Affordable Care Act Open Enrollment Ends on Jan. 17

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.

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.”

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.