2024 Open Enrollment: What's New at HealthCare.Gov this year? Quite a bit, actually.

Some of this was already mentioned briefly in the formal press release issued yesterday, but the accompanying Fact Sheet from the Centers for Medicare & Medicaid Services (CMS) goes into further detail and also mentions some other important enhancements to the federal ACA exchange:

The Marketplace Open Enrollment Period on HealthCare.gov generally runs from November 1 to January 15. Consumers who enroll by midnight December 15 (5 a.m. EST on December 16)  can get full-year coverage that starts January 1, 2024. In 2024, January 15 is a federal holiday; accordingly, consumers will have until midnight on Tuesday, January 16 (5 a.m. EST on January 17) to enroll in coverage. Consumers who enroll after December 15 but before the deadline in January will have coverage that starts February 1, 2024.

This year, the Centers for Medicare & Medicaid Services (CMS) is focusing on increasing access to consumer assistance, ensuring robust outreach and education efforts to reach consumers about the opportunity to enroll in or re-enroll in Marketplace coverage. CMS has also committed to raising awareness around low-cost plans for the 2024 plan year (PY), as a result of the American Rescue Plan (ARP) and the Inflation Reduction Act.

CMS invested $98.6 million in grant funding to 57 returning Navigator organizations for the 2024 Open Enrollment Period to provide increased and enhanced enrollment assistance to help consumers find the right health  coverage option, complete their Marketplace application, and enroll in coverage. Navigator awardee organizations are available to provide comprehensive assistance through customized educational and outreach activities, especially to underserved communities. 

Continued Access to Lower Costs 

In 2021, the ARP expanded the availability of financial assistance for coverage through the Marketplace, making financial assistance available to more consumers and at greater levels. Thanks to the Inflation Reduction Act, these benefits continue through 2025, and they are available to eligible new and returning consumers for PY2024. In part as a result of the Inflation Reduction Act, four in five HealthCare.gov customers will be able to find health care coverage for $10 or less per month for PY 2024 after subsidies. 

Facilitating the Plan Selection Process with Non-Standardized Plan Option Limits

Over the last several plan years, the excessive rate of plan proliferation in the Marketplace has made it increasingly difficult for Marketplace consumers to meaningfully compare all their available plan options. In fact, the number of plans that Marketplace consumers have had to choose from has increased more than fourfold in just four years. This increased rate of plan proliferation has significantly increased the risk of suboptimal plan selection, which has in turn increased the risk of unexpected financial harm for consumers least able to afford it. 

Thus, in order to reduce the risk of plan choice overload, and to further facilitate the plan selection process for consumers, in conjunction with the requirements for issuers to offer standardized plan options that were introduced in plan year 2023, issuers offering plans through the Marketplace (including State-based Marketplaces on the Federal Platform) will be limited to offering four non-standardized plan options per product network type, metal level, inclusion of dental and/or vision benefit coverage, and service area in plan year 2024, and two in plan year 2025 and subsequent years. Limiting the number of non-standardized plan options that issuers can offer will streamline the plan selection process and reduce the risk of suboptimal plan selection as well as unexpected financial harm.

I'm glad that they're at least starting to put some limitations here, but this strikes me as being weak tea even as a starting point. Cutting it down to two next year should help, however. Eventually I'd like to see only standardized plans allowed, but that could take awhile...

Connecting Eligible Re-Enrollees with Benefits in Silver Plans

New for PY 2024, the Marketplace has updated the automatic re-enrollment process to help more consumers take advantage of cost savings. Specifically, the Marketplace will automatically re-enroll certain income-based cost-sharing reduction (CSR)-eligible enrollees who would otherwise be automatically re-enrolled in a Bronze plan into a Silver plan. This automatic re-enrollment will apply only for consumers who do not make an active plan selection on or before the deadline for January 1 coverage, and only if a Silver plan is available in the same product type, with the same provider network, and with a monthly premium after premium tax credits that is no greater than that of the Bronze plan into which they would otherwise be automatically re-enrolled. Silver plans offer better cost-sharing for enrollees, ensuring that consumers will in this situation receive a higher value plan for the same, or lower, monthly premium.

This should have a huge impact and could help put millions of enrollees into more comprehensive, less-expensive policies. CMS has been very wary of doing this for years, most likely due to the initial "if you like your plan you can keep it!" backlash back in 2009-2010...but it's been 14 years now, and the caveats are carefully designed to make sure that they're only going to do this if the only impact it has on the enrollee is to save them money (that is, the plan has to have the same carrier, the same provider network/etc.).

