It's That Time Again! Here's 13 important things to remember before you #GetCovered for 2023!

Tuesday, November 1st is the start of the official 2023 #ACA Open Enrollment Period (OEP) for anyone who needs quality, affordable healthcare coverage.

The 2023 OEP is the best ever for the ACA for several reasons:

  • Second, because several states are either expanding or retooling their own state-based subsidy programs to make ACA plans even more affordable for their enrollees;

There's also expanded carrier & plan offerings in many states/counties, and as always, millions of people will be eligible for zero premium comprehensive major medical policies.

If you've never enrolled in an ACA healthcare policy before, or if you looked into it a few years back but weren't impressed, please give it another shot now. Thanks to these major improvements it's a whole different ballgame.

Here's thirteen important things to know when you #GetCovered for 2023:


1. DON'T DELAY; GET COVERED SOONER RATHER THAN LATER!

The official 2023 Open Enrollment Period runs from November 1st through January 15th in most states, but there are some exceptions at both ends. Idaho already launched their OEP on October 15th, while New York doesn't kick theirs off until November 16th. At the opposite end, several states have later final deadlines, including California, DC, Massachusetts, New Jersey, New York and Rhode Island...but there's also two states which end their OEPs earlier (Idaho and Maryland).

In prior years, one or more state exchanges almost always announces some sort of deadline extension for either January 1st coverage, February 1st coverage or both...but I wouldn't count on that; make sure you visit the exchange for your state as early as you can so you can make sure you're squared away for the new year!

Here's a summary of the deadlines to sign up for 2023 ACA healthcare coverage, and when that coverage will start:

If you want to enroll outside of the dates above, you may have to qualify for a Special Enrollment Period (SEP). Qualifying Life Experiences (QLEs) which make you eligible for a SEP include things like:

  • Losing employer-sponsored healthcare coverage
  • Getting married or divorced
  • Giving birth/adopting a child
  • Turning 26 and having to move to your own policy
  • Losing eligibility for Medicaid or CHIP
  • Moving out of your current rating area

However, if your income is less than 150% FPL, or if you're a member of a federally-recognized Native American tribe or are an Alaskan Native, you can enroll in an ACA exchange plan year-round regardless of what state you live in.

In addition, if you're eligible for Medicaid; the Children's Health Insurance Program (CHIP); Massachusetts' "ConnectorCare" program; Minnesota's "MinnesotaCare" program; or New York's "Essential Plan" program, you can enroll year-round.


2. ONLY ENROLL VIA AN OFFICIAL ACA HEALTH EXCHANGE OR AN AUTHORIZED ENROLLMENT PARTNER.

ACA financial subsidies are available to millions more Americans than they used to be...but they're only availalble to eligible enrollees who sign up through an official ACA exchange or an authorized 3rd-party exchange entity, known as an Enhanced Direct Enrollment (EDE) entity.

There's a ton of junk plans and scam artists out there, especially these days. Fraudulent plans are being hawked endlessly via both robocalls, spam emails and fly-by-night websites. If you're enrolling online, make sure to use one of the official ACA exchange websites:

Note: While you could also enroll in ACA-compliant policies directly via the insurance carrier's website I STRONGLY recommend only using one of the exchange websites listed above. You have to enroll on-exchange to be eligible for financial help!

On a related note...


3. IF YOU'RE ENROLLED OFF-EXCHANGE, SEE IF YOU CAN ENROLL ON-EXCHANGE INSTEAD.

As far as I can figure, somewhere between 2.3 - 3.0 million Americans are still enrolled in OFF-exchange, ACA-compliant individual market policies. Historically, the main reason for this has been that they didn't qualify for financial help, so didn't see the point of filling out any additional forms by enrolling on-exchange.

The reality, however, is that some of these off-exchange enrollees may have been eligible for ACA subsidies after all if they had enrolled in the exact same plan but had done so via their ACA exchange instead of directly through the carrier...and thanks to the American Rescue Plan's dramatically improved & expanded subsidy formula, the odds are that as many as half or more of those 2.3 - 3.0 million people will be leaving hundreds or thousands of dollars on the table if they don't make the switch!

Again: If you weren't eligible a few years ago or even last year, check again this year; you may be in for a very pleasant surprise!

On average, full-price/unsubsidized ACA premiums were essentially flat in 2021 nationally. In 2022 they went up around 3.5% overall; for 2023, it looks like they're going up around 7% overall, with wide ranges from state to state, carrier to carrier and plan to plan.

I can't repeat this enough times: If you enroll off-exchange, there's a good chance you'll be leaving potentially thousands of dollars in savings on the table.


