Phantom enrollees are a subset of the ACA exchange enrollees who make zero medical claims in a given year. The term describes individuals who are enrolled in an ACA plan but either already have other coverage or are unaware of their enrollment, often due to fraudulent or improper sign-ups, and thus generate no health care claims. Paragon’s researchers approximate phantom enrollees by the excess number of zero-claim enrollees relative to a normal health insurance market. As a result of the ACA’s enhanced premium tax credits, phantom enrollees soared in the Obamacare exchanges in 2023 and 2024.
Glossary Term