Q: How do I use the search tool?
A: Each of the AIS Health Data applications is different, but start by viewing the Help on the upper right of the dashboard.

AIS's Directory of Health Plans requires you to select one or more search criteria in order to submit a search.

Tip: To learn about a particular insurer, select that company in the Insurer field first, then when you pull down the States options it will show ONLY those states for which that company has enrollment records.

Q: I see that National is one of the options in the State search criteria. How does that work in the search results without double-counting data?
A: If you are selecting National criteria, you will need to go to the Enrollment-National filter in your results to view enrollment data. If you are selecting one or more State criteria, you will need to pull down the Enrollment-State filter to view enrollment data. If you select both National and State criteria — for instance if you want to view all operations for a single insurer — you will have to view both filters to get a complete picture of the company's enrollment, especially if the insurer operates in multiple states. You will see that the state-level records are blank in the Enrollment-National filter and the national-level record is blank in the Enrollment-State filter. This ensures that the total enrollments calculated at the bottom of each numeric column are accurate, with no double-counting.

To view all fields for all plans in Excel spreadsheets that you can manipulate in any manner you desire, view the Enrollment Data Spreadsheets document under In-App Downloads to download the full relational data tables to your desktop in Excel.

Q: Why do some records appear to be duplicated? And why do some records have National-level enrollment and others have State-level?
A: Every health insurer has National-level enrollment, plus one or more State-level enrollment breakdowns are available in most cases, for the states in which a company operates. Each geographic option is presented as a separate record, so that the Totals calculated at the bottom of the screen will not represent double-counted numbers. For instance, the National figures for any plan will only be counted once within any search criteria. To reduce confusion, we recommend you search for Either National records OR State records.

Q: There are a LOT of different enrollment fields! How do they all relate to one another? What adds up to what?
A: Great question! It is very important to understand how the different categories of enrollment relate to one another. Please read the Field Definitions and view the Enrollment Field Hierarchy and Definitions document under In-App Downloads for additional explanations.

Q: I am trying to search for a particular plan, but I can’t find it.
A: Some records represent large national companies (like UnitedHealthcare, Anthem, etc.), which may each offer hundreds of different plans around the country — many continue to be branded under the names of acquired entities. For instance, Empire Blue Cross Blue Shield in New York is owned by Anthem. Most likely, the name you are searching is not the current company name, but perhaps a former name, the name of a subsidiary, or the name of a product the company sells. If the plan is brand new, it will not appear in this database until it has actual enrolled members as of our most recent research cycle.

Please look in the Health Plan Index under In-App Downloads; if you cannot find what you're looking for there, please email us at Support@AIShealth.com.

Q: What happened to the plan I was tracking last year?
A: A health plan may have gone out of business, changed its name, or been acquired by another entity. Or, the record could have been consolidated with an affiliated company in the database. If you cannot find the plan you seek in the Health Plan Index, refer to the MCO ID Master, which tracks all DHP records by their MCO ID number from one year to the next.

Q: Why can't I find the Insurer I want in the State I want?
A: In the Search Criteria, when you select a state, the Insurer options will adjust to show you only those companies operating in the selected state. And, vice versa, if you first select an Insurer, the State options will adjust to show you only states in which that insurer operates. If you believe the database is missing any service areas for a particular insurer, please alert the researchers asap at Support@AIShealth.com.

Q: I'm confused about how public exchange enrollment is counted. I see under Field Definitions that exchange enrollees are counted in the commercial sector, but I thought it was a public program — can you clarify?
A: While the ACA exchanges are regulated by CMS and run by government entities, the actual plans sold on those exchanges are private-sector plans because they are not part of an entitlement program. They are sold privately to individuals OR via small employers through the SHOP exchanges. Entitlement programs such as Medicare and Medicaid guarantee coverage to people who are eligible; the ACA does not guarantee coverage, it mandates coverage, and people have options as to where/how to get themselves covered. Approximately 80% of individuals purchasing on exchanges are eligible for a government subsidy to help make this coverage affordable, and these subsidies are comparable to traditional employer-sponsored plans in which the employer pays a portion of the premium cost for its employees.

It is also important to note that many plans in the commercial risk-based individual and small-group markets are sold BOTH on and off exchanges. And commercial risk plans that are sold exclusively off exchange are subject to the same ACA regulations as the plans offered on exchanges. So within a commercial risk plan, some members may come through the public exchange channel while others come through a broker or purchase directly from a health plan's website. Likewise, some enrollees may have their premiums paid partially by a government subsidy, while others are paying 100% out of pocket.

Public exchanges screen people for eligibility for Medicaid, CHIP and/or individual subsidies. Exchange enrollment is counted after people have enrolled in a specific plan, so if they enroll in an individual or SHOP plan they will be in the commercial risk sector, and if they end up in a Medicaid or CHIP plan they will be in the public-sector category.

Q: How are Blue Cross and Blue Shield entities indicated in this Database, and how can I track them?

