extended to Dec. 18, 2019 due to enrollment issues in the closing hours of the established period.