ACA marketplace enrollment in 2022 plans surged at higher incomes

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Enrollment in ACA marketplace plans has surged, thanks to expanded eligibility for ACA marketplace subsidies. Leading that surge: buyers with higher incomes.

Enrollment climbed as more buyers gained subsidy eligibility

After the American Rescue Plan (ARP) expanded eligibility for premium subsidies in the ACA marketplace in 2021, enrollment in 2022 plans increased by 21%. Enrollment in 2023 plans is on pace to grow by another 13%, to about 16.4 million by the time the open enrollment period ends in all states. Plainly, Americans who lack access to affordable employer-sponsored health plans, Medicaid, or Medicare are recognizing that the ARP made health plans in the ACA marketplace far more affordable.

The ARP increased premium subsidies in the ACA marketplace at every income level and removed the income cap on subsidy eligibility, which had been 400% of the Federal Poverty Level (FPL) since the ACA marketplace launched in 2014. In 2023, 400% FPL is $54,360 for an individual and $111,000 for a family of four. Enrollees with income above that level used to pay the full premium without subsidy. Now they receive premium subsidies if the unsubsidized benchmark Silver plan premium would cost them more than 8.5% of annual family income.

The table below shows the enrollment increase at each income level for 2022 plans in the 33 states that use HealthCare.gov, the federally run exchange. While enrollment in 2022 coverage rose by double-digit margins at all reported income levels, the growth rate increased with income and was highest at incomes over 400% FPL – i.e. among those formerly ineligible for subsidies. (Information about 2023 enrollees’ income is not yet available.)

A note on one data limitation: the chart combines enrollment by those with incomes below 100% FPL and above 400% FPL because that’s the way CMS reported income in 2021, when enrollees with incomes over 400% FPL were not eligible for subsidies. In 2022, 146,297 enrollees in HealthCare.gov states had income below 100% FPL, while 655,944 reported income above 400% FPL – so likely almost all of the increase in that combined category is attributable to enrollees with incomes above 400% FPL.

An obvious surge in enrollment at income levels over 400% FPL

In 2022, the first year in which there was no income cap on subsidies, enrollment at incomes above 400% FPL more than doubled. When you look at premiums with and without subsidies for enrollees of different ages, as shown below, it’s not hard to see why.

Coverage is much more affordable at incomes above 400% FPL than it was prior to 2022 – far more so than many people who looked at marketplace offerings before they became subsidy eligible probably recognize.  Note also that the number of enrollees who did not report income plummeted. That’s doubtless because the ARP dramatically reduced the number of enrollees who earn too much to obtain a subsidy.

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Enrollment Increase by Income 2021-2022
HealthCare.gov states
Platform and year 2022 enrollees – all incomes 100-150% FPL 150-200% FPL 200-250% FPL 200-250% FPL2 300-400%FPL 400% FPL Unknown income
Total HC.gov 2021 (2022 states) 8,071,160 3,341,683 1,526,852 1,047,400 646,920 717,830 290,957 499,518
Total HC.gov 2022 10,255,636 4,144,112 1,852,059 1,316,029 860,181 937,198 802,241 343,816
Change 2021-2022 – HC.gov 2,184,476 802,429 325,207 268,629 213,261 219,368 511,284 -155,702
% Change 2021-2022 – HC.gov 27.1% 24.0% 21.3% 25.6% 33.0% 30.6% 175.7% -31.2%

Source: 2022 Marketplace Open Enrollment Public Use Files / CMS.gov

The enrollment surge, illustrated

Let’s take a closer look at one of the ACA’s hottest markets: Houston, Texas. Enrollment in 2022 coverage in Texas increased by 42%, and enrollment in 2023 plans is on pace to increase another 32%. The chart below shows what premiums now look like for couples of different ages with an annual income of $74,000 – slightly above the 400% FPL threshold – compared to what those couples would pay if they were ineligible for subsidies, as they would have been in years before 2022.

The source for all premiums quoted below is the “See plans and prices” tool on HealthCare.gov.

Impact of the American Rescue Plan on ACA premium subsidies

Monthly premiums paid with and without ARP subsidy increases: Houston, TX in 2023

Married 40-year-olds, annual income $74,000 (404% FPL)
Legal status Lowest-cost Bronze Lowest-cost Silver Lowest-cost Gold
ARP in effect $261 $523 $393
No ARP $624 $887 $756

Married 63-year-olds, annual income $74,000 (404% FPL)
Legal status Lowest-cost Bronze Lowest-cost Silver Lowest-cost Gold
ARP in effect $0 $522 $222
No ARP $1,441 $2,047 $1,747

Notice that the premiums that the older couple will pay (after subsidy) for Bronze and Gold plans are much lower than those paid by the 40-year-olds. That’s because premiums before subsidies are credited rise with age: At age 64, they are three times the premium for a 21-year-old and more than twice the premium for a 40-year-old.

But subsidies are structured so that everyone with the same income pays the same amount for the benchmark Silver plan: An enrollee with income at >400% of FPL receives a subsidy in a fixed amount that enables the enrollee to pay not more than 8.5% of their income for the benchmark, regardless of age. So the subsidy for the older couple is bigger than for the younger couple.

When the subsidy gets bigger, it covers a larger share of the premium for plans that cost less than the benchmark plan. Since the “spread” between the benchmark plan’s premium and the premiums for cheaper plans (one Silver and many Bronze plans) increases in proportion to the age of enrollees, older enrollees get bigger savings on cheaper plans.

Louise Norris has more on how the ARP has decreased premiums for older enrollees. For eligible higher income and older enrollees, the ARP subsidy boosts are not just an “8.5% solution.” Coverage, including sometimes Gold coverage, is often available for much less.

What do the lowest-cost Bronze, Silver and Gold plans shown above look like? Below are some key features. Note that in ACA marketplace plans, select features may not be subject to the deductible, meaning you don’t have to pay full price before you meet your deductible (i.e. a service may be free or you may pay only a co-pay).

  • The lowest-cost Bronze plan in this market from Blue Cross Blue Shield of Texas, has a deductible of $7,400, and an annual out-of-pocket maximum of $9,100 (the highest allowable by law). Primary care doctor visits are free regardless of whether the plan’s deductible has been met, and generic drug prescriptions are $5, also before the deductible.
  • The lowest-cost Silver plan, from Ambetter, has a $5,800 deductible and an $8,900 out-of-pocket max. Primary care visits are $40 and generic drug prescriptions are $20, both before the deductible, and other services (urgent care, specialist visits) are also not subject to the deductible.
  • The lowest-cost Gold plan, from Blue Cross Blue Shield, has a deductible of $1,100, an out-of-pocket max of $9,100. Primary care doctor visits are free and generic drug prescriptions of $5, neither subject to the deductible.

Bargains are Gold-plated in Texas and a handful of other states

The tables also show an extra benefit in the Texas marketplace. In 2022, the Texas legislature unanimously passed a law, signed by Gov. Greg Abbott, instructing the Department of Insurance to issue regulations that would ensure that insurers price Gold plans lower than Silver plans. How can that be?

Well, most marketplace enrollees have incomes below 200% FPL, and below that threshold, Cost Sharing Reduction (CSR) subsidies give Silver plans lower out-of-pocket costs than Gold plans. In Texas in 2022, 88% of Silver plan enrollees had income below 200% FPL. So, setting Gold plan premiums below Silver premiums is a major benefit to enrollees with incomes above 200% FPL, for whom Gold plans have lower out-of-pocket costs than Silver.

