At the annual Affordable Care Act open enrollment period, individuals can purchase health coverage through state and federal marketplaces. The open enrollment period runs annually between November 1 and January 15 (and was permanently extended in 2021).
Increased subsidies instituted under the American Rescue Plan Act and extended in August by the Inflation Reduction Act have made marketplaces more affordable for millions of Americans; however, premium prices continue to increase.
Open Enrollment Period
At least 16 million Americans have enrolled in coverage through state and federal Affordable Care Act health exchanges this year, including nearly 3 million newcomers to the marketplace. Unfortunately, however, their eligibility for premium assistance could be redetermined this spring, leading to possible interruption in coverage. Congress recently passed a spending package which included a special enrollment period specifically dedicated to those affected by redetermination so they have another opportunity to find an insurance plan on the marketplace.
The annual open enrollment period for the health insurance marketplace runs from November 1 to January 15. If you need to make changes outside this window due to a qualifying life event, special enrollment periods may apply. Otherwise, during open enrollment period you can select plans that fit both your needs and budget, while applying for Medicare, Medicaid, and CHIP using the marketplace.
Special Enrollment Period
At any point during open enrollment period, consumers can sign up for individual and family health plans through state and federal Affordable Care Act marketplaces, such as Health Reimbursement Arrangements or Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs). They also have the option of enrolling in Medicaid or Children’s Health Insurance Program (CHIP).
Millions of Americans will take advantage of enhanced premium tax credits this year to significantly lower monthly insurance costs and record-low uninsured rates, helping many find affordable plans with low deductibles and copays.
Consumers experiencing certain life-altering events may qualify for a special enrollment period (SEP), such as losing job-based coverage, marrying someone new, moving to a new area, having a baby/adopting, or experiencing significant income changes. An SEP typically lasts 60 days from when it starts on your application – with low-income consumers receiving this benefit first offered back in 2022 continuing until 2025.
If you don’t make changes during the Open Enrollment Period, your next opportunity to select a plan will be January 15, 2024. However, Special Enrollment Periods or qualifying events could allow for Marketplace coverage; alternatively you could apply through Short Term Health Insurance plans, employer-based plans, Medicare, Medicaid and CHIP coverage options.
The Affordable Care Act Marketplace offers Qualified Health Plans (QHPs) from 12 insurers across four metal tiers – platinum, gold, silver and bronze – each providing free preventive care, hospital stays, emergency care and doctor services; comprehensive reproductive health services; maternity coverage; mental health and substance abuse services; prescription drugs as well as rehabilitative and habilitative devices and services.
The Marketplace estimates the costs associated with your plan based on your anticipated income and household size; the actual costs will only become clear during Open Enrollment when you submit an application and select one or more plans.
This year, unsubsidized silver plan premiums will rise by about 4% nationally due to medical inflation and new rules limiting cost sharing subsidies for family coverage. Under these new rules, family coverage no longer meets affordability requirement of 9.12% of income, making individuals ineligible for marketplace subsidies.
With lower costs and improved subsidies available this year, it seems likely that overall marketplace enrollment will remain near its record-setting high levels.
Individual Marketplace health plans in Indiana can only be provided by licensed sellers like Anthem, CareSource, Cigna, MHS/Ambetter and US Health and Life dba Ascension Personalized Care. These companies are the sole ones authorized to sell individual market insurance policies here.
These companies employ certified enrollment assistors who offer personalized help with Marketplace application processes, program eligibility reviews, financial aid estimates and cost comparisons as well as plan comparisons. Their resources can be found both offline and online.