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ACA Open Enrollment for 2023 Ends Jan. 15

Consumers still have time to sign up or change their health coverage

spinner image woman using a laptop to fill out affordable care act application during open enrollment
YinYang / Getty Images

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.

The 8.5 percent premium cap brings down the premium for those older Americans to about $300 or $400 a month, Pollitz says.

"If older people looked at marketplace coverage in the past and said, 'I can't afford those ridiculous premiums,' they need to know that now the federal government will protect you," she says.  


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More choice of plans

For coverage that starts in 2023, 92 percent of marketplace plan enrollees will have a choice of three or more insurers compared to 89 percent who had that choice in 2022.

CMS has also implemented standardized plan choices at every category of plan — platinum, gold, silver and bronze. Under this feature, consumers will be able to choose a plan that has standard deductibles and cost-sharing for certain benefits and standard out-of-pocket maximums. The cost-sharing for these plans also include flat copays instead of coinsurance percentages, something CMS says provides more financial certainty. Consumers can still elect to enroll in non-standardized plans.

Most of these standardized plans also offer many services that will not be subject to the annual deductible, including primary care, generic drugs, preferred brand-name drugs, urgent care, specialist visits, mental health and substance use outpatient office visits and speech, occupational and physical therapy.

Family glitch fixed

Whether you can qualify for a subsidy to reduce your ACA plan premium depends on your income. But it also depends on whether you have the ability to get affordable coverage through an employer or government program. Under the ACA rules, if you can get other affordable coverage you won't qualify for a federal subsidy.

Until now, the government just looked at whether an employer plan was affordable to the employee alone in determining whether that employee could get a subsidy for an ACA plan. What it didn't consider was whether that employee's family coverage was affordable. It is not unusual, Pollitz explains, for an employer to pay much more for health coverage for the employee but contribute less — or nothing — for the employee's spouse and/or children.

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CMS has changed that rule for 2023. The government will consider the entire health insurance bill a family must pay for employer coverage in determining whether they would be eligible for a subsidy. If their employer-based health insurance premium would amount to more than 9.12 percent of their income, they will be eligible for a subsidy. Pollitz said an estimated 5 million people have been caught up in this family glitch each year.

Some states extend open enrollment

How to Apply for ACA Health Coverage

Click here for the federal ACA marketplace or learn about your state exchange if you live in one of these 18 locations:

While anyone who lives in one of the 33 states that use the federal marketplace and many of the state-based health exchanges has until Jan. 15 to enroll, some states have other ACA open enrollment deadlines.

  • Massachusetts: Jan. 23
  • California, District of Columbia, New Jersey, New York and Rhode Island: Jan. 31

More help available

The federal government is spending a record $98.9 million during this year's ACA open enrollment period to fund 59 organizations that provide assistance to consumers signing up for ACA coverage. These navigators help people apply for coverage and determine what, if any, subsidies they're eligible for.

Consumers can find a navigator by going to the local help tab at Pollitz cautions that the local help function also includes links to insurance brokers. In order to find assistance from a navigator at one of the nonprofit organizations, consumers should click on Assister under the Type of Local Help tab.

The ACA hotline (800-318-2596) is also available seven days a week, 24 hours a day.

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