4. MILLIONS OF AMERICANS CAUGHT IN THE "FAMILY GLITCH" MAY NOW BE ELIGIBLE FOR UP TO THOUSANDS OF DOLLARS IN SAVINGS!

As I explained here, due to how the U.S. Treasury Dept. and the Obama Administration interpreted an obscure provision of the Patient Protection & Affordable Care Act regarding employer coverage affordability thresholds, there are several million people who really should have been eligible for ACA subsidies for years now but who haven't been.

The very short version of the problem is this:

  • Let's say you have healthcare coverage for yourself only through your employer, and you only have to pay, say, 5% of your annual household income for your premiums
  • However, you're married with two kids, and adding each of them would tack on another 5% in premiums apiece. Covering all four of you would cost 20% of your annual household income, ouch.
  • Because your individual premiums come in at less than ~9.12% of your income, the rest of your family doesn't qualify for ACA subsidies even though the premiums for the family as a whole costs far more than the maximum amount you'd otherwise have to pay for an ACA exchange plan.

Thankfully, as of October 2022, this is no longer an issue for many of these folks (there's still some households which wouldn't qualify due to some even more wonky regulatory language, but most of them should). The Kaiser Family Foundation estimates that around 5.1 million Americans fall into the "family glitch" zone, but that doesn't mean all of them would necessarily be better off with an ACA exchange plan even with the subsidies for provider network or other reasons.

The Biden Administration estimates that perhaps 1.2 million people will take advantage of the regulatory change in the short term; you could be among them, so make sure to visit your states ACA exchange and look into it!


5. OTHERS WHO DIDN'T USED TO QUALIFY FOR FINANCIAL HELP NOW QUALIFY AS WELL!

Before I get into this, it's important to understand what the Federal Poverty Line (or FPL) is. 100% FPL depends on how many people live in your household. For a single adult with no dependents, it's $13,590/year; for a family of four, it's $27,750/year. These amounts increase somewhat each year to account for inflation.

Prior to the American Rescue Plan (and later, the Inflation Reduction Act), ACA subsidies were limited (on a sliding income scale) to enrollees earning between 100 - 400% FPL (roughly $54,000/year for one person or $111,000/year for a family of four this year). If you earned more than 400% FPL, however, you had to pay full price no matter how expensive the premiums were.

Thanks to the ARP (and later the IRA), however, the ACA's infamous "Subsidy Cliff" has been killed at last (through at least the end of 2025, anyway; I'm still hoping this correction will be made permanent).

This means two extremely important things:

  • First: Households earning less than 400% of the Federal Poverty Line (FPL) are now eligible for more generous financial assistance than they were pre-ARP/IRA.
  • Second: Millions of people who earn more than 400% FPL, who weren't eligible for any financial help pre-ARP/IRA, are now eligible for financial help after all, which can mean thousands of dollars in savings for many of them.

Here's a table laying out the percent of your household income which you're restricted to paying for the benchmark Silver plan in your area for 2023:

I should also follow up on something I posted a few paragraphs earlier. I noted that the official FPL threshold amounts increase each year to account for inflation. This is one of the few areas where high inflation rate we're experiencing nationally actually has a positive effect (sort of). From 2021 to 2022, 100% FPL for a single adult went up less than 1%, from $12,760 to $12,880. 400% FPL for that same single adult therefore increased by $480/year to $51,520.

For 2023, however, 100% FPL is jumping by a whopping 5.5% to $13,590...an increase of $710/year. 4x that is $54,360...an increase of over $2,800/year. All of this means that people earning the same amount in 2023 as 2022 will be eligible for even more generous financial subsidies (or alternately, households which used to earn a little too much to be eligible for any subsidies will now qualify after all.


6. TEN STATES ARE OFFERING *ADDITIONAL* SAVINGS *ON TOP OF* THE EXPANDED ARP SUBSIDIES!

In addition, several states have special programs and/or additional savings on top of the enhanced federal subsidies which can save many lower-income enrollees even more!

  • Colorado: Thanks to the states Health Insurance Affordability Fund, enrollees earning between 150 - 200% FPL will receive additional help to reduce out-of-pocket expenses (deductibles, co-pays, etc.) reduced even beyond the federal Cost Sharing Reduction (CSR) subsidies. In addition--new for 2023--enrollees earning up to 300% FPL who otherwise wouldn't qualify for federal subsidies (such as undocumented immigrants) will be eligible for state-based premium subsidies as well.
  • Connecticut: If your household income is up to 175% FPL, you're likely eligible for their "Covered Connecticut" program, which as far as I can tell covers 100% of ACA premiums and cost-sharing as long as they enroll in a Silver exchange plan.
  • Maryland and at least one of the enrollees in your household is between the ages of 18 - 34 and your household income is below 400% FPL, they may qualify for additional premium savings via the states new Young Adult Premium Subsidy program.
  • New Mexico is launching their Health Care Affordability Fund starting in 2023! This will reduce benchmark Silver premiums for enrollees earning up to 200% FPL down to $0, while also reducing them for enrollees earning between 200 - 400% FPL.
  • New York: If your household income is below 200% FPL, you're likely eligible for the Essential Plan which is similar to MinnesotaCare, except as of 2023, no enrollees have to pay any premiums.