These enrollees will receive a notice from the Marketplace advising them that they will be re-enrolled into a Silver plan if they don’t select a QHP to enroll in  on or before December 15, and they will see the Silver plan highlighted in the online shopping experience if they return to HealthCare.gov on or before December 15 to review their options. If they don’t select a QHP to enroll in on or before December 15, they will receive an additional communication from the Marketplace after December 15 reminding them of their new plan enrollment for January 1.

Again, they're not gonna surprise people, and anyone who chooses to actively enroll in the existing plan won't be crosswalked; it'll only happen if the enrollee takes no action whatsoever.

Focusing On Health Equity and Reducing Barriers to Access

For the first time, the Marketplace application will be asking optional demographic questions regarding sex assigned at birth, sexual orientation, and gender identity. The new questions will be used to analyze health disparities in access to coverage. Collecting sexual orientation and gender identity data will help to improve the Marketplace consumer experience by enabling consumers to attest in a way that better reflects and affirms their identities.

The new questions are completely optional. Consumers can choose to answer, skip, or indicate they prefer not to answer any or all of the three questions.  An individual’s responses or decision to skip has no impact on their eligibility results, plan pricing, or plan costs. The privacy of all information shared will be protected. At this time, any data received from the three new optional sexual orientation and gender identity questions won’t be shared with downstream systems or agencies, including health insurance issuers or state Medicaid and the Children's Health Insurance Program (CHIP) agencies. 

State-based Marketplaces (SBMs) and State Medicaid/CHIP agencies will also have the option to include these data collection questions on their applications but won’t be required to do so. Those that plan to implement or have already implemented sexual orientation and gender identity questions must make them optional for consumers, and ensure appropriate safeguards are in place to protect the privacy and security of the information being collected.

Good across the board.

Key Updates and Enhancements to HealthCare.gov 

As Open Enrollment nears, CMS has continued its commitment to improving the consumer experience on HealthCare.gov and CuidadoDeSalud.gov. CMS has continued refreshing site design, and the assistance the site provides to guide consumers as they apply for and enroll in coverage. More of the site continues to be visually refreshed to provide consumers with a more consistent look and feel throughout their journey and enhancing communications around actions, notices, and reminders.

I haven't really poked around HealthCare.Gov beyond the window shopping tool in several years, since my wife and I are currently enrolled in a student policy via her university, but we'll be moving back to the exchange after she graduates. Perhaps it's time to kick the tires again...

Applying for Coverage 

The application experience incorporates new navigation and cues to help consumers know what they need and where they are in the process, and allow them to pick up where they left off if they need to gather additional information when completing or updating their application. The application includes a new start page to set expectations for the sections of information they’ll be asked. Consumers that start their application and need to pause and come back later are now able to see where they left off and jump back in, or choose to review information they already entered before continuing. These enhancements help guide consumers through their next steps with tips along the way.

Glad to hear it. The HC.gov application process has always been pretty grueling when it comes to pausing & restarting later on.

Shopping For a Plan That Best Meets a Consumer’s Needs 

The enrollment experience incorporates a refreshed visual design for key plan information around costs and benefits. New highlights to help consumers understand their choices and tailor their shopping by comparing plans that will best meet their needs. A streamlined layout of key plan information and costs helps consumers scan key plan information with improved ease.  

Providing more comprehensive cost-sharing information:

Plan summaries on HealthCare.gov include cost-sharing information for two new benefits: urgent care and mental health outpatient visits. Like in past years, plan summaries continue to highlight costs for primary care, specialty care, emergency room care, and generic drugs. Urgent care and outpatient mental health services have been added to plan summaries alongside other key cost information such as primary care and specialist care based on consumer and partner feedback around these key benefits to help consumers more easily compare costs across plans. 

New this year, when shopping, plan summary information will specify whether a benefit’s cost-sharing is subject to the deductible or whether the consumer can access the benefit “from day 1” for primary care, specialist care, urgent care, and outpatient mental health services. Plans offering coverage from day 1 of enrollment in any of these categories without requiring the consumer to meet the deductible may be valuable for consumers looking to minimize their out-of-pocket expenses when using their insurance to obtain care.

