Open enrollment is here for Affordable Care Act (ACA) marketplace health insurance plans, and there are important, new changes that can have an impact on your health and your finances. But you don’t necessarily want to just take the path of least resistance and re-enroll in what you had last year.
“on a plan can be hard, but it’s a good idea to actively choose a plan each year,” says Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation, an organization in Washington D.C. that helps promote equitable access to affordable healthcare.
This is especially true if your health needs have changed in the past year. Because there are more options in the ACA marketplace this year, you might miss out on the best plan for you if you simply keep the same plan.
You’ll be happy to hear that changes to both the national marketplace and state-run exchanges are making plans more affordable. There’s also more time to enroll than in previous years, so take advantage and start researching your options now. Doing so may help you save money and help you and your family find the right coverage for your needs.
5 key changes to the ACA marketplace that you need to know about:
1. You have more time to enroll. You now have nearly 11 weeks to sign up for a plan or make changes to your coverage. (The enrollment period in recent years had been just six weeks.) Open enrollment for the federal marketplace started on November 1, 2021, and will run through January 15, 2022.
Marketplaces run by the states may have even longer open enrollment periods. For example, New York, California, New Jersey, Rhode Island, Washington, and the District of Columbia all have deadlines of January 31.
One important note of caution: If you need health coverage starting on January 1—maybe you’re covered now by a plan that runs out at the end of this year—be sure you double-check the sign-up cut-off, which is likely to be earlier than the general end date of the open enrollment period. On the federal marketplace and in many states, that deadline is December 15.
2. There are more plans with lower premiums. You may be pleasantly surprised by the number of choices you have when you browse the marketplace this time around. Most enrollees will have six to seven plan options available to them this year, as opposed to the four or five they did last year, according to a report from the Centers for Medicare & Medicaid Services (CMS).
Another beneficial change: lower estimated plan costs. The same CMS report estimates that average premiums for benchmark plans will decrease by 3% in 2022. After subsidies, 4 out of 5 enrollees may find health coverage for less than $10 a month.
3. There are more available subsidies. Maybe the most dramatic shift in marketplace plans this year is enhanced premium subsidies across income levels, a change made under the American Rescue Plan that was signed into law by President Biden in March. “The good news is that subsidies are expanded, which means you may qualify even if you haven’t before,” says Donovan.
If you make between 100% and 150% of the Federal Poverty Level (FPL), you may be eligible for zero-premium coverage. (In the past, you may have been required to pay 2% of your income toward insurance premiums.)
How does that translate to actual dollars? For a family of two, for example, the FPL is $17,420. (Note: The FPL in Alaska is $16,090 and Hawaii, $14,820.) So if you make that amount or up to $26,130 per year, you could pay no premiums at all next year.
Doing the math for a family of four, you could be premium-free if you make between $26,500 and $39,750. (To calculate whether you qualify for a subsidy, you can use a marketplace calculator like the one inside HealthMarket’s online shopping experience.
Higher earners are now more likely to qualify for a subsidy too. In 2021, people who made over 400% of the FPL—about $51,000 for an individual and $104,800 for a family of four—were not able to get subsidized coverage and sometimes went outside the marketplace for a plan.
But now if you’re one of these higher-earning individuals, you may be eligible for a more affordable plan than last year. More good news if you’re in this income bracket: The amount you pay for benchmark-plan premiums is capped at 8.5% of your income.
That can translate to significant savings. According to the CMS, a family of four with an income 500% above the federal poverty line—about $131,000—would have paid $1,064 in premiums per month for a bronze plan prior to the American Rescue Plan. Now eligibility for subsidies would cut the monthly payment almost in half, to $561 a month.
4. There are more state-run marketplaces. Not every state participates on the federal exchange. In 2022, Kentucky, Maine, and New Mexico have created new state-run marketplaces, joining California, Colorado, Connecticut, the District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and Washington.
If you live in one of those places, remember that each state may have slightly different open enrollment periods and sign-up deadlines. Don’t assume the dates for Healthcare.gov coverage apply to your state—you may miss out on coverage. Find your state’s deadline on this list.
5. There’s more help to enroll. This year, grant funding was significantly increased for navigator programs for Healthcare.gov enrollees. Navigators are people (or organizations) who are trained to help you sort through the sometimes-complex healthcare marketplace and understand your options. They can help you enroll in the plan you decide on too.The service is often offered through community-based nonprofits and call-center assistance programs. State-run exchanges may have unique assistance programs that can help you get your questions answered and help with any enrollment issues or questions that come up.
It’s important to note, however, that navigators are not allowed to make recommendations for health insurance, unlike agents, who can take into account your health needs and, based on their experience and knowledge, suggest plans that might benefit you. In addition, agents are state licensed, whereas navigators are not.
Ready to get started? If you’re in the market for a new plan, HealthMarkets can help you search for the right health insurance at no cost to you. Start reviewing your options online today, or call (800) 304-3414 to speak with a licensed insurance agent.