What’s new, what’s changed in ACA open enrollment season

Nov. 1 marks the start of the 10^th open enrollment season under the Affordable Care Act, and KFF compiled a list of nine changes to watch for in this upcoming period.

1. Unsubsidized premiums are on the rise.

KFF estimates that ACA marketplace benchmark premiums are increasing an average of 4% across all 50 states and the District of Columbia. KFF’s analysts found that insurers cite rising prices and increased health care usage as driving the bulk of these premium increases.

2. Enhanced marketplace subsidies continue and will reduce net premiums for most consumers.

The enhanced subsidies in the Inflation Reduction Act reduce costs across the board by further lowering payments for people who were already eligible for subsidies under the original ACA subsidy structure and by extending subsidy eligibility to middle-income people by removing the upper income limit on subsidies.

The Inflation Reduction Act extends eligibility for premium tax credits to reach people with incomes over 400% of federal poverty level ($54,360 for a single person in 2023, or $111,000 for family of four).

3. More Marketplace enrollees could renew coverage than ever before.

Marketplace enrollment reached a record high of 13.8 million people in 2022, with 12.5 million receiving a subsidy. Individual market enrollment overall (including on and off exchange) also remains higher than before the ACA was implemented. It is likely ACA-compliant enrollment (both on- and off-Marketplace) is currently at a record high and that non-compliant enrollment is at a record low.

This means the 2023 open enrollment period may be the busiest yet, with more people renewing coverage than ever before.

4. The “family glitch” is fixed.

New rules will take effect for the 2023 coverage year, measuring the affordability of family coverage based on the worker’s premium contribution for family coverage. If that amount is more than 9.12% of household income in 2023, family members will have the option of buying health coverage through the Marketplace and will be eligible for premium tax credits based on their income.

5.     Other Marketplace eligibility rules have been relaxed on HealthCare.gov.

During the Trump Administration, insurance companies offering policies on HealthCare.gov were permitted to refuse to renew coverage for people who had fallen behind on premium payments. For 2023, that will no longer be the case. In addition, once Open Enrollment ends, people will continue to be able to sign up for Marketplace coverage mid-year if they have a qualifying life event (such as loss of other coverage, marriage or divorce, or a permanent move) using a 60-day special enrollment period.

6. New insurers are entering the market while others are leaving.

On average, consumers in HealthCare.gov states will have a choice of 6 to 7 qualified health plan issuers in 2023, which is similar to the number in 2022. In 2023, 92% of enrollees will have a choice of 3 or more qualified health plan issuers, up from 89% in 2022. However, some insurers are exiting or scaling back their presence in the marketplace. Most notably, Bright Health, a lost-cost insurer in several states, will no longer sell marketplace coverage.

7. Active renewing is strongly recommended.

In most states, if enrollees have not updated their application and plan selection for 2023, the marketplace may auto-re-enroll them in their current plan or a similar plan for the coming year. However, plans can change from one year to the next and subsidies may have changed as well. Consumers should shop for plans to evaluate changes in out-of-pocket costs.

8. More enrollment help is available.

The Biden administration is spending $89.9 million in grant funding to the marketplace navigator program, the single largest navigator funding award to date.

9.     Low-income individuals will be able to sign up for marketplace coverage year-round.

People with annual income up to 150% of FPL ($20,385 for a single person and $34,545 for a family of three in 2023) will be able to enroll in marketplace plans year-round.

The full KFF report can be seen here.