Affordable Care Act (ACA) Health Insurance Open Enrollment is in full swing, and if you haven’t been keeping up with all the changes, you may be pleasantly surprised about some of the latest enhancements and changes designed to save money while expanding coverage to millions more Americans.
Many people will see lower premiums through 2025, thanks to provisions in the Inflation Reduction Act, which extends financial help first put in place by the American Rescue Plan. On average, about 15 million consumers who receive premium tax credits through the federal insurance exchange save about $800 a year, according to Xavier Becerra, secretary of the Department of Health and Human Services (HHS). Some 4.6 million more people received financial help in 2023 compared to 2021, he notes.
“Plans are more affordable than they’ve ever been. And it’s easier today to compare your options than it’s ever been. So not only are you going to be saving more money, but you’re going to be saving money because you’re able to choose the best plan that really fits your family’s needs ,” he tells Fortune. “In fact, four out of five people will qualify for plans that cost as little as $10 per month.”
That can be hard to believe, since a Kaiser Family Foundation analysis found that unsubsidized plan premiums will rise by an average of 5% for 2024 for the benchmark second-lowest-tier silver plans. However, the Inflation Reduction Act extended premium subsidies and eliminated the “subsidy cliff,” which capped financial help at 400% of federal poverty level ($120,000 for a family of four) through 2025.
Additionally, more insurers are entering new markets, compared with those leaving the marketplace, KFF found. That means more choices for consumers, Becerra says. “They should also make sure it’s clear what qualifies them for the subsidies.” A quick check of your family’s income and household size can help you estimate what financial assistance you may be entitled to.
Picking the right plan is easier this year
Choosing a plan can be confusing and time-consuming, but the Secretary says healthcare.gov is trying to take some of the guesswork out of the process. Current rules require insurers to offer standardized plan options on the federal and state exchanges, and to offer no more than four qualified plans under each metal level in 2024, which may include dental and/or vision benefit coverage. Insurers will be limited to just two options per metal level in plan year 2025 and beyond. Consumers will also find a more streamlined layout on healthcare.gov, making it easier to compare plans side by side.
Becerra stresses that most preventive care, including vaccines, is covered under all plans with no out-of-pocket costs. “There will be no cost if you’re insured under the marketplace plan for your vaccines and we’re doing everything we can to make sure that something like the COVID vaccine is available without charge, even though it’s now commercial.”
If you’re not currently on the exchange or have a high-deductible Bronze plan, experts at healthinsurance.org suggest you recheck your options, since you may now be eligible for a subsidy, even if you didn’t previously qualify. If you are eligible, you will pay no more than 8.5% of your household income in premiums. Some state-based exchanges also offer their own subsidies.
HHS is also working to train more primary care physicians, to make it easier for more people to receive basic health services, including behavioral and mental health, according to Becerra.
“We’re doing quite a bit to work with states to ensure that we have the community of primary care physicians that we need, because they’re the front door to health care; and that they’re being trained in behavioral health, mental health, substance use disorders as well,” he says. ”We are desperately in need of health professionals who understand behavioral health well, and we want them to be able to start helping you the moment you walk through the front door, not only when you get referred to a specialist.”
One approach is to strengthen the Commissioned Corps of the US Public Health Service. In exchange for working in underserved areas for five or more years, medical students and some other health professionals can receive student loan forgiveness.
Meanwhile, if you’re still searching for the right plan for you or your family, Secretary Becerra says the first step is visiting healthcare.gov to find out whether you qualify for a subsidy. He also suggests:
- Don’t automatically re-enroll in your existing plan. There are more choices and options than before, and with an enhanced premium subsidy or a cost-sharing subsidy, a more comprehensive plan may be more affordable than you think.
- Don’t just compare the cost of premiums. Look at total yearly costs, such as prescription drug coverage and specialist visits. A plan with lower premiums could actually end up costing you more in the long term if medications or copays for specialist visits are higher.
- Reach out to a marketplace call center representative or marketplace navigator if you’re confused by the choices and financial forms. This free service connects you with trained representatives who can help you select the right plan for your needs and determine whether you qualify for a subsidy. Navigators are offering more nontraditional appointment hours, bringing in-person assistance to consumers through the use of mobile units, and offering virtual appointments aimed at reducing transportation barriers, making it easier for consumers to get help signing up for quality, affordable health care coverage and reduce health disparities in communities across the country, according to the Centers for Medicare and Medicaid Services. You can also find local assistance through a broker or agent.
- Most states also offer free assistance through their exchanges; trained representatives can help you sort through the choices, figure out your financial eligibility, and sign you up for health insurance in one phone call.
Keep these deadlines in mind
- Open enrollment for 2024 coverage on the federal exchange runs through Jan. 15, 2024 (or Jan. 16, 2024 due to the federal holiday on Jan. 15).
- For coverage beginning on Jan. 1, 2024, you need to enroll by Dec. 15, 2023, on the federal exchange. In states with their own exchanges, you may have a bit more time, since they can set their own enrollment deadlines.
- Some special enrollment periods (the time outside of open enrollment) may be extended if you were disenrolled from Medicaid. Those with low incomes can sign up for Marketplace coverage or change plans throughout the year.