Note: California had their own state-based subsidy program for awhile which was supposed to be continued/retooled, but it appears to have been put on the back burner for now via a veto by Gov. Newsom.


7. MILLIONS OF PEOPLE ARE ELIGIBLE FOR FREE "SECRET PLATINUM" PLANS (LABELED AS SILVER)!

As I explain in detail here, if your household earns less than 200% FPL in any state (around $25,500/yr if you're single; around $52,000/yr for a family of four), make sure to choose a SILVER plan! Thanks to the ACA's Cost Sharing Reductions (CSR) system, you'll receive additional financial help which will lower your deductible, co-pays and coinsurance so much it effectively transforms Silver plans into Platinum plans!

Furthermore, thanks to the expanded ARP/IRA subsidies, the premiums for these "Secret Platinum" plans are literally nothing for anyone earning under 150% FPL and max out at just 2% of your annual income from 150 - 200% FPL! (As noted above, in some states you may not have to pay a dime in premiums for a Silver plan even if your income is as high as 200% FPL).


8. VIA SILVER LOADING, SOME SUBSIDIZED ENROLLEES MAY BE ABLE TO GET FREE GOLD PLANS!

As I explained here, due to a long, strange series of events, subsidized enrollees earning 200% FPL or more may end up getting a Gold plan for less than Silver, or a Bronze plan for free!).

In fact, last year David Anderson ran an analysis and finds that there are 820 counties where at least one Gold plan is priced lower than the benchmark Silver plan even at full price! Once you add Silver Loading into the mix, this means many people will qualify for a ZERO-PREMIUM GOLD plan even if they earn over 200% FPL! The counties where these are available and other details will vary for 2023, but the point still stands.


9. THE INDIVIDUAL MANDATE IS STILL AROUND IN FIVE STATES!

The single most controversial part of the Patient Protection & Affordable Care Act was the Shared Responsibility Provision, commonly known as the "Individual Mandate Penalty." In essence, all American citizens who didn't qualify for an exemption were required to either have ACA-compliant healthcare coverage (this could include Medicare, Medicaid, CHIP, qualifying Employer-Sponsored healthcare policies, or ACA exchange plans) or they would be charged a financial penalty for not having qualifying coverage.

The federal ACA individual mandate was reduced to nothing in 2017, so it isn't an issue any longer...but there are actually five states which have since reinstituted their own healthcare coverage requirement:

  • CALIFORNIA
  • DISTRICT OF COLUMBIA (I know, it's not actually a state...yet)
  • MASSACHUSETTS
  • NEW JERSEY
  • RHODE ISLAND

In CA, DC, NJ & RI, the penalty either identical or very close to the old federal penalty. Massachusetts uses their own formula. The financial penalty for not having coverage (assuming you don't qualify for an exemption) will be charged when residents file their 2022 state taxes in spring 2023.


10. MANY STATES & COUNTIES WILL HAVE MORE CARRIER & PLAN CHOICES THAN EVER.

Every year sees churn on the ACA markets as new carriers enter or expand their coverage areas to more counties/states...or as currently-participating carriers pull out of them. In addition, existing carriers often add new plans or phase out current ones. Here's just some of the changes for 2023:

  • Idaho is gaining two new carriers (Moda and St. Luke's Health Plan)
  • In Virginia, Aetna is expanding while Anthem is launching a new EPO
  • In Washington State, Community Health Plan is adding new "Cascade Select" plans
  • Maine is gaining Taro Health Plan
  • Delaware is going from just a single carrier to three, with the addition of Aetna and AmeriHealth
  • Texas is seeing several additions...besides Cigna, they're also gaining another Ambetter division, Ascension Care and Imperial Insurance Co.
  • North Carolina is gaining CareSource NC
  • Both Celtic and US Health & Life are entering the Alabama market

At the same time, some carriers are pulling up stakes in one or more states, such as the recently-announced news that Friday Health Plans are leaving Texas and that Bright HealthCare is almost completely abandoning the individual market less than a year after dramatically expanding their presence nationally. Oscar Health is dropping out of Colorado and Arkansas.

