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Affordable Care Act Open Enrollment Ends on Jan. 17

Monthly premiums will increase, but most enrollees are eligible for federal subsidies


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Courtesy Healthcare.gov

Open enrollment for Americans who get their health care coverage through the Affordable Care Act’s (ACA) federal marketplace have until 5 a.m. Eastern Time on Wednesday, Jan. 17 to sign up for or change their plan. That will also be the open enrollment deadline for most people who get their health plan through a state exchange.

The average monthly premiums for health insurance sold through all ACA marketplaces are projected to increase by about 5 percent in 2024, but those hikes are expected to be offset by federal subsidies available to most Americans. 

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The 11th annual open enrollment period for the program is the one time during the year when most people can sign up for individual health insurance coverage or change the plan they have. 

Those who live in the 37 states that are part of the federal marketplace can go to healthcare.gov to review their coverage or to sign up. Usually, Jan. 15 is the final day for federal ACA open enrollment, but because Jan. 15 will be the celebration of Martin Luther King Jr.’s birthday, consumers will have until 5 a.m. ET on Jan. 17 to enroll.

Thirteen states and the District of Columbia operate their own marketplaces, and in seven of those states, the open enrollment period differs from the federal window. In California, New Jersey, New York, Rhode Island and Washington, D.C., residents have until Jan. 31 to sign up. Massachusetts consumers have until Jan. 23 to enroll, and Idaho’s open enrollment period began on Oct. 15 and ends Dec. 15. Consumers can find a link to their state marketplace at healthcare.gov.

Satisfied with your insurance? It’s still a good idea to shop the marketplace, health experts say.

“Even if you like your current plan, these markets change so much from year to year that the plan that was best for you this year may no longer be the best plan for you next year,” says Cynthia Cox, a vice president at the nonpartisan KFF and head of its ACA program. “Premiums, provider networks, prescription drug costs and deductibles can all change, so it’s important to reassess your options every year.”

People who miss the open enrollment period may qualify for a special enrollment period, including those who have been affected by a natural disaster, have lost job-based coverage or who no longer qualify for Medicaid, the federal-state health insurance program for people with low incomes.

Cox says the expansion of Medicaid benefits during the pandemic expired, so millions of Americans have been disenrolled from that program. “People who are no longer eligible for Medicaid should check healthcare.gov or their state exchange to see if they’re eligible for financial help,” she says.

The addition of many former Medicaid beneficiaries will likely contribute to another record enrollment in ACA plans, according to KFF. ACA enrollment peaked last year at 15.7 million. 

What ACA plans cost

ACA plans fall into four main categories: bronze, silver, gold and platinum. 

In general, bronze plans have the lowest monthly premiums and the highest deductibles and copays. Silver plans are the most popular, with generally moderate premiums and copays. They are designed to provide more coverage of routine health care. Gold plans, in general, have high monthly premiums and lower out-of-pocket costs for most routine care, and platinum plans come with the highest monthly premiums and lowest out-of-pocket costs for care.

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For the second straight year, average monthly premiums in the federal marketplace for the most popular silver-level plans are slated to increase by 4 percent. Actual increases will vary, depending on what plan you select and where you live.

According to a KFF analysis, the rising premium costs can be attributed to inflation and the fact that more people are getting health care that may have been delayed during the COVID-19 pandemic. KFF experts point out that the premium hike may be somewhat mitigated by less need for COVID-19-related care.

Most people won’t be impacted much by premium increases. About nine out of 10 people are eligible for a federal subsidy, and four out of five consumers should be able to find a health insurance plan with a monthly premium of $10 or less, according to the Centers for Medicare & Medicaid Services (CMS), which administers the ACA. Eligibility for subsidies was expanded in 2021 and will continue through 2025. 

Under the expanded financial assistance, people with annual incomes below 150 percent of the federal poverty limit ($21,870 in 2024 for an individual and $45,000 for a family of four) 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 $58,320 for an individual and $78,880 for a couple — are eligible for premium subsidies. The amount of the subsidy depends on your income and what health plan you choose.

If your income is over 400 percent of the federal poverty level, you can still get a premium subsidy if your monthly charge for the most popular silver-level plan would be more than 8.5 percent of your income. AARP fought for that provision to be included in the 2021 American Rescue Plan premium expansion because many older adults who were not eligible for subsidies before faced ACA plan premiums of more than $1,000 a month.

“Higher-income people who have applied for marketplace coverage a few years ago and were told that their income was too high to get a subsidy should reapply,” Cox says. “They may find that because the income limit on getting a subsidy was removed, they will now qualify for the assistance.”

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Consumers should look beyond monthly premiums when deciding on coverage. “It is important for people to not only consider the premium but also any out-of-pocket costs like the deductible or coinsurance,” Cox says. A CMS tool that compares overall yearly costs would, she says, “be a good way to compare all of your financial liability across the year rather than just thinking about your monthly premium.” Depending on your income you may qualify for a federal cost-sharing subsidy to help pay for out-of-pocket costs beyond premiums. 

More plan choices

Participation in the ACA continues to grow. In 2024, 96 percent of consumers in the federal marketplace will have a choice of three or more insurers, up from 93 percent in 2023. CMS officials say they are mindful that people can be overwhelmed by the sheer number of plans, so the agency is beginning to limit how many plans an insurer can offer, especially within the same “metal” level.

CMS created “easy pricing” plans on the healthcare.gov website to make it easier for consumers to compare the different plans. These plans all have the same deductible and cost-sharing for most benefits and the same out-of-pocket limits as other plans within the same metal category. 

In 2024, for the first time, health plans will be required to include coverage for services at mental health facilities, substance abuse treatment centers and rural emergency hospitals in the plan holder’s network.

Adult children benefit 

Under the ACA, parents who get their plans through the healthcare.gov federal marketplace are able to cover their children in their individual insurance policies through the end of the calendar year that their sons or daughters turn 26. This benefit is optional for the state marketplace, so consumers need to check with their local health exchange.

Enrollment help available

To get help applying for a health policy, including finding out if you are eligible for a premium subsidy or a subsidy to help you pay your deductibles and copays, you can contact the healthcare.gov call center at 800-318-2596, 24 hours a day, seven days a week.

You can also get help from what CMS calls “navigators.” For 2024, 57 organizations received a total of nearly $99 million to provide help to consumers shopping in the marketplace. These helpers, as well as insurance agents and brokers, are available by going to healthcare.gov and selecting the “find local help” option. 

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