At least six states have taken measures to have Gold plans consistently priced below or on a rough par with Silver, and in other states and regions, insurers have done so on their own. This post by Charles Gaba spotlights states and counties in which the economic upsides for Gold plans are most extreme.

Pricing CSR directly into Silver plan premiums is a practice known as “silver loading,” which began in 2018 after the federal government stopped paying insurers separately for the value of CSR. Silver loading creates discounts in Bronze as well as Gold plans – often wiping out the Bronze premium entirely, as the chart above illustrates in the case of the 63-year-olds. Insurers in all states except Mississippi and Indiana practice Silver loading to some degree.

When premiums go high, so does subsidy eligibility

At an income of $150,000 per year for a couple of 40-year-olds – more than 800% FPL for a two-person household –  the unsubsidized benchmark Silver plan in Houston costs less than 8.5% of income. The premium would be the same if the ARP were not in effect.

Married 40-year-olds, annual income $150,000 (819% FPL)
Legal status Lowest-cost Bronze Lowest-cost Silver Lowest-cost Gold
ARP in effect $624 $886 $756
No ARP $624 $886 $756

For two 60-somethings, however, the benchmark premium rises so high that it’s more than 8.5% of income even for a couple earning $150,000.  Subsidies therefore kick in even at this high income.

Married 63-year-olds, annual income $150,000 (819% FPL)
Legal status Lowest-cost Bronze Lowest-cost Silver Lowest-cost Gold
ARP in effect $455 $1,061 $761
No ARP $1,441 $2,047 $1,747

Those prohibitively high unsubsidized premiums may seem like an extreme case, but they’re not unusual for older enrollees. Providing affordable insurance to people who retire or are laid off before they’re eligible for Medicare is a major function of the ACA marketplace. In 2022, 28% of all enrollees were aged 55-64.

The ARP of course made plans significantly more affordable at every income bracket below 400% FPL as well.  Examples of how the subsidy increases affect enrollees at various income levels are laid out in this post.

Will high-earner enrollment continue to surge?

The American Rescue Plan was originally designed as COVID-19 relief, and the subsidy increases in the ACA marketplace were only granted through 2022. The Inflation Reduction Act, enacted in August 2022, extended the increased subsidies through 2025. Beyond that point, their future is uncertain, though they have plainly helped to reduce the uninsured population nationwide.

At least through 2025, if you need to find insurance in the individual market and have not yet examined your options, you’re likely to be pleasantly surprised – particularly if you were jolted by unsubsidized premiums in the past and now find yourself eligible for subsidized coverage.

Andrew Sprung is a freelance writer who blogs about health care policy and ACA implementation at xpostfactoid and at healthinsurance.org. His articles have appeared in publications including Health Affairs, The American Prospect, USA Today, The New York Times, The Incidental Economist, Mother Jones, The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Health Care Digital Media Award and holds a Ph.D. in English literature from the University of Rochester.

Open enrollment for 2023 ACA coverage: what to expect

Key takeaways

The tenth annual open enrollment for ACA-compliant individual/family health coverage is just around the corner. It starts November 1, and will continue through January 15 in most states.

Millions of Americans will enroll or renew their coverage for 2023 during open enrollment. Some have been buying their own health insurance for years, while others are fairly new to the process. And some are currently uninsured or have been covered by plans that aren’t ACA-compliant – such asa  healthcare sharing ministry plan or short-term health insurance.

This article will give you an overview of what to expect during the open enrollment period. For even more information about open enrollment, check out our comprehensive guide to open enrollment.

ACA open enrollment will look mostly familiar this fall

In general, this year’s open enrollment period will be fairly similar to last year’s, but with some changes that we’ll address in more detail below:

  • Each state will continue to use the same exchange/marketplace platform it used last fall (HealthCare.gov in 33 states, and a state-run platform in DC and the other 17 states). And most states will continue to use the same enrollment schedule they used last year.
  • The Inflation Reduction Act has extended the American Rescue Plan’s subsidy enhancements through 2025, so the subsidy rules that were in effect for 2022 will continue to be in effect for 2023. (There’s no “subsidy cliff” and the percentage of income that you have to pay for the benchmark plan is lower than it used to be.)
  • Because the subsidy enhancements have been extended, the record-high enrollment we saw this year is likely to continue, and the improved affordability that the American Rescue Plan created will also continue. But that doesn’t mean your premium will stay the same — more on this below.
  • Brokers and Navigators will continue to provide assistance with enrollment. And Navigator funding is higher than ever before, in an effort to increase outreach and enrollment assistance.
  • The insurers offering health plans through the exchanges (and outside the exchanges) will generally be the same insurers that offered plans for 2022. But there are several insurers joining the exchange or expanding their coverage area for 2023, and some insurers that are shrinking their coverage areas.
  • The IRS has proposed a fix for the “family glitch” which will make some families newly eligible for premium subsidies in the marketplace.

Open enrollment dates and deadlines for 2023 plans

By now, most people are accustomed to the fact that individual/family health coverage is no longer available for purchase year-round, and instead uses open enrollment and special enrollment periods, similar to those used for employer-sponsored plans. The same open enrollment schedules apply to plans purchased through the exchange/marketplace and to plans purchased from insurance companies through private channels (ie, “off-exchange”).

Open enrollment begins November 1, and in nearly every state, it will continue through at least January 15. (Note that Idaho is an exception: Open enrollment in Idaho starts and ends earlier, running from October 15 to December 15. Idaho is the only state where open enrollment for 2023 coverage will end before the start of the year.)

So in most states, the enrollment schedule will follow the same timeframe that was used last year. And in most states, you’ll need to enroll by December 15 in order to have your coverage take effect on January 1. Enrolling after December 15 will generally result in a February 1 effective date.

One caveat to keep in mind: If your current health plan is terminating at the end of 2022 and not available for renewal, you can select a new plan as late as December 31 and still have it take effect January 1.

Although open enrollment continues through at least mid-January in most states, it’s generally in your best interest to finalize your plan selection in time to have the coverage in force on January 1. We’ve explained this in much more detail here.

In most states, that means you’ll need to enroll or make a plan change by December 15. In terms of the effective date of your coverage, there’s no difference between enrolling on November 1 versus December 15. But waiting until the last minute might feel a bit more stressful, and you might have trouble finding an enrollment assister who can help you at that point. You don’t need to be the first person in line, but it’s good to give yourself a bit of wiggle room in case you run into glitches with the enrollment process or find that you’d like assistance with some or all of it.

Rest assured, however, that open enrollment continues until at least mid-January in most states. So if there’s no way for you to get signed up in the earlier part of the enrollment window, you can most likely complete the process after the start of the year and have coverage in effect as of February.

Insurers entering and leaving individual and family markets

As is always the case, there will be some fluctuation in terms of which insurers offer individual/family health coverage for 2023. For the last several years, the general trend has been toward increased insurer participation in the exchanges. Here’s more about what we saw in 2020, 2021, and 2022.)

That trend is continuing in 2023, with new insurers joining (or rejoining) the exchanges in many states. But there are also some insurer exits that existing enrollees need to be aware of.

