The Affordable Care Act’s (ACA) enrollment period is opening with expectations of complexity and record-high sign-ups. Over a third of marketplace enrollees struggle to choose appropriate coverage, a challenge greater than that faced by those on Medicare or Medicaid. The end of COVID-19 pandemic adjustments and rising inflation are pushing premiums higher, though many are cushioned by federal subsidies. State-level reforms and an influx of insurers into the market further shape the 2024 enrollment landscape.
The ACA’s insurance marketplaces are poised to kick off their open enrollment season, which can be daunting for many prospective insurees, recent studies indicate.
The enrollment phase, spanning from November 1 to January 15, promises several developments, as outlined by KFF experts. Their comprehensive survey, which included over 3,600 insured U.S. adults, reveals that 35% of ACA plan members face difficulties in selecting suitable plans—this is notably more challenging than for Medicare, employer-provided insurance, or Medicaid recipients.
Marketplace insurance often acts as a bridge for those in between other types of coverage, leading to frequent transitions in and out of ACA plans, especially for newcomers. Variability in state and marketplace outreach efforts exacerbates the complexity, often resulting in an overwhelming array of choices for consumers.
KFF has identified additional trends to monitor during this enrollment period:
Enrollment numbers may hit new records due to recent increases and the shifting of many from Medicaid to ACA plans following renewed eligibility checks.
Inflationary pressures and normalized post-pandemic healthcare utilization are driving unsubsidized premiums up, with estimated increases of 5% for silver and 6% for bronze plans. Despite this, enhanced subsidies under the Biden administration are mitigating cost impacts for many.
State-specific adjustments, such as California’s additional subsidies and North Carolina’s Medicaid expansion, are poised to significantly alter the enrollment experience and choices for residents.
Finally, the exchange will see a dynamic shift in insurer participation, with more new insurers entering than existing ones leaving, notwithstanding notable exits like Oscar Health from California and Cigna from Kansas and Missouri. This indicates a strengthening and diversification of the insurance marketplace going into 2024.
