Open enrollment for plans available through the Affordable Care Act (ACA) Marketplace has officially begun, and this year’s sign-up period will have some new factors that may make it easier for more people to sign up for coverage.
Prospective customers now have until Jan. 15 to sign up for ACA insurance plans, though those who want coverage at the start of the calendar year should sign up by Dec. 15. Last year’s enrollment reached record numbers — 15.7 million — and this year’s is expected to exceed that rate.
“We're already at a record high in terms of ACA Marketplace enrollment and there's really been a couple of years of record highs in a row,” said Cynthia Cox, KFF vice president and director of the program on the ACA.
“A lot of that was driven by the enhanced subsidies. The pandemic also might have motivated more people to get or maintain their health coverage.”
Several factors could drive up this year’s enrollment, including the ongoing disenrollment of beneficiaries from Medicaid, new sign-up mechanisms set up through healthcare.gov and more engagement from insurers.
Flexible timelines
Most people enrolling in ACA coverage will have to sign up by December or January, but some who were disenrolled from Medicaid this year after the end of the COVID-19 public health emergency will have until July 31 to enroll, with some likely already having done so.
The Centers for Medicare & Medicaid Services set up a temporary “Medicaid Unwinding Special Enrollment Period” this year in anticipation of widespread disenrollments. This special enrollment period began March 31.
More than 10 million people have been disenrolled from Medicaid since the unwinding period began, according to KFF. Many are still considered eligible for Medicaid but may have been booted off due to administrative issues like a missing address or failure to complete the necessary paperwork.
“A relatively small share of those people are moving on to the Marketplace because a lot of the people who are losing Medicaid are losing it for procedural reasons,” Cox noted. “So, if they reapply for Medicaid, they might find that they're still eligible for Medicaid. Additionally, some people losing Medicaid coverage — especially if they lost eligibility for that Medicaid coverage — it might be because, you know, they got Medicaid early in the pandemic when they got laid off and then they've since regained employment and got employer coverage.”
Marketplace applicants this year will also have more time to submit documents verifying their income. This data is automatically checked through sources like the IRS and Social Security, but if income cannot be verified, applicants are normally asked to provide the necessary information within 90 days.
This year, people will have up to 150 days to submit this information.
New automatic reenrollment policy
Those who are already enrolled in a plan and don’t act to renew or change their coverage will be automatically reenrolled on Dec. 16 in many cases. This has always been the protocol for ACA plans, but it usually meant a person was reenrolled in the plan they were already on.
This year, the process will be slightly different with healthcare.gov checking to see if enrollees on Bronze plans — which have the lowest monthly premiums — are eligible for cost-sharing reduction plans at the Silver level, the next tier up.
Deductibles and out-of-pocket costs on Silver plans are usually lower than Bronze plans. Eligibility for cost-sharing reduction plans extends to those who earn an income that is at or below 250 percent of the federal poverty level.
“They've just tinkered with the algorithm this year in an effort to try to make sure that as many people as possible are getting all the benefits they qualify for,” said Louise Norris, policy analyst for healthinsurance.org.
Norris called this “a good change” but cautioned people to not rely on auto reenrollment.
“No matter what, it's in your best interest to go in there and look at the plans that are available and pick your own instead of relying on an algorithm to pick a renewal plan for you,” she advised.
Stronger insurer participation
KFF has noted there will be more insurance providers entering new markets this year than exiting. According to Cox, this is because insurers have figured out how to be profitable with ACA plans.
“After the market became more clearly profitable, then you started seeing insurers coming back in or new ones entering. And so this year, you notice kind of a continuation of that trend that's been going on for the last few years,” said Cox.
While applicants may appreciate having more options, Cox noted this could also be a detriment.
“It's also getting to a point, though, where there might be too many choices for people,” Cox said. “It's like this kind of balance where you want there to be enough insurers participating that there's meaningful competition on the market. And, of course, at least one insurer participating so that the market at least exists.”
Cox noted a handful of insurers may end up offering multiple plans for each level — Bronze, Silver, Gold and Platinum — meaning applicants will open healthcare.gov to find hundreds of different plans available to them.
Many people accustomed to getting coverage through their employer may choose between two different health plans, so several hundred options may prove to be “daunting” or “intimidating,” said Cox.
Insurers have learned to become more profitable on the ACA Marketplace, in part, by offering plans with more restrictive networks — HMOs and EPOs — to contain their expenses.
Norris noted that Marketplace plans have been trending toward more restrictive networks but said network adequacy rules that are in place should ensure people can find the providers they need in their network.
“I would say from a consumer perspective, the thing to keep in mind is just always check,” Norris said. “Even if you're renewing the same plan, don't assume that your doctors are still going to be in network next year.”
The ACA’s Navigator program — which raises awareness of Marketplace plans and consumers in filling out their applications — is also available for those who may need assistance in the more crowded market.
The Biden administration increased investments into these programs after the prior administration cut funding.
“It is tricky if you don't know your way around the system and know what questions to ask and what to look for,” Norris said. “I do think the Navigator program is pretty robust at this point. But it has been robust for the last couple of years as well.”
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