Several insurers are joining exchanges in the following states for 2023:

But there are also some insurers exiting the marketplaces in several states, including:

And even in states where the participating 2023 insurers will be the same ones that offered coverage in 2022, there may be service area changes in some states. This could result in an insurer’s plans becoming newly available in some areas, or no longer available in some areas.

Last year, we detailed the things that people need to keep in mind if a new insurer is joining the exchange. All of those points are still applicable for people in areas where new insurers will offer plans in 2023.

The main takeaway point is that it’s important to actively compare your available plan options, as opposed to just letting your existing plan auto-renew. One of the new plans (or another existing plan) might end up being a better fit for your needs. But it’s also possible that the benchmark plan’s pricing could change significantly, affecting the amount of your subsidy. If the price of your current plan shoots up, a comparable plan will likely be available for about what you paid this year (if your income and family size haven’t changed).

It’s also worth keeping in mind that the insurer’s estimate of what you’re likely to pay in the coming year, provided in a letter this fall, may be inaccurate – again, because of a shift in its pricing relationship to this year’s benchmark plan. You’ll get a separate letter from the exchange with details about your subsidy amount for 2023 and the amount you’ll pay if you let your current plan renew. But it’s also essential to log onto the exchange, update your information, and learn what your current plan and alternative plans will cost in 2023.

The ‘family glitch’ fix will help some buyers

Ever since ACA-compliant plans debuted in the fall of 2013, people have been ineligible for subsidies if they’re eligible for an employer-sponsored health plan that’s considered affordable. And the affordability determination has always been based on the cost of employee-only coverage, without taking into account the cost to add family members to the plan. But if the employer-sponsored plan was deemed affordable, the entire family was ineligible for subsidies in the marketplace, as long as they were eligible to be added to the employer’s plan. This is known as the “family glitch,” and it has put affordable health coverage out of reach for millions of Americans over the years.

Earlier this year, the IRS proposed a long-awaited fix for the family glitch, which is expected to be in place by the time open enrollment gets underway. Under the proposed rule change, the marketplace will do two separate affordability determinations when a family has access to an employer’s plan: one for the employee, and one for total family coverage. If the employee’s coverage is considered affordable but the family’s is not, the rest of the family will potentially be eligible for subsidies in the marketplace.

Some families will still find that they prefer to use the employer’s plan, despite the cost. But some will find that it’s beneficial to put some or all of the family members on a marketplace plan, even while the employee continues to have employer-sponsored coverage.

The main point to keep in mind here is that it’s important to double check your marketplace options this fall – even if you looked in the past and weren’t eligible for subsidies due to an offer of employer-sponsored coverage.

How are ACA premiums changing for 2023?

The only way to know for sure what your 2023 premium will be is to watch for correspondence from your insurer and exchange. They will notify you this fall about changes to your plan for 2023, including the new premium (and subsidy amount if you’re subsidy-eligible; most people are).

There’s a lot of variation from one plan to another in terms of pricing changes, and your net (after-subsidy) premium will also depend on how much your subsidy changes for 2023. But here’s a general overview of what to keep in mind:

  • Across most of the states, the preliminary average rate change for 2023 amounts to a 7.7% increase, according to ACA Signups. Final rates aren’t yet available in many states, but we’re generally seeing final rates that tend to be a bit lower than the insurers proposed. (This is partly due to the Inflation Reduction Act — which was enacted after insurers filed their rates and which will result in slightly smaller-than-proposed rate increases for some plans — and partly due to state regulators’ actions to reduce rates during the review process).
  • That’s a little larger than the overall average rate increases we’ve seen for the last few years (3.5% for 2022, less than 1% for 2021, and a slight decrease for 2020). But an overall average rate change only gives us a big picture; it doesn’t tell you how much your own plan’s premium will change or how much your net premium will change, and it also doesn’t account for the new plans that will be offered for 2023.
  • If the benchmark (second-lowest-cost Silver plan) premium in your area goes up, subsidy amounts will also go up. Conversely, if the benchmark premium goes down, subsidy amounts will also go down. This is independent of what your own plan’s price does. It can be possible, for example, for your plan’s premium to go up while the benchmark premium goes down (perhaps because a new insurer takes over the benchmark spot), resulting in a more significant increase in the actual amount you pay each month. This is why it’s so important to pay close attention to the information you receive from your insurer and the exchange, and to carefully consider all of your options during open enrollment.

As open enrollment draws closer, we’ll continue to update our open enrollment guide and our overview of each state’s marketplace.

You can start doing your plan shopping research now

If you already have marketplace coverage, keep an eye out for correspondence from the marketplace and your insurer. If you currently have off-exchange coverage, be sure to check your eligibility for subsidies in the marketplace; you might find that you can get a much better value by switching to a plan offered through the marketplace.

And if you’re currently uninsured or enrolled in non-ACA-compliant coverage, you’ll definitely want to look at the plan options that are available to you during open enrollment, and check your eligibility for subsidies. You might be surprised to see how affordable your coverage can be. The average enrollee is paying $133/month this year, and more than a quarter of enrollees are paying less than $10/month. Although specific plan prices change from one year to the next, this same overall level of affordability will continue in 2023.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

ACA sign-ups hit all-time high – with a month of open enrollment remaining

Key takeaways

The Biden administration announced last week that enrollment in ACA marketplace plans had reached an all-time high of 13.6 million* as of December 15, with a month still to go in the open enrollment period (OEP) for 2022 in most states.

That’s an increase of about 2 million (17%) over enrollment as of the same date last year, according to Charles Gaba’s estimate, and well above the previous high of 12.7 million recorded as of the end of open enrollment for 2016, which lasted until January 31 in most states. When OEP ends this coming January, enrollment in marketplace plans will exceed 14 million.

92% of marketplace enrollees in HealthCare.gov states received health insurance subsidies

In the 33 states using the federal exchange, HealthCare.gov (for which the federal government provides more detailed statistics than in the 18 state-based exchanges), almost all enrollees (92%) received premium tax credits (subsidies) to help pay for coverage – including 400,000 who would not have qualified for subsidies prior to passage in March of this year of the American Rescue Plan (ARP). That bill not only increased premium subsidies at every income level through 2022, but also removed the previous income cap on subsidies, which was 400% of the federal poverty level (FPL) ($51,520 per year for an individual and $106,000 for a family of four). In 2022, no enrollee who lacks access to other affordable insurance pays more than 8.5% of income for a benchmark Silver plan (the second cheapest Silver plan in each area), and most pay far less.

The enrollment increase is tribute to the huge boost in affordability created by the ARP subsidies. A benchmark Silver plan with strong Cost Sharing Reduction (CSR, attached to Silver plans for low-income enrollees) is now free at incomes up to 150%FPL ($19,320 for an individual, $39,750 for a family of four in 2022) and costs no more than 2% of income ($43/month for an individual) at incomes up to 200% FPL. The percentage of income required for the benchmark Silver plan  was reduced at higher incomes as well.  The ARP also provided free high-CSR Silver coverage to anyone who received any unemployment insurance income in 2021.

