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Individual/Family Health Insurance Open Enrollment - Big Changes!

Updated: Nov 11, 2022

It’s fall again, meaning shorter days, cooler temperatures, and Open Enrollment for Affordable Care Act Marketplace insurance. Enrollment for 2023 health coverage began November 1st and will run through January 15th, 2023 -however to ensure coverage begins January 1st– your enrollment must be submitted by November 15th, 2022.

A rule recently finalized by the Treasury Department aims to address what has long been termed the “family glitch”. The change expands the number of families with job-based insurance who can choose to forgo their coverage at work and qualify for subsidies to get an ACA plan. Before, employees could only qualify for a subsidy for marketplace insurance only if the cost of their employer-based coverage was considered unaffordable based on a threshold set annually by the IRS. That determination considered only how much workers would pay for insurance themselves. The cost of adding family members to the employer sponsored plan was NOT a part of the calculation, and family coverage is often far more expensive than employee only coverage. The families of employees who fall into the “glitch,” either go uninsured or pay more through their jobs for coverage than they might if they were able to get an ACA subsidy. Workers will now be able to get marketplace subsidies if their share of the dependent premium for their job-based coverage exceeds 9.12% of their expected 2023 income.

Subsidy enhancements created by the American Rescue Plan have allowed a huge number of Americans to qualify for premium tax credits. The Inflation Reduction Act, signed into law in August 2022, extends the current subsidy enhancements through 2025. During the 2023 Open Enrollment period, due to enhanced federal subsidies, people whose income is under 150% of the federal poverty level qualifies for a $0 premium Marketplace plan.

Insurers can no longer deny coverage to members enrolling in coverage who owe past-due premiums for previous coverage. If members fell behind on their 2022 premiums, they must be allowed to reenroll in 2023 and when the first payment is made to activate coverage, the insurer must apply that payment to their January 2023 premium.

Comparison shopping will likely be easier for 2023 plans, new rules require ACA health insurers to offer a set of plans with specific, standardized benefits. The standard plans, for example, have the same deductibles, copays and other cost sharing requirements.

Under a different set of rules, beginning January 1st, all health insurers must make available cost-comparison tools online or over the phone that will assist patients predict their cost for 500 “shoppable services”, such as repairs to a knee joint, colonoscopy, a chest X-ray or childbirth services.

Expect rate increases for 2023 Marketplace health insurance. Insurers reported that rising prices paid to hospitals, doctors and drug companies and utilization trends will account for 4% to 8% of their premium growth in 2023.

Enrollment can be expedited if you have the necessary information such as name, address, social security number, birthdate and citizenship status (proof of lawful residency may be required). Other pertinent information is doctor’s names and addresses, a list of prescription medication for each individual who will be covered by the plan, household size and income (pay stubs, tax return or W-2), and coverage details for any employer-sponsored plan that is available to your household (regardless of whether you are enrolled or have declined coverage). There is no longer a federal penalty for not having health insurance, but even healthy people can be faced with extraordinary costs for unforeseen health reasons especially those with no insurance.

In most States, if enrollees have not updated their application and plan selection for 2023, the Marketplace may auto-re-enroll them in their current plan or a similar plan for the coming year. However, passively renewing can sometimes place consumers at a disadvantage. If the enrollee’s benchmark plan changes from one year to the next, the dollar value of the subsidy can also change. A person who was enrolled in the benchmark plan in 2022 may no longer be enrolled in the 2023 benchmark plan and therefore may have to pay the difference on cost between their plan and the new benchmark plan. To take full advantage of the subsidy, Marketplace enrollees should actively shop each year to make sure they are in the best plan available.

Insurance Solutions is your one stop shop for all things insurance related, recognized as an Elite Plus Marketplace Circle of Champion for the third year in a row.


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