Helping consumers consider all costs and find the best plan for them:

Also new this year, the shopping experience after submitting a new or updated application will always include displaying an estimate of total yearly costs (premiums, co-payments, co-insurance, and other out-of-pocket costs) to help consumers understand how much they might pay over the course of a year for coverage among different plans. In addition, plan results are now sorted by low to high total yearly cost estimates, rather than by monthly premium. Considering plans based on estimated total yearly costs can help consumers find a plan that is more cost-effective for the level of coverage that fits their individual needs. Enhanced customization features have been added for these estimates so consumers can choose a level of anticipated use of health care services (low, medium, or high). By default, total yearly cost estimates are calculated using a medium level of healthcare service utilization.

There are also continued improvements to help consumers eligible for extra savings in Silver plans  find and consider the value those plans can offer in reducing their out-of-pocket expenses when using their Marketplace plan. 

Save Plans When Browsing and Easily Compare Final Prices When Enrolling: Consumers that preview plans now can create a list of plans they want to save for when they’re ready to enroll. Consumers can send the link of their saved plans to themselves for later, and upon accessing it and then logging in, consumers will see these saved plans in their plan results after submitting their application, for ease of comparison of final pricing when enrolling in coverage.  

Finding Different Types of Local Assistance: For this Open Enrollment, HealthCare.gov has improved the visual experience and added easier ways to find and choose among assisters or agents/brokers when using Find Local Help to locate trained resources in their area. 

CMS will continue to improve and enhance the application, enrollment, and educational support based on consumer feedback and testing.

Consumer Tools and Support 

Consumers Can Preview and Compare Affordable, Quality PY 2024 Plans Ahead of The Marketplace Open Enrollment Period 

CMS launched window shopping for PY 2024 (the “See plans & prices” page on HealthCare.gov) to allow consumers to preview plans and prices before Open Enrollment begins. As in previous years, previewing plans lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadoDeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a PY 2024 Marketplace plan.

Marketplace Call Center 

The Marketplace Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. For the last several Open Enrollment Periods, the consumer satisfaction rate remained high – averaging 90% – throughout the entire Open Enrollment Period. To help prepare the Marketplace Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Marketplace Call Center staff before Open Enrollment and weekly refreshers throughout the Open Enrollment Period. 

In addition to the Marketplace Call Center, local assistance will continue to be available to help consumers with enrollment through local assisters and Marketplace-registered agents and brokers. 

CMS’s Outreach Campaign 

Building on the successes from over the last several years, CMS is continuing an extensive outreach effort which includes a broad-reaching national campaign with traditional broadcast advertising and targeted digital efforts. Open Enrollment outreach will include investments to reach multiple audiences that experience lower access to health care. CMS has partnered with cultural marketing experts, for example, to deliver strong campaigns to African Americans, Spanish and English-speaking Latinos, and Asian American and Pacific Islander communities in multiple languages. These campaigns will connect people to local help and resources. 

Local Assistance Resources 

Consumers will benefit from a continuing robust Navigator presence. Navigators are unbiased experts who help consumers, especially those in underserved communities, understand their benefits and rights, review plan options, and enroll in Marketplace coverage. In addition to an increased staffing capacity, Navigators are offering more non-traditional appointment hours, bringing in-person assistance to consumers through the use of mobile units, and offering virtual appointments aimed at reducing transportation barriers and making it easier for consumers to get help signing up for quality, affordable health care coverage and to reduce health disparities in communities across the country. 

The Navigator program is augmented by additional assisters, agents, and brokers. More than 3,900 assisters (including Navigators, certified application counselors, and other enrollment assisters) and over 57,000 agents and brokers are already trained to assist consumers. Additional assisters, agents, and brokers will complete training before November 1. 

In June, CMS finalized a policy permitting assisters (Navigators, Enrollment Assistance Personnel (EAPs), and Certified Application Counselors (CACs)) to conduct direct door-to-door enrollment assistance to increase consumer engagement and advance health equity. Assisters had previously been allowed to conduct direct outreach, education, and schedule follow-up appointments for enrollment assistance, but were prohibited from providing enrollment assistance as part of an initial interaction at the consumer’s residence. The prohibition on direct enrollment assistance during the first contact burdened the consumer and assisters and created access barriers for consumers to receive timely enrollment assistance.

CMS will continue to partner with the “Help On Demand” service for agents and brokers. This service allows consumers to request that a Marketplace-registered, state-licensed agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers can set times when they’re available and then reach out to consumers who expressed interest in assistance. 