The American Rescue Plan boosted enrollment throughout 2021 and into 2022

The enrollment gains during OEP build on the enrollment surge triggered by the emergency special enrollment period (SEP) opened by the Biden administration on February 15 of this year, which ran through August 15 in the 33 states using HealthCare.gov, and for varying periods in the 15 states that ran their own exchanges in 2021. (There are now 18 state-based exchanges, as Kentucky, Maine and New Mexico launched new ones for 2022.)

The ARP subsidies came online in April (or May in a few state marketplaces). From February to August, 2.8 million people enrolled during the SEP, and total enrollment increased by 900,000 on net from February to August (as people also disenrolled every month, and many enrollees doubtless regained employer-sponsored coverage during a period of rapid job growth).

In addition, once the ARP subsidy increases went into effect, 8 million existing enrollees saw their premiums reduced by an average of 50%, from $134 to $67 per month. Enrollees’ premiums in 2022 should be similar to those of the SEP.

Enrollment growth was concentrated in states that have not expanded Medicaid

Enrollment increases during open enrollment – as during the SEP and the OEP for 2021 – were heavily concentrated in states that have not enacted the ACA expansion of Medicaid eligibility. There were 14 such states during most of the SEP and 12 during the (still current) OEP, as Oklahoma belatedly enacted the Medicaid expansion starting in July of this year, and Missouri in October.

In non-expansion states, eligibility for ACA premium subsidies begins at 100% FPL, while in states that have enacted the expansion, marketplace subsidy eligibility begins at 138% FPL, and Medicaid is available below that threshold. In non-expansion states, the marketplace is the only route to coverage for most low-income adults, and those who report incomes below 100% FPL mostly get no help at all – they are in the notorious coverage gap. In those states, about 40% of marketplace enrollees have incomes below 138% FPL – that is, they would be enrolled in Medicaid if their states enacted the expansion.

During OEP, these 12 non-expansion states account for 81% of the enrollment gains in the 33 HealthCare.gov states, and about two-thirds of enrollment gains in all states. The table below also shows gains over a two-year period, encompassing the effects of the COVID-19 pandemic.

Total plan selections in non-expansion states**
Dec. 15 open enrollment snapshots 2020-2022
State 2020 2021 2022 Increase 2021-2022 % increase 2021-2022 Increase 2020-2022 % increase 2020-2022
Alabama 159,820 168,399 205,407 37,008 22.0% 45,587 28.5%
Florida 1,912,394 2,115,424 2,592,906 477,482 22.6% 680,512 35.6%
Georgia 464,041 541,641 653,999 139,358 27.1% 189,958 40.9%
Kansas 85,880 88,497 102,573 14,076 15.9% 16,693 19.4%
Mississippi 98,868 110,519 132,432 21,913 19.8% 33,564 33.9%
North Carolina 505,159 536,270 638,309 102,039 19.0% 133,150 26.4%
South Carolina 215,331 230,033 282,882 52,849 23.0% 67,551 31.4%
South Dakota 29,330 31,283 39,292 8,009 25.6% 9,962 34.0%
Tennessee 200,723 211,474 257,778 46,304 21.9% 57,055 28.4%
Texas 1,117,882 1,284,524 1,711,204 426,680 33.2% 593,322 53.1%
Wisconsin 196,594 192,183 205,991 13,808 7.2% 9,397 4.8%
Wyoming 24,665 26,684 33,035 6,351 23.8% 8,370 33.9%
Non-expansion states 5,010,687 5,509,931 6,855,808 1,345,877 24.4% 1,845,121 36.8%
All HC.gov states 7,533,936 8,053,842 9,724,251 1,670,409 20.7% 2,190,315 29.1%

In the 39 states that have enacted the ACA Medicaid expansion (21 on HealthCare.gov and 18 running their own exchanges), far fewer enrollees are eligible for free Silver coverage. In expansion states, eligibility for marketplace subsidies begins at an income of 138% FPL, as people below that threshold are eligible for Medicaid. Nevertheless, enrollment growth in non-expansion states during the current OEP is substantial, increasing by about 755,000 year-over-year, or 13%.

The marketplace has been a pandemic ‘safety net’

The marketplace has been a bulwark against uninsurance during the pandemic, among low-income people especially and in the non-expansion states in particular. As shown in the chart above, enrollment in these 11 states increased by 1.8 million from Dec. 15, 2019 to Dec. 15, 2021 – a 37% increase. For all states, the two-year increase is in the neighborhood of 25% and will approach 3 million (from 11.4 million in OEP for 2020 to above 14 million when OEP for 2022 ends in January). That’s in addition to an increase of more than 12 million in Medicaid enrollment during the pandemic.

While millions of Americans lost jobs when the pandemic struck, and millions fewer are employed today than in February 2020, the uninsured rate did not increase during 2020, according to government surveys, and may even prove to have downticked during 2021 or 2022 when the data comes in.

While the government has not yet published detailed statistics as to who has enrolled during the current OEP, they did do so in the final enrollment report for the emergency SEP. During the emergency SEP, out of 2.8 million new enrollees, 2.1 million were in the 33 HealthCare.gov states. In those states, 41% of enrollees obtained Silver plans with the highest level of CSR, which means that they had incomes under 150% FPL (or received unemployment income) and so received free coverage in plans with an actuarial value of 94% – far above the norm for employer-sponsored plans.

The median deductible obtained in HealthCare.gov states was $50, which makes sense, as 54% of enrollees obtained Silver plans with strong CSR, raising the plan’s actuarial value to either 94% (at incomes up to 150% FPL) or to 87% (at incomes between 150% and 200% FPL). Two-thirds of enrollees in HealthCare.gov states paid less than $50 per month for coverage, and 37% obtained coverage for free.

At higher incomes, as noted above, 400,000 enrollees who received subsidies in HealthCare.gov states would not have been subsidy-eligible before the ARP lifted the income cap on subsidies (previously 400% FPL). The same is also doubtless true for several hundred thousand enrollees in state-based marketplaces. The SBEs account for a bit less than a third of all enrollment, but in those states, all of which have expanded Medicaid, the percentage of enrollees with income over 400% FPL is almost twice that of the HealthCare.gov states (12% versus 7% during the emergency SEP).

ARP: a patch for the coverage gap?

The strong enrollment growth in non-expansion states – an increase of 37% in two years – indicates that during the pandemic, some low-income people in those states found their way out of the coverage gap (caused by the lack of government help available to most adults with incomes below 100% FPL).  In March 2020, the CARES Act (H.R.748) provided supplementary uninsurance income of $600 per week for up to four months to a wide range of people who had lost income during the pandemic, likely pushing many incomes over 100% FPL. In 2021, anyone who received any unemployment income qualified for free Silver coverage, and during the emergency SEP, 84,000 new enrollees took advantage of this provision (along with 124,000 existing enrollees). That emergency provision is not in effect in 2022, however.

Marketplace subsidies are based on an estimate of future income. For low-income people in particular, who are often paid by the hour, work uncertain schedules, depend on tips, or are self-employed, income can be difficult to project. The desire to be insured during the pandemic may have spurred some applicants to make sure their estimates cleared the 100% FPL threshold. (Enrollment assisters and brokers can help applicants deploy every resource to meet this goal.)

For OEP 2022, the Biden administration raised funding for nonprofit enrollment assistance in HealthCare.gov states to record levels, enough to train and certify more than 1,500 enrollment navigators. This past spring, in compliance with a court order, the exchanges stopped requiring low-income applicants who estimated income  over 100% FPL to provide documentation if the government’s “trusted sources” of information indicated an  income below the threshold.

