BEYOND THE NUMBERS
Ahead of Open Enrollment, Millions Poised to Benefit From Extended Tax Credits, Administrative Improvements
Open enrollment for 2023 marketplace coverage begins November 1, and the next 11 weeks are a critical opportunity for more of the millions of people eligible for an affordable plan to sign up for one. Last year’s open enrollment period was record breaking — more than 14.5 million people selected a marketplace plan — and several important developments since then may make this year’s even more successful:
Enhanced premium subsidies remain available. Improved premium tax credits that eliminated or reduced out-of-pocket premiums for millions of people in 2021 and 2022 are also in place in 2023 (and 2024 and 2025), under the Inflation Reduction Act enacted in August. This will prevent millions of enrollees from experiencing significant premium hikes, many of whom would likely have become uninsured. The tax credits are also available to more people than prior to 2021; previously many middle-income people had incomes too high to qualify, but now no one is paying more than 8.5 percent of their household income for a benchmark plan — and people with lower incomes pay far less. These policies are likely the main reason that a record proportion of enrollees are receiving premium tax credits in 2022 — over 92 percent in states that use HealthCare.gov.
The enhanced premium tax credits have been critically important for enrollees with the lowest incomes. Those with income up to 150 percent of the poverty level ($19,320 for an individual and $32,940 for a family of three) can get a zero-premium plan, with reductions to deductibles and other cost sharing. The Inflation Reduction Act’s extension of these provisions also provides important help to older marketplace enrollees, particularly those with incomes above 400 percent of the poverty level, who tend to face higher premiums.
- The “family glitch fix” will make more people eligible for financial help. The federal government recently finalized a rule that will more realistically determine what’s considered an “affordable” offer of employer coverage for an employee’s family members. People with an affordable offer aren’t eligible for premium tax credits, but the previous affordability calculation blocked many family members from qualifying for financial assistance even if they lacked access to coverage their family could actually afford. The new rule takes effect for eligibility determinations for 2023, and an estimated 1 million more people are expected to receive tax credits over the next ten years due to this change. Families of low-paid workers, small-business employees, workers in the service industry, and children under age 18 are expected to benefit most.
- Other marketplace improvements will make it easier for people to compare plans, enroll, and get care. The latest annual payment notice setting marketplace policies for 2023 made several changes that will improve the enrollment process and potentially improve access to care for marketplace enrollees. Insurance companies can no longer prevent people from enrolling in coverage because they have past-due premiums. HealthCare.gov is also accepting people’s attestations that they aren’t enrolled in or don’t have an offer of job-based coverage without generally requiring further paperwork (and state-based marketplaces can opt to do the same), reducing barriers to enrollment and to financial help. People shopping on HealthCare.gov will also see the return of standardized plans (plans that have the same cost-sharing charges for specific services no matter what insurance company is offering them), so people can compare plans more easily based on remaining differences in premiums, provider networks, and quality ratings. Finally, marketplace plans must include more essential community providers, including community health centers, Indian Health Care Providers, and Ryan White HIV/AIDS Program providers, in their networks for 2023.
Open enrollment is an important time not just for people to newly gain coverage. It’s also an opportunity for current enrollees to return to the marketplace to update their information and actively choose a plan for 2023. Although the marketplace can automatically re-enroll many people who don’t return to the marketplace by December 15 and update their information for 2023, actively renewing is the best way to ensure people get the right amount of financial help, learn about new opportunities to get help due to the family glitch fix, and reduce the likelihood of having to repay advance payments of the premium tax credit at tax time in 2024. Plans and prices also change every year; active re-enrollment allows people to shop for the plan that best meets their health care needs for the coming year. People who actively re-enroll also tend to save money.
For more information about marketplace rules, including webinar recordings, FAQs, and other tools designed for enrollment assisters, see the Center on Budget and Policy Priorities’ Health Reform: Beyond the Basics website.