To find someone local or to be contacted by a Marketplace-registered agent or broker, consumers should visit here. Consumers can choose if they’d like to browse and select an assister or an agent/broker in their area or can request that an agent/broker contact them directly to help with their application and enrollment. Consumers who choose to search through available assisters, agents, and brokers in Find Local Help can look for a specific person or organization and can filter results based on their preferences and services provided, including language capabilities.

CMS will continue to boost its outreach with the help of the Champions for Coverage program, a community initiative that includes more than 1,000 local organizations that are active in providing outreach and education about the Marketplace and how consumers can enroll in coverage through HealthCare.gov, Medicaid, or the CHIP. 

Open Enrollment Notices 

Each year, the Marketplace sends notices to consumers who are currently enrolled in a Marketplace plan before November 1 about the upcoming Open Enrollment Period. This notice provides consumers with key dates for Open Enrollment and emphasizes the importance of consumers returning during this time to update their application and actively re-enroll in a plan for 2024. The notice also provides certain consumers with customized messaging for specific situations, such as if they’re at risk of losing premium tax credits. Consumers receive additional notices from their current insurance company with important information about premiums, coverage, and benefit changes, and plan availability for 2024. 

To see examples of Open Enrollment notices, visit here.

Automatic Re-enrollment Process 

Consumers who are currently enrolled in Marketplace coverage are strongly encouraged to come back and update their information, compare, and pick a plan that best suits their needs before the December 15 deadline for coverage effective January 1, 2024. However, current consumers who do not actively select a plan by December 15 will be automatically re-enrolled into their 2023 plan or a suggested alternate plan for 2024. After December 15, the Marketplace sends a notice to consumers who were automatically re-enrolled; consumers who prefer to actively select a new plan can return to the Marketplace to do so before the January 15 close of Open Enrollment, at which point their January coverage will be through the auto re-enrolled plan, and their active selection will be effective February 1. 

As in previous years, consumers who are currently enrolled in 2023 Marketplace coverage with an issuer who is not returning to the Marketplace for PY 2024 will be matched with a similar plan for re-enrollment with a different issuer for PY 2024. The 2024 plan will be similar to their current 2023 plan. These consumers will receive an additional notice with information about this alternate plan, and are especially encouraged to review their options and pick the best plan for 2024 that meets their needs. Consumers who are matched with an alternate issuer through automatic re-enrollment are eligible for a Special Enrollment Period and have until December 31 to make a plan selection for coverage effective January 1.

As noted above, the Marketplace will also match income-based CSR-eligible Bronze enrollees who would otherwise be auto re-enrolled in a Bronze plan, into a Silver-level QHP if a Silver plan is available in the same product and with the same provider network as the Bronze plan into which they would otherwise be re-enrolled, and that has a monthly premium that does not exceed that of the Bronze plan after the application of the premium tax credit.

HealthCare.gov Operations 

HealthCare.gov Scheduled Maintenance Windows 

Every year, CMS establishes scheduled maintenance windows for HealthCare.gov. Like other IT systems, these scheduled maintenance windows are how we update and improve our systems to run optimally and are part of the normal course of business. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. The purpose of scheduling these times is to minimize any consumer disruption. 

Regularly scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, which are Sunday mornings. 

For more information on the scheduled maintenance times, visit here.

State-based Marketplaces 

Consumers in states operating their own Marketplace platform can also enroll in a 2024 Marketplace plan starting on November 1 (with Idaho's Marketplace opening October 15).  For 2024, Virginia is transitioning from HealthCare.gov to its own Marketplace. Consumers in these states can find information about available plans and prices, how to obtain in-person or virtual help or attend a local event, and state-specific enrollment deadlines by visiting or calling their state’s Marketplace. 

An additional State-based Marketplace fact sheet includes details for each State-based Marketplace and consumers can visit here to find their state’s website. 

Small Business Health Options Program (SHOP) 

Similar to previous years, small business employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov allows employers to preview available SHOP plans and find an issuer or agent/broker to work with to offer SHOP coverage to their employees. Quality rating information will also be available for SHOP plans.

I had honestly almost forgotten SHOP still existed. It's almost never mentioned by CMS these days and there's only about a half-dozen states where there's significant enrollment in SHOP plans.

Enrollment Snapshots 

CMS plans to release enrollment snapshots for HealthCare.gov and State-based Marketplaces throughout the Open Enrollment Period. Consistent with last year, snapshots will be released approximately biweekly and will include national-level data (that incorporates data from State-based Marketplaces).

Note: "Biweekly" means every two weeks, not twice per week, unfortunately...