Comparatively weak enrollment growth in Wisconsin may support the hypothesis that under pressure of the pandemic, some enrollees in other non-expansion states are climbing out of the coverage gap. Alone among non-expansion states, Wisconsin has no coverage gap, as the state provides Medicaid to adults with incomes up to 100% FPL (rather than up to the 138% FPL threshold required by the ACA Medicaid expansion, which offers enhanced federal funding to participating states). In Wisconsin, those whose income falls below the 100% FPL marketplace eligibility threshold have access to free coverage. Wisconsin is the only non-expansion state that did not experience double-digit enrollment growth in OEP 2022 or from 2020-2022.

The future of increased subsidies is unclear

The American Rescue Plan was conceived as emergency pandemic relief, and its increased subsidies run only through 2022. President Biden’s Build Back Better bill, which passed in the House of Representatives but is currently stalled in the Senate, would extend the ARP subsidies through 2025 or possibly further.

The large increase in enrollment this year should add pressure on Congress to extend the improved subsidies into future years. Consumer response to the increased subsidies has proved immediate and dramatic. The ARP subsidy boosts brought the Affordable Care Act much closer than previously to living up to the promise of “affordable” care expressed in its name. Going backwards on that promise should not be seen as a politically viable or ethical path.

* * *

* Another million people are enrolled in Basic Health Programs established under the ACA by Minnesota and New York – low-cost, Medicaid-like programs for state residents with incomes under 200% FPL. Enrollment in these programs is on track to increase by 13% this year, according to Charles Gaba’s estimate.

** HealthCare.gov all-state totals are for the 33 states using the federal exchange this year. Source: Charles Gaba, OE snapshots as of mid-December, 2021-22, 2020-2021; see also CMS end-of-OEP snapshots for 2020, 2021, 2022

 

 

Andrew Sprung is a freelance writer who blogs about politics and healthcare policy at xpostfactoid. His articles about the Affordable Care Act have appeared in publications including The American Prospect, Health Affairs, The Atlantic, and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award. He holds a Ph.D. in English literature from the University of Rochester.

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The COVID SEP ended in most states. The ARP is still making premiums more affordable.

Although August 15 marked the end of a one-time COVID-related special enrollment period (SEP) for marketplace health insurance in most states, the enhanced subsidies that enticed millions of consumers are still available for many individual-market buyers (as noted below, the SEP is ongoing in some states).

The American Rescue Plan’s enhancements to the Affordable Care Act’s health insurance subsidies will continue long after the end of the COVID SEP. That means that when you do have an opportunity to buy coverage again – either through open enrollment or due to a personal qualifying life event – you’ll likely find individual health insurance much less expensive than you might have expected.

The ARP’s affordability provisions are still helping with premiums

As we’ve noted over the past few months, the American Rescue Plan included numerous provisions that make ACA-compliant plans more affordable than ever. The additional health insurance subsidy enhancements delivered by the ARP include:

All of those benefits continue to be available. The additional subsidies based on unemployment compensation continue through the end of 2021, while the other subsidy enhancements will be available through the end of 2022 (and possibly longer, if Congress extends them).

How popular are the ARP’s subsidy enhancements?

HHS reported last week that more than 2.5 million people had already enrolled in coverage during the COVID-related special enrollment period, and that another 2.6 million existing marketplace enrollees had activated their ARP subsidies.

Among all of the new enrollees, average after-subsidy premiums were just $85/month, as opposed to $117/month before the ARP’s subsidies became available. And across all of the new and renewing enrollees, about 35% had obtained coverage with after-subsidy premiums of less than $10/month.

That illustrates how substantial premium subsidies have become under the ARP. And again, nothing has changed about those subsidies: the special enrollment window has ended in most states, but the subsidies are still available if you’re eligible to enroll for the remainder of 2021 — and again during open enrollment for 2022, which starts November 1.

So if you’re in a state where enrollment is still open, or if you’re eligible for an individual special enrollment period in any state, it’s certainly in your best interest to see what plan options are available to you.

Enrolling as soon as you’re eligible will mean that you’re able to start taking advantage of the ARP’s subsidies right away, rather than having to wait for open enrollment and coverage that starts in 2022.

States where enrollment continues

Although the COVID SEP ended on August 15 in the states that use HealthCare.gov – and some of the states that run their own exchanges – enrollment is still actually ongoing in several states:

Enrollment if you have a qualifying life event

Not in one of those states? Special enrollment periods are available to individuals who experience a wide range of “life changes.” The most common trigger for a personal SEP is a loss of other coverage — usually job-based coverage.

(Note that there’s usually only a 60-day window to enroll in a new plan after losing other coverage. But HealthCare.gov is making an exception for people who lost their coverage as long ago as January 2020, if they missed their enrollment deadline because they were “impacted by the COVID-19 emergency.” People who need to utilize this flexibility have to call the marketplace directly to qualify for a special enrollment period on a case-by-case basis.)

In addition to a loss of coverage, there are also other situations in which you’ll qualify for a SEP. They include events such as the birth or adoption of a child, marriage (as long as at least one spouse already had minimum essential coverage), or even your grandmothered or grandfathered plan coming up for renewal.

More opportunities to enroll in ACA-compliant coverage

In addition to the states with ongoing COVID-related enrollment periods and the individual SEPs triggered by qualifying life events, there are other circumstances under which you might still be eligible to enroll in affordable health coverage:

Mark your calendar for 2022 open enrollment

If you don’t have an enrollment period now, be sure to mark your calendar for the start of open enrollment on November 1. That’s when you’ll be able to sign up for health coverage that will take effect in January, with coverage for essential health benefits and pre-existing conditions. During open enrollment, your medical history won’t matter, and neither will your coverage history.

And if you’re already enrolled in an ACA-compliant plan – or soon will be – you’ll still want to pay attention to open enrollment this fall. There are new insurers joining the marketplaces in many areas, which might have an unexpected effect on your premium subsidy. And even if you’re happy with the plan you have now, you might find that a different plan works better for the coming year.

Fortunately, the ARP’s subsidy enhancements will continue to be available for 2022. So if you’re eligible for subsidies – and most people are – your coverage for next year is likely to be quite affordable.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Why you should care about the August 15 special enrollment deadline

This spring and summer, more than 2 million Americans have already flocked to the health insurance marketplaces in their states, enticed by larger health insurance subsidies during a one-time special enrollment period (SEP). This SEP was created to address the COVID-19 pandemic and allow people to take advantage of the extra subsidies created by the American Rescue Plan (ARP).

But this limited enrollment opportunity is about to end in most states.

There are a few state-run exchanges where the COVID-related SEP has already ended, and a few others where it extends past August 15. But in most of the country, August 15 is the last day to sign up for 2021 coverage without needing to show proof of a qualifying life event.

How many people bought individual health insurance during the SEP?

HHS reported that 2.1 million people had already enrolled in coverage under this SEP by the end of June. This is two to three times higher than typical enrollment volume during that time of year (when a qualifying event would normally be necessary).

And enrollment likely increased even more in July, when the additional subsidies were made available for people who had received unemployment compensation in 2021.

What happens when the SEP ends on August 15?

