Shopping for ACA health insurance? Here's what's new

It's fall again, meaning shorter days, cooler temperatures, and open enrollment for Affordable Care Act marketplace insurance.

Even though much of the coverage stays the same from year to year, there are a few upcoming changes that consumers should note this fall, especially if they are having trouble buying expensive policies through their employer.

In the past year, the Biden administration and Congress have taken steps - mainly related to premiums and subsidies - that will affect 2023 coverage. Meanwhile, confusion caused by court decisions may trigger questions about coverage for preventive care or for abortion services.

Open enrollment for people who buy health insurance through the marketplaces began Nov. 1 and, in most states, lasts through Jan. 15. To get coverage that begins Jan. 1, enrollment usually must occur by Dec. 15.

Many people who get coverage through their jobs also must select a plan at this time of year. And their decisions could be affected by new ACA rules. So, what's new, and what should you know if you're shopping?

* Some families who did not qualify for ACA subsidies now do. One big change is that some families who were barred from getting federal subsidies to help them purchase ACA coverage may now qualify.

A rule recently finalized by the Treasury Department was designed to address what has long been termed the "family glitch." The change expands the number of families with job-based insurance who can choose to forgo their coverage at work and qualify for subsidies to get an ACA plan instead. The White House estimates that this adjustment could help about 1 million people gain coverage or get more affordable insurance.

* Preventive care will still be covered without a copay, but abortion coverage will vary. Many people with insurance are happy when they go in for a cancer screening, or seek other preventive care, and find they don't have to pay anything out-of-pocket.

That comes from a provision in the ACA that bars cost sharing for a range of preventive services, including certain tests, vaccines, and drugs. But a September ruling by U.S. District Judge Reed O'Connor in Texas led to confusion about what might be covered next year. The judge declared unconstitutional one method the government uses to determine some of the preventive treatments that are covered without patient cost sharing.

Ultimately, that might mean patients will have to start paying a share of the cost of cancer screenings or drugs that prevent the transmission of HIV. The judge has yet to rule on how many people the case will affect. But, for now, the ruling applies only to the employers and individuals who brought the lawsuit. So, don't worry. Your nocost screening mammogram or colonoscopy is still no cost. The ruling is likely to be appealed, and no decision is expected before the start of the 2023 coverage year.

· Premiums are going up, but that may not affect most people. Health insurers are raising premium rates for both ACA plans and employer coverage. But most people who get subsidies for ACA coverage won't feel that pinch.

That's because the subsidies are tied to the cost of the second cheapest "silver" plan offered in a marketplace. (Marketplace plans are offered in colored "tiers" based on how much they potentially cost policyholders out-ofpocket.) As those baseline silver plans increase in cost, the subsidies also rise, offsetting all or most of the premium increases. Still, shop around, experts advise. Switching plans might prove cost effective.

As for subsidies, passage this summer of the Inflation Reduction Act guaran- teed that the enhanced subsidies that many Americans have received under legislation tied to the COVID-19 pandemic will remain in place.

· Debts to insurers or the IRS won't stop coverage. Thank COVID for this. Typically, people who get subsidies to buy ACA plans must prove to the government on their next tax filing that they received the correct subsidy based on the income they actually received.

If they fail to reconcile that with the IRS, policyholders would lose eligibility for the subsidy the next time they enroll. But, because of ongoing COVIDrelated problems in processing returns at the IRS, those consumers will get another reprieve, continuing an effort set in place for the tax year 2020 · Comparison shopping will likely be easier. Although ACA plans have always been required to cover a wide range of services and offer similar benefits, variation still existed in the amounts that patients paid for office visits and other out-of-pocket costs. Starting during this year's open enrollment, new rules aimed at making comparison easier take effect.