For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It鈥檚 time to compare benefits and prices and change to a new plan or enroll for the first time.
Open enrollment starts Nov. 1 for the ACA鈥檚 federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.
In most states, open enrollment , although some states have different time periods. California鈥檚, for example, is longer, , but Idaho鈥檚 runs from . In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.
Health policy experts and brokers recommend all ACA policyholders at least look at next year鈥檚 options, because prices 鈥 and the doctors and hospitals in plans鈥 networks 鈥 may have changed.
It Could Be Another Record Year
ACA plans are now well entrenched 鈥 an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the covid pandemic remain available, and some states have boosted financial help in other ways.
In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. Many of those ousted could be eligible for an ACA plan. They can sign up as soon as they know they鈥檙e losing Medicaid coverage 鈥 even outside of the open enrollment season.
Another important caution: Don鈥檛 wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be that they voluntarily agreed to brokers鈥 assistance and that their income and other information provided by brokers is accurate.
It’s a good protection for both parties, said broker , founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.
鈥淏rokers will need to stop what they are doing right at the end before they click 鈥榮ubmit鈥 and wait for the consumer to sign a statement saying they reviewed the policy,鈥 Brooker said.
Premiums Are Changing
While some health plans are lowering premiums for next year, many are increasing them, , according to a Peterson-蘑菇影院 Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.
Premiums, and whether they go up or down, vary widely by region and insurer.
Experts say that鈥檚 a big reason to log on to the federal website, , in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia . Changing insurers might mean a lower premium.
鈥淚t鈥檚 very localized,鈥 said , research professor and co-director of the at Georgetown University. 鈥淧eople should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers.鈥
Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.
Household income is also a factor. Subsidies are on a sliding scale based on income.
Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden鈥檚 Inflation Reduction Act, passed last year.
Online calculators, including , can provide subsidy estimates.
You May Qualify for Lower Deductibles and Copays
In addition to the premium subsidies, for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or for a family of four or $36,450 for a single-person household.
ACA plans are grouped into colored tiers 鈥 bronze, silver, gold, and platinum 鈥 based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.
Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.
There are safeguards built in, said insurance expert and broker , so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces 鈥 California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington 鈥 have enhanced their by extending eligibility or increasing benefits.
Some 26-Year-Olds Will Get to Stay on Parents鈥 Plans Longer
Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents鈥 plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were .
States that run their own markets can set similar rules, for longer periods on a parent鈥檚 plan.
Networks May Still Be Small
Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.
It鈥檚 also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.
鈥淭he general message is, don鈥檛 assume anything and make sure you check to see who is in the network,鈥 Norris said.
Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.
What We Still Don鈥檛 Know
A few things remain uncertain as the end of the year approaches. For example, the Biden administration to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.
Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn鈥檛 final.
Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status 鈥 a group known as 鈥淒reamers.鈥