Once the COVID/American Rescue Plan special enrollment period ends in your state, regular individual-market enrollment rules will apply. This means that you’ll need a qualifying event in order to enroll in coverage with a 2021 effective date.

The next open enrollment opportunity will start nationwide on November 1, but that enrollment period will be for coverage that takes effect January 1, 2022.

Why review your coverage before the SEP deadline?

Even if you’re already enrolled in a health plan through the marketplace in your state and you’re happy with your coverage, you should take a few minutes to double check everything before the SEP ends.

You can update your account to make sure that you’re receiving the enhanced subsidy amount available under the ARP. And if you need to switch plans to best take advantage of that subsidy, now’s your chance to do so.

This could be the case, for example, if you’re newly eligible for cost-sharing reductions because you’ve received unemployment benefits this year. (You need to be enrolled in a Silver plan to receive that benefit.)

It could also be the case if you’re currently enrolled in a plan that costs less than your new subsidy amount. You might find that you can upgrade your coverage and still have minimal premiums each month.

One thing to note: Before you make a plan change, make sure you understand whether deductible and out-of-pocket amounts will transfer to the new plan. They probably will, as long as you stick with the same insurer.

If you’re enrolled through HealthCare.gov and you don’t update your account to activate the new subsidies, you should still see your subsidy amounts updated as of September. HHS will be updating accounts in August to align the ARP’s subsidy structure with the income amounts that enrollees had previously projected for 2021.

This will be helpful in terms of giving people more affordable coverage for the final few months of the year, as opposed to having to wait until tax season to claim the extra subsidy. But there will be no opportunity to change your 2021 coverage at that point, unless you have a qualifying event.

Why should you enroll now if you haven’t already?

Millions of Americans are already enrolled in health coverage through the exchanges. But there are still millions more who are uninsured or enrolled in non-ACA-compliant coverage such as short-term health plans or health care sharing ministry plans.

If that’s you or someone you know, the current enrollment period is an excellent opportunity to make the switch to comprehensive major medical health insurance. And chances are, it’ll be less expensive than you’re expecting, especially if it’s been a while since you checked your coverage options.

There are several reasons for this:

Will my premiums be higher if I wait until November?

The current SEP is for 2021 coverage, whereas the open enrollment period that starts in November will be for 2022 coverage. If you buy health coverage now, you’ll be locking in your premiums for the rest of this year.

In January 2022, your premium is likely to change, though we don’t yet have a clear picture of exactly how premiums will be changing. Across the states where rate filings have been made public, we’re seeing insurers proposing mostly single-digit rate increases, although there have also been some decreases and a handful of larger increases proposed.

But since most marketplace enrollees receive premium subsidies, changes in benchmark premium prices (and the related changes in subsidy amounts) will play a significant role in how much your net premiums change for 2022.

Should I enroll before the deadline if I’m uninsured?

If you’re uninsured, there’s no benefit to skipping coverage now and waiting for the start of open enrollment. That will just guarantee that you won’t have coverage in place until January, and your 2022 premium will be the same either way.

If a sudden and serious health condition were to arise while you’re uninsured, you would have no way to obtain coverage that starts before January 2022 unless you experience a qualifying event.

When will my coverage start if I enroll during the SEP?

As is always the case, your coverage won’t take effect immediately. If you enroll during the current SEP in most states, your plan will take effect the first of the following month.

How long will my coverage last if I enroll by the SEP deadline?

ACA-compliant individual/family health plans renew each year on January 1. This is true regardless of when you sign up for the plan. So if you’re enrolling during the current SEP, the specifics of your health plan – including the monthly premium – will remain the same through the end of December. (Note that your after-subsidy monthly premium could change if your income changes later in the year.)

At that point, your plan will likely be available for renewal for 2022, but the premiums and the coverage details might change. So for example, the deductible and out-of-pocket limit might change, and your premium will almost certainly change – due to both the change in your own plan’s premium, as well as changes to your subsidy amount caused by fluctuations in the benchmark premium amount in your area.

If I enroll now, do I need to enroll again in November?

In most cases, coverage will auto-renew if you don’t log back into your account during the fall open enrollment to manually pick your coverage for 2022. But for a variety of reasons, auto-renewal is not in your best interest.

Instead, you should plan to spend at least a few minutes this fall comparing your options for 2022. Even though the open enrollment window is just around the corner (it starts November 1) the options for 2022 might be very different from what you’re seeing right now for the rest of 2021. Insurers are joining the marketplaces in many states, and existing insurers are expanding their coverage areas.

That can affect plan availability as well as subsidy amounts, so you’ll want to plan to spend some time reconsidering your options for 2022.

Is there any way to enroll in 2021 coverage after August 15?

In California, DC, New Jersey, New York, and Vermont, the COVID-related special enrollment period is already scheduled to extend past August 15. (In Vermont, this applies to uninsured residents. Current enrollees who wish to switch plans must do so by August 15.) But even in those states, it’s in your best interest to enroll sooner rather than later, in order to take advantage of the enhanced subsidies that are available under the American Rescue Plan.

After August 15, in most states, you’ll need a qualifying event to be able to sign up for coverage that starts prior to January 2022. You’ll have access to open enrollment this fall, but that coverage won’t take effect until January, even if you enroll right away on November 1.

What do I need to do if I’m getting a COBRA subsidy?

The American Rescue Plan’s COBRA subsidy continues through the end of September. Assuming your COBRA or state continuation coverage is eligible to continue past that date, you’ll have the option to keep it by paying the full premiums yourself as of October, or switch to a self-purchased individual/family plan instead.

If you want to switch to a self-purchased plan, you can enroll in a plan in the marketplace in September and have your new coverage take effect seamlessly on October 1. Although the COVID-related special enrollment period will have ended by that point, you’ll be eligible for a special enrollment period triggered by the termination of the COBRA subsidy.

If you’re choosing to switch to a new plan when the COBRA subsidy ends, you’ll want to pay close attention to details regarding any deductible and out-of-pocket costs you’ve accumulated this year. As a general rule, you should assume that those will reset to $0 when you switch to an individual market plan. But it’s possible that your insurer might allow you to transfer them if you switch to an individual plan offered by the same insurer that provides your group coverage.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

 

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Twenty-something, out of work, and losing sleep worrying about health insurance

It’s been a widely held conclusion in the health insurance industry and among health policy types that one of our biggest hurdles lies with the challenge of getting coverage for “young invincibles” – Americans old enough to vote but under 30. That label itself is tied to a widely held perception that – because of their youth – “twenty-somethings” believe they’re healthy enough that they simply won’t need all of the bells and whistles of comprehensive health insurance (any time soon, at least).

As an agent and an avid observer of health insurance trends, I know it’s not that simple: young adults, in many cases, are keenly aware of their need for comprehensive coverage. But – despite various federal and state efforts to make coverage more affordable and accessible (including provisions of the American Rescue Plan) – there are definitely barriers making it difficult for young adults to enter the individual health insurance market.

Last week, I spoke with Carolyn Kettig, a young woman who’s determined to get coverage but facing barriers that many young Americans face. Carolyn Kettig is a professional actor in New York, and has thus far maintained health coverage under her mother’s policy. But that will end this summer, when Carolyn turns 26. She shares her story with me here, and I’ve added my own commentary wherever it might help readers in similar situations understand their coverage options.

