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The 10th annual open enrollment period for the Affordable Care Act (ACA) health insurance marketplaces ends on Jan. 15, with most consumers having until then to sign up for a plan that meets their medical needs and their budget.
People who need individual health insurance need to "pay attention because this is the one time of the year when they can sign up for marketplace coverage," says Karen Pollitz, a senior fellow at the nonpartisan Henry J. Kaiser Family Foundation.
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There are two ways people can get coverage outside of the open enrollment period. One is if they have what is called a "qualifying life event," such as a marriage or loss of a job and the health insurance that went with it. You typically have 60 days to sign up for coverage either before or after your qualifying event. The second is for consumers whose annual incomes are no more than 150 percent of the federal poverty level — $20,385 for an individual and $27,465 for a couple in 2023. The ACA marketplace is open to them year-round.
Federal subsidy expansion extended
According to the Centers for Medicare and Medicaid Services (CMS), which also administers the federal ACA marketplace, 4 out of 5 consumers should be able to find an insurance plan with a monthly premium of $10 or less. That's because of the subsidies provided under the ACA. Under the Inflation Reduction Act, the ACA subsidies that had first been expanded in the 2021 American Rescue Plan are extended through 2025.
The subsidy expansion means that people with annual incomes below 150 percent of the federal poverty limit are eligible for zero-premium coverage, depending on what plan they select.
People with incomes between 150 percent and 400 percent of the federal poverty level — up to $54,360 for an individual and $73,240 for a couple in 2023 — are eligible for premium subsidies. The amount of the subsidy depends on someone’s income and what health plan they choose.
People with incomes above 400 percent of the federal poverty level are also eligible for subsidies if their premium payments for the most popular silver-level ACA plan would be more than 8.5 percent of their income.
"That's going to be especially important for older Americans," Pollitz said of the extension of the expanded subsidies. Before the American Rescue Plan expansion, ACA subsidies weren't available for people with incomes at or above 400 percent of the federal poverty rate. That meant, Pollitz said, that because insurers can charge more for people over age 50, many seniors who were not eligible for subsidies were facing premiums of more than $1,000 a month.