A: Blue Cross and Blue Shield licensees are indicated with a "TRUE/FALSE" checkbox in the main Enrollment Data Spreadsheet, and you can search for them specifically on the Online Search Tool by indicating Yes in the "BCBS Affiliate?" option. For more information about what it means to be a BCBS plan and how they compare to other plans in insurance markets, please CLICK HERE.

Q: Why is the enrollment total listed for the insurer I’m researching so much lower than the total the insurer cites on its website?

A: In most cases, the insurer is likely including non-medical enrollment in the total cited on its website. This can include enrollment related to behavioral services, limited benefit plans, care management, dental plans, long-term support care, pharmacy benefit management and other types of services or care. Many of these members may be already counted in the insurer’s medical enrollment, or under another insurer’s medical enrollment. To avoid this kind of double-counting, the Directory only counts primary medical enrollment.

Q: I’m comparing your data to CMS’s Medicare Advantage report, and your enrollment numbers appear to fall short of theirs. Can you explain why?

A: Yes. In the case of Medicare Advantage plans, the monthly CMS report includes dual-eligible Special Needs Plans (D-SNPs) and duals demonstrations plans. DHP no longer counts these members as a subset of Medicare Advantage and instead has made a concerted effort to categorize all dual-eligible lives into their own category to avoid double-counting. Dual eligibles are counted using AIS’s definition, so this count may differ from the way insurers categorize such members elsewhere. AIS defines as a Dual-Eligible plan, any plan that, in a coordinated manner, covers people who are eligible for both Medicare and Medicaid.

Q: When I look at stand-alone PDP enrollment using your search engine, the total of PDP enrollment is significantly less than what CMS is reporting in its monthly report. Why is this?

A: Our search engine only includes enrollment for stand-alone PDPs that are affiliated with an insurer listed in the Directory of Health Plans, and many PDPs are either unaffiliated with a specific insurer (for example, CVS Health or Express Scripts) or affiliated with more than one MCO ID. For a full set of PDP enrollment, see the Public Sector Enrollment Data workbook in the In-App Downloads section.

Q: Your total medical enrollment for all companies exceeds current U.S. Census estimates of the total United States population. How did this happen?

A: This can be attributed to several causes. First, U.S. Census Dept. estimates used here are based on the most recent census data, but are still just estimates; actual hard data representing the current population is not available at any point from Census, as even a newly released Census count is based on a sampling. Additionally, health insurance is provided to many foreign nationals who are working in the U.S. as well as many U.S. citizens working overseas--either of these situations may be missed in a Census count.

Current estimates put the uninsured population at about 10%. Of all sectors and risk-types, we have found the Total Non-Risk/ASO category to have the most potential for overlap, particularly among the largest carriers like UnitedHealthcare and Anthem. In cases where these large entities are renting their networks to other insurers in the database, there can be overlap with other insurers. In addition, many insurers provide administrative services to state Medicaid departments and count these members in their ASO figures, but we are often unable to isolate these members to remove them from affected states. For the most accurate understanding of state market share, we advise customers to pay the most attention to risk-based enrollment, and assume the ASO figures are inflated and/or may overlap.

In addition, there are likely dual-eligible members counted in Medicaid whose primary payer is Medicare fee-for-service; we remove these members when we are able to specifically identify them from our state Medicaid sources, but not all Medicaid agencies separate out these members in their reports or can do so on request.

Q: Can I track pharmacy benefit membership by summing up the total medical enrollment for all insurers that list a given pharmacy benefit manager (PBM) as their contractor?
A: AIS Health's parent company, MMIT, tracks lives at the pharmacy benefit level; for more information, contact Sales@AISHealth.com.

Q: What happened to the Key Executives and downloadable Mailing Lists that you used to provide?

A: AIS Health is no longer collecting and tracking names of key executives or plan contact names within this app. AIS Health’s contact data is now being tracked within a new product called MMIT Reach — a robust database of more than 10,000 health care executive contacts. MMIT Reach is continuously updated and features email instead of snail-mail addresses, an upgrade requested by our clients. By separating the two research efforts AIS Health researchers are able to focus 100% on enrollment data, catalysts and trends in health insurance markets. Learn more at https://marketplace.aishealth.com/product/mmit-reach/ or contact Sales@AISHealth.com.

Q: How can I differentiate between managed SCHIP plans and fee-for-service SCHIP?

A: DHP contains just one category for lives enrolled in the State Children’s Health Insurance Program (SCHIP), a Medicaid program for children whose families exceed the income limit to receive health benefits for the entire family. Enrolled children can receive health benefits through either a Medicaid managed care plan, or traditional fee-for-service (FFS). Medicaid and SCHIP fee-for-service benefits are delivered through the beneficiary’s state of residence, which pays providers directly for all covered services. AIS tracks Medicaid fee-for-service enrollment in DHP’s “State of” records, and subscribers can find all relevant SCHIP FFS enrollment in the “State of” records.

Due to variations in state Medicaid reporting methods, AIS is not able to report a FFS SCHIP breakdown in every state, so all SCHIP enrollment is represented in one category to avoid confusion.