Before we begin, it’s worth noting that because Carolyn lives in New York, she has access to a Basic Health Program. New York and Minnesota are the only states that offer these programs, and they’re an excellent coverage option for people who are eligible to enroll. But if you’re not in New York or Minnesota, you’ve still got plenty of options.

That’s particularly true now that the American Rescue Plan has been enacted, making premium subsidies larger and more widely available. For many young people, the American Rescue Plan makes robust coverage much more affordable than it used to be. (Previously, it was common for young people to feel like their only truly affordable health coverage option was a plan with a deductible that may have felt impossibly high).

Louise: What’s your current insurance situation and how is it changing this year? What are your options for coverage?

Carolyn: I’m lucky enough to currently be covered by my mother’s health insurance. She has a very generous insurance plan and I’ve been privileged to, thus far, be fully covered. Unfortunately, because I’m turning 26, I’ll be losing coverage this spring.

As a professional actor, my early twenties were filled with countless side jobs that supported me as I sought acting work in New York City. None of these jobs ever came with healthcare benefits, which at the time was okay as I was covered by my mother’s plan. Three years ago, when I landed my first big theater job, I had the opportunity to join the actor’s union, which among many other wonderful things, provides working actors with comprehensive, affordable health insurance.

The only catch, and it’s a fairly large one, is that an actor must work a certain number of weeks in order to qualify. Even without a pandemic, finding steady work in the theater is difficult. Factor in a pandemic that shutters theaters for over a year and causes the union to hemorrhage money … needless to say, healthcare coverage in my industry has become a near impossibility.

I’m hopeful that live entertainment will return in a vaccinated world, but until then, I’m doing my best to make enough money to pay my bills. I’m grateful to be employed part-time as a program director for a teen program. My job has kept me afloat during this devastating time, but, unfortunately, does not come with healthcare benefits. I make very little money and live paycheck to paycheck, which leaves me relatively few options when it comes to insurance. I will most likely go with New York State’s Essential Plan, which is the best option for low-income people who make too much money to qualify for Medicaid.

Louise: The Essential Plan is New York’s Basic Health Program (BHP), which is available to people earning up to 200% of the poverty level. (For a single person in 2021, that amounts to $25,760.) The Affordable Care Act allowed for the creation of BHPs, but New York and Minnesota are the only states that have opted to establish them.

The Essential Plan provides robust health coverage with no monthly premium, and it has much lower cost-sharing than we typically see in the individual/family health insurance market. The Essential Plan is also being enhanced as of June 2021. Previously, some enrollees had to pay $20/month, and there was an extra premium for dental and vision coverage; dental and vision are now included at no cost.

Louise: How much is the need for coverage weighing on you and other people your age? 

Carolyn: I’ve lost sleep over this! It weighs on me heavily. Having grown up in New York, I have a long history with some of my doctors, most of whom will not accept my new insurance plan. This means that I will either be forced to find new doctors or pay hundreds of dollars out of pocket for routine check-ups.

I’m also aware that, even with insurance coverage, an unexpected hospital stay could cost me thousands of dollars. It makes me enraged to know that, in an emergency situation, I would avoid going to the hospital because of the cost.

Louise: The Essential Plan provides much more robust coverage than people may be used to seeing elsewhere. There is no deductible, emergency room visits cost $75, and inpatient hospital stays are only $150 per admission – and these fees are waived altogether for enrollees with income up to 150% of the poverty level, or a little more than $19,000 for a single person. This is better coverage than most people have even with higher-end employer-sponsored plans.

Carolyn: I know that I’m not alone in this. Especially since my generation is now living through a global health crisis, I think my peers are more aware than ever before of how broken our healthcare system really is. Moreover, as a white, cisgendered woman from a middle-class background, I’m cognizant of the privilege my identities afford me and deeply disturbed by the ways in which our healthcare system disregards and harms BIPOC, low-income families, LGBTQIA+ youth, and undocumented workers (many of whom are essential workers and yet have little access to healthcare coverage) among many others. Alongside the climate crisis and the fight for racial equality, I believe that healthcare reform will dominate the American political landscape for the next few decades.

Louise: I agree that our healthcare system is in need of extensive reform. The American Rescue Plan, enacted just last month, is the first major change we’ve seen since the Affordable Care Act was signed into law 11 years ago. It includes some substantial improvements designed to make health coverage more affordable and accessible.

But these improvements are temporary unless Congress takes additional action to make them permanent. And there are other issues, such as the ACA’s family glitch, and the Medicaid coverage gap that exists in the dozen states that have refused to expand Medicaid, that haven’t yet been fixed. Fortunately, lawmakers in Congress are continuing to push forward on these issues, and voters can reach out to their elected officials to express their opinions.

Louise: What do you see as challenges in this situation?

Carolyn: I’ve mentioned many challenges already, but I think chief among them is simply how confusing and difficult it is to make informed choices. Reading about insurance options requires learning an entirely new language and navigating nearly impenetrable websites.

Louise: For folks who are confused by the terminology and concepts that go along with health insurance, our glossary is a great resource. We’ve incorporated plenty of details, since that’s where the nuances always are. And we’ve focused on explaining things using plain language that’s easy to understand.

Help from the American Rescue Plan

Louise: Are you aware of the changes that the American Rescue Plan has made? Do you think it will make it easier for you to access coverage?

Carolyn: I’ve read a bit about the changes made by the American Rescue Plan and am thrilled that this administration is attempting to expand access to healthcare (even though I’d love to see more substantial reform). I don’t think that I will be impacted directly by the bill because I already live in a state that offers an affordable plan for people in my income bracket.

Louise: If you lived in another state, the American Rescue Plan would make your coverage more affordable. But you’re correct: Assuming your 2021 income doesn’t exceed 200% of the poverty level (about $25,760), you’ll be eligible for either The Essential Plan or Medicaid in New York, both of which are already robust coverage with no monthly premiums.

But for others in a similar situation who live elsewhere, the American Rescue Plan implements a variety of improvements that make it easier for young people to transition to their own coverage. Among other provisions, the American Rescue Plan:

Louise: What do you expect to happen with your coverage this summer? Do you have a good idea of the plan you’ll be on after you transition away from your mom’s coverage, or is it still up in the air?

Carolyn: Fortunately, through The Actors Fund, I have access to a professional who will guide me through the process of finding a plan, although I’m fairly certain I will end up on the Essential Plan.

I’ve been told to begin the process a couple months before I lose coverage, so that’s coming up very soon! I also have many friends who are in a similar situation or have already gone through the process, so I expect I’ll be texting them a whole lot. Even though I’m anxious about navigating the system on my own for the first time, I feel well supported as I approach this transition.

Louise: As you’re going through this insurance transition, what do you feel are the most important things for other people your age to keep in mind?

Carolyn: I think it’s important to do your research, seek out trusted professionals or peers to guide you, and ask a lot of questions. The system is designed to be confusing and ultimately benefit insurance companies, so I believe the more questions you ask, the better positioned you’ll be to advocate for yourself. Get acquainted with the vocabulary and make sure you know the basic terms (i.e. premium, deductible, out of pocket maximum, in-network, enrollment period). And if you’re uninsured for a period of time, know that you can find sliding scale clinics, sliding scale hospital services, and assistance paying for prescription drugs. Your health, both physical and mental, is of utmost importance!

