BOOM: More than 4.5M Select Affordable #ACA Marketplace Coverage Since Start of Open Enrollment Period

Back on November 9th, President Biden issued the first hint suggesting that the 2024 ACA Open Enrollment Period would be the most successful ever:

In the first week of Open Enrollment, 1.6 million people have signed up for a plan at HealthCare.Gov, including 301,000 new consumers – that’s a 50% increase from last year.

Join them by visiting HealthCare.Gov today.

— President Biden (@POTUS) November 9, 2023

As I noted in my original post, 1.6 million via in the first 7 days was likely around a 43% enrollment increase compared to the first week of November last year. This was even more impressive considering that Virginia split off onto their own state-based ACA exchange this year, while North Carolina is launching Medicaid expansion next month...both of which reduce the pool of Qualified Health Plan (QHP) enrollees available to sign up via the federal ACA exchange.

President Biden's tweet also noted 301,000 new enrollees, which mean people who didn't already have an ACA exchange plan; also impressive.

Well, today, at long last, the Centers for Medicare & Medicaid Services (CMS) has issued the first official 2024 Open Enrollment Period report, and it's a big one:

With four out of five people eligible for coverage at $10 or less per month, the Biden-Harris Administration urges everyone to visit and sign up for high-quality, affordable health care

Approximately 4.6 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. This represents activity through November 18 (Week 3) for the 32 states using and through November 11 (Week 2) for the 17 states and the District of Columbia with State-based Marketplaces (SBMs).[1] Total plan selections include 920,000 people (20% of total) who are new to the Marketplaces for 2024, and 3.7 million people (80% of total) who have active 2023 coverage and returned to their respective Marketplaces to renew their coverage or select a new plan for 2024.

Note: The SBM sentence has a's 18 states plus DC, not 17, since Virginia split off onto their own SBM this year.

I admit it's a bit irritating that they're choosing to use different "thru dates" for the federal exchange vs. the state-based exchanges, but that's how they did it last year so I can still run an apples-to-apples comparison...almost. The graph below shows how these numbers have increased since the same time period last year. I've had to adjust slightly for the fact that there's one fewer day included for both the federal exchange (18 days vs. 19) and the state exchanges (11 days vs. 12).

I've also had to adjust for the fact that Virginia moved from the federal exchange to its own state-based exchange this year, which is further complicated by CMS reporting 3 weeks for the federal exchange but only 2 weeks for state-based exchanges. I've done my best to adjust for all of these factors below (the subtotals are accurate; the new/returning breakout for 2023 are estimates but should be pretty close):

As you can see, the initial enrollment numbers are dramatically higher across the board:

  • is 47% higher (54% more new enrollees, 46% more returning enrollees)
  • SBMs are 27% higher (19% more new enrollees, 29% more returning enrollees)
  • Overall: 45% higher (50% more new enrollees, 44% more returning enrollees)

Additionally, data shows strong Marketplace enrollment increases during 2023. Prior to the start of the 2024 OEP, approximately 1.5 million more people enrolled in Marketplace coverage nationwide from March to September 2023, compared to the same period in 2022. These data point to the impact of new and stronger Marketplace systems and policies on helping people access affordable, comprehensive coverage through the Marketplaces. This includes individuals who are transitioning from Medicaid coverage as states resume Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals for the first time in three years following the COVID-19 pandemic. CMS continues to release separate information about Medicaid renewals and coverage transitions.

As I noted a couple of weeks ago, over 590,000 Medicaid Unwinding folks had moved to an ACA exchange plan through the end of July, plus another 88,000 who enrolled in BHP plans in Minnesota & New York. CMS hasn't posted the August report yet but should do so soon.

“This year’s Marketplace enrollment season is off to a strong start. At HHS, we are working nonstop to connect everyone who needs health care with coverage they can afford. Americans deserve the peace of mind that comes with being insured,” said HHS Secretary Xavier Becerra. “This year, four out of five people can find a plan for $10 or less a month after subsidies on Nearly 96 percent of consumers will be able to choose plans from at least three health insurers. And thanks to the historic Inflation Reduction Act, these lower costs and better benefits are available to more Americans. Don’t miss your opportunity to sign up for quality, affordable health care.”

“In the first weeks of Open Enrollment, we have seen an increase in plan selections and a significant increase in the number of new enrollees year over year. Providing quality, affordable health care options is a top priority and the numbers prove that our focus is in the right place,” said CMS Administrator Chiquita Brooks-LaSure. “I am excited to see such a strong early showing and I encourage all those looking for affordable health care coverage to visit”

The 2024 Marketplace Open Enrollment Period runs from November 1, 2023, to January 15, 2024, for Marketplaces using the platform. Consumers who enroll by midnight on December 15 can get full-year coverage that starts January 1, 2024. State-based Marketplace enrollment deadlines vary. State-specific deadlines and other information are available in the State-based Marketplace Open Enrollment Fact Sheet.

The Biden-Harris Administration has continued its commitment to making health insurance available and affordable to everyone. For three years, the Inflation Reduction Act and the American Rescue Plan have helped keep insurance affordable. The Administration continues to issue Navigator Awards, allowing organizations to hire staff who are trained to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to helping consumers in every Marketplace state.

The Biden-Harris Administration encourages all families to visit and check out the health care coverage options and savings available to them. Because of continuing provisions in the Inflation Reduction Act, CMS expects 9 out of 10 customers to be eligible for savings.

People with current coverage through are encouraged to return and shop to see if another plan better meets their needs at a lower cost.

Marketplace coverage may also be an option for individuals transitioning from Medicaid and CHIP as states continue eligibility renewals for these programs this year. Individuals should visit to see if they are eligible to enroll in a low-cost, quality health plan today. Additional information about Medicaid and CHIP renewals is available at

Individuals enrolling in Marketplace coverage this year will also benefit from a highly competitive Marketplace. For plan year 2024, 96% of enrollees will be able to choose among three or more plans. In addition, standardized plan options are available and offer the same deductibles and cost-sharing for certain benefits. These plans have the same out-of-pocket limits as other standardized plans within the same health plan category, making it easier for consumers to compare and choose plans. Most of these standardized plan options offer many services pre-deductible, including primary care, generic drugs, preferred brand drugs, urgent care, specialist visits, mental health and substance use outpatient office visits, as well as speech, occupational, and physical therapies.

Individuals can enroll or re-enroll in health insurance coverage for 2024 by visiting, or, or by calling 1-800-318-2596 to fill out an application. Individuals wanting assistance signing up for coverage may go to Find Local Help on to find a Navigator, Certified Application Counselor, or agent or broker.

I'll be posting another analysis of the state-by-state numbers, including additional confirmed ACA exchange enrollment I've put together on top of these totals soon.