Any time a carrier reduces their participation in a given county or state it means that anyone currently enrolled in their policies will either be automatically "mapped" to a similar plan with a different carrier or they have to actively seek out a new policy to enroll in.

11. STANDARDIZED PLANS ARE BACK!

I debated a long time on whether to make this its own separate category or not.

Several states such as California and Massachusetts already mandate "Standardized" ACA policies. This means that every plan offered within a given metal level category (Bronze, Silver, Gold, Platinum) has to have the same cost sharing across the board. That is, co-pays, deductibles, etc. have to be the same. This simplifies the decision process for enrollees by allowing them to focus on premiums and networks instead of having to sweat the co-pays for 80 different services.

Standardized plans were offered by some carriers on the federal ACA exchange a few years back, but it was pretty scattershot since they didn't have to. Starting in 2023, all carriers offering plans on HealthCare.Gov have to include standardized plans at every metal level.

So why was I hesitant to give standardized plans (aka "Easy Pricing") their own bullet point on this list? Because unlike CA & MA, the "Easy Pricing" plans which have to be included on HealthCare.Gov's offerings are in addition to the dozens (or even hundreds) of existing "non-standardized" plans already offered. This means that instead of simplifying the shopping experience, it could actually make it more confusing for some people.

All of this can get understandably confusing to the point that it becomes overwhelming. Fortunately...


12. THE NAVIGATOR PROGRAM IS BACK AT FULL STRENGTH, BABY!

Years ago, the Trump Administration effectively gutted both the ACA's marketing/outreach budget (slashing it down by 90%) as well as its "Navigator" program, causing dozens of organizations around the country devoted to helping ACA enrollees find their way through the confusing world of health insurance enrollment (as well as those needing guidance to get into Medicaid, CHIP and other healthcare programs).

Thankfully, those days are no more: The Biden Administration reversed this damage last year, quadrupling the number of ACA Navigators to over 1,500 and increasing the grant program to $80 million.

The news is even better for underserved communities...those who need help the most:

Awardees will focus on outreach to people who identify as racial and ethnic minorities, people in rural communities, the LGBTQ+ community, American Indians and Alaska Natives, refugee and immigrant communities, low-income families, pregnant women and new mothers, people with transportation or language barriers or lacking internet access, veterans, and small business owners.

To find authorized local help, search here. If you live in a state with its own ACA exchange you'll be redirected there.


13. FOR THE LOVE OF GOD, WHATEVER YOU DO, *DON'T* LET YOURSELF BE PASSIVELY AUTO-RENEWED!

It's always been a good idea to actively shop around the ACA marketplace each Open Enrollment Period to see whether there's a better value for the upcoming year, but it's even more important now.

Between the massively expanded & enhanced subsidies thanks to the ARP/IRA, the dramatic increase in carrier participation in many states, the supplemental financial assistance being provided to many enrollees in nearly a dozen states, the seemingly counterintuitive pricing structure caused by "Silver Loading" and a host of other factors, you should absolutely NOT let yourself be "auto-renewed" this year!

My friend & colleague Louise Norris lists some important reasons for this:

  • In most states, you’ll have limited opportunities to pick a new plan after your coverage is auto-renewed. The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. Since open enrollment now extends into January in nearly every state, enrollees in most states have until at least January 15 to pick a new plan if they ended up deciding that the auto-renewed option wasn’t the best choice after all.

  • Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. If the cost of the benchmark plan changes, premium subsidy amounts in that area will also change. The benchmark plan for 2023 may or may not be the same plan that held the benchmark spot in 2022.

  • If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining. If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for the coming year), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years, or if you failed to reconcile your premium subsidy on the prior year’s tax return.

  • If your plan is being discontinued at the end of 2022, auto-renewal will result in the exchange or your insurer picking a new plan for you. They will try to assign you to the plan that most closely matches the coverage you had in 2022, but selecting your own new plan is a better option.

  • Auto-renewal might result in a missed opportunity for a better value. Even if the plan you have in 2022 represented the best value when you selected it, there may be different plans available for 2023. Provider networks and benefit structures can change from one year to the next, as can premiums. You might still decide that renewing your 2022 plan is the best option for 2023. But it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering the other available options.

Note that this doesn't necessarily mean that you shouldn't actively renew your existing plan--it may turn out that sticking with the same healthcare policy really is your best bet after all. Just don't assume that's the case, because even if nothing changes at your end (same income, same household size, etc.), the plans, premiums, networks and especially the subsidies you're eligible for could still change dramatically.

IN SHORT: SHOP AROUND, SHOP AROUND, SHOP AROUND!

Advertisement