Louise: The advice to seek out assistance and ask lots of questions is spot-on. There are no silly questions, and any question you might have about health insurance is certainly shared by plenty of other people.

Thanks to the American Rescue Plan, there has never been a better time to be transitioning to your own health insurance policy. And even if you’re not experiencing a qualifying event (such as aging off of a parent’s health insurance policy), there’s a COVID-related enrollment window that runs through August 15 in most states, giving people an opportunity to enroll and take advantage of the newly enhanced premium subsidies.

And in every community, there are navigators, enrollment counselors, and health insurance brokers who can help you pick a plan and answer any questions you might have. We also have an extensive collection of FAQs, including several that are specific to young adults.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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What are the deadlines for Obamacare’s open enrollment period?

Key takeaways

Q. What is the deadline to enroll in health insurance coverage in the individual market?

open enrollment 2021

Our 2021 Open Enrollment Guide: Everything you need to know to enroll in an affordable individual-market health plan.

A.  In most states, open enrollment for 2021 health plans ended on December 15, 2020. HealthCare.gov, which is the exchange platform that’s used by the majority of the states, tends to follow this schedule fairly closely, while the states that run their own exchange platforms generally offer slightly longer enrollment windows.

HealthCare.gov is being used in 36 states for enrollment in 2021 health plans (it was 38 states as of 2020, but Pennsylvania and New Jersey have both transitioned to their own enrollment platforms as of the fall of 2020; both have also opted to extend their open enrollment windows).

As described below, California, Colorado, and DC have opted to permanently extend their open enrollment periods. And most of the other fully state-run exchanges have opted to extend the open enrollment period for 2021 coverage, meaning it will continue past December 15.

Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event.

Native Americans and Alaska Natives can enroll year-round in plans offered in the exchange. Applicants who are eligible for Medicaid or CHIP can also enroll year-round.

States where open enrollment ended on December 15, 2020

In the following states, open enrollment ended on December 15 (although due to high call volume on December 15, HealthCare.gov had some callers leave their contact information; the exchange will call these people back over the next few days to complete their enrollment in 2021 coverage):

California, Colorado, and DC: Open enrollment has been permanently extended

California: November 1 – January 31. California enacted legislation in 2017 and again in 2019 that permanently establishes different enrollment dates within the state, both on and off-exchange. Open enrollment for 2021 health plans began November 1, 2020 and will continue through January 31, 2020. California’s enrollment schedule has varied in previous years, but this three-month window, from the beginning of November through the end of January, will be the permanent enrollment window going forward.

Colorado: November 1 – January 15. Colorado’s Division of Insurance has also permanently extended open enrollment. The state finalized regulations in late 2018 that call for an annual special enrollment period, running from December 16 to January 15, that is added to the end of open enrollment each year. So open enrollment in Colorado will effectively last 2.5 months for all future enrollment periods (November 1 to January 15). Plans selected between December 16 and January 15 must take effect no later than February 1 (for 2021 coverage, the exchange is giving people until December 18 to enroll, although they have to call the customer service center to request a January 1 effective date if they’re enrolling between December 16 and 18).

DC: November 1 – January 31. DC’s exchange board voted unanimously to permanently implement an open enrollment window that runs from November 1 to January 31.

Compare plans and rates in your ZIP code



Enrollment for 2021 health plans still open in ten states and DC

In addition to the three permanent extensions described above, open enrollment for 2021 health plans has also been extended in ten of the other 12 fully state-run exchanges. The extended deadline has already passed in Minnesota and Idaho, but open enrollment is still ongoing as of early January in ten states and DC, with the following enrollment deadlines:

The deadline for a January 1 effective date has passed in all of those states, so enrollments are currently (as of early January) being processed for a February 1 effective date.

Although open enrollment ended on December 15 in Maryland, the state announced in early January that it was opening a new COVID-related special enrollment period that will continue through March 15, 2021. Uninsured Maryland residents can use this window as an opportunity to enroll in coverage through Maryland’s exchange, but people who already have coverage cannot make plan changes during this window.

Minnesota‘s exchange and Idaho‘s exchange also extended open enrollment, but they ended December 22 and December 31, respectively. Idaho announced its extension on December 18 (three days after the original deadline had passed; this is the first time Idaho’s exchange has ever added a significant extension to open enrollment). Connecticut stuck with a December 15 deadline right up until the end of open enrollment, and then announced an additional month starting on December 16.

The only other fully state-run exchanges are in Vermont and Maryland, so they’re the only other states that had the option to extend open enrollment beyond the deadline that HealthCare.gov imposes. But both of them opted to end open enrollment on December 15. As noted above, however, Maryland is allowing uninsured residents a COVID-related special enrollment period that continues through March 15, 2021.

State-run exchanges have some flexibility on open enrollment schedule

The 2017 market stabilization rule noted that the November 1-December 15 open enrollment period would apply in every state in the fall of 2017. However, they also noted that some state-based exchanges — there are 13 of them as of 2020, and potentially 16 as of 2021 — might experience logistical difficulties in getting their systems ready for the new schedule on a fairly tight timeframe.

As such, the market stabilization rule clarified that state-based exchanges could use their own flexibility to “supplement the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.” Since then, the majority of the state-based exchanges have opted to extend open enrollment for most years.

For 2020 enrollments, Maryland, Vermont, and Nevada opted to keep the December 15 end date (and Idaho came very close to it; their reason for a one-day extension was that their call center isn’t open on Sundays, and the 15th fell on a Sunday. In general, Idaho residents should expect that the enrollment window will not be extended in the future, given how well they’ve adhered to that deadline for the last few years).

As we can see from the decisions in DC, California, and Colorado (to permanently extend open enrollment), and in Pennsylvania and Nevada (to extend open enrollment for 2021 coverage), states with their own enrollment platforms still have flexibility going forward. HHS has defined open enrollment as the window from November 1 to December 15, and that applies in every state. But state-run exchanges have the option to offer special enrollment periods before or after that window, in order to effectively extend open enrollment.

In addition to Pennsylvania, New Jersey is expected to also have state-run exchange platform by the fall of 2020; New Mexico plans to join them in the fall of 2021, and Maine might do so as well by the fall of 2021. Oregon may join them in the future as well. Fully state-run exchanges are the only ones with the ability to extend open enrollment on their own (in the other states, the decision has to come from CMS, since the extension has to be issued via HealthCare.gov), and most of them have been choosing to do so each year.

Outside of the open enrollment window, enrollment is only available with a qualifying event

After open enrollment ends, people can only purchase coverage if they have a special enrollment period triggered by a qualifying event such as:

Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies, and special enrollment periods are necessary in order to enroll at any other time of the year.

In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods, and they further tightened the rules in 2017, as part of the market stabilization rule. As a result, the rules are being followed much more closely than they were in previous years, and in most states, anyone enrolling during a special enrollment period is required to provide proof of the qualifying event that they experienced.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post What are the deadlines for Obamacare’s open enrollment period? appeared first on healthinsurance.org.

 

Maddox Insurance Agency

Insurance Agency in Memphis, Tennessee

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2151 Courtland Place | Memphis, TN 38104

Licensed in Tennessee, Mississippi & Arkansas

Contact

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Lee.Maddox@maddoxinsured.com

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