ACA Open Enrollment 2023 Guide

During the open enrollment period for 2022 coverage, enrollment reached a record high, with more than 14.5 million people signing up for coverage through the exchanges (marketplaces). The record-high enrollment was driven in large part by the subsidy enhancements created by the American Rescue Plan (ARP). And enrollment for 2023 was even higher, with 16.3 million marketplace enrollees by January 15 (open enrollment continued past that point in several states). 

The ARP’s improvements to the ACA’s subsidy structure have allowed an unprecedented number of Americans to qualify for premium tax credits that are larger than they used to be. And the Inflation Reduction Act, signed into law in August 2022, extends the current subsidy enhancements through 2025.

So during the open enrollment period for 2023 coverage, the enhanced subsidies continued to be available. And depending on the price of coverage, subsidies have also continued to be available to households with income above 400% of the poverty level.

Enrollment assistance has been more available than ever in late 2022 and early 2023, thanks to the Biden administration’s historically large investment in Navigator funding. 

In the fall of 2022, shortly before the start of the open enrollment period, the IRS finalized a fix for the “family glitch,” making some workers’ families newly eligible for premium subsidies in the exchange. 

For 2022, additional insurers entered or expanded their presence in the marketplaces, increasing health plan options for consumers around the country. For 2023, there were once again numerous insurers that joined the exchanges or expanded their coverage areas, but there were also some insurers that exited the marketplaces in some states. Insurer exits and entries can result in changing benchmark premiums, which can change premium subsidy amounts. Here’s what you need to know about how that works.

Standardized health plans returned to HealthCare.gov for 2023, and continue to be available in several of the state-run exchanges.

And as of 2023, health plans will have to publicize their pricing for a list of 500 common medical services, which will help people comparison shop for medical care. 

• Name, address, email address, social security number (here’s why you have to provide your SSN), birthday, and citizenship status. (Proof of lawful residency status may be required).

• Payment information that the insurer will be able to use to charge your premiums (this will generally be bank account information, but some insurers will allow automatic payments by credit card).

• A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary (covered drug list), so you’ll want to check to see which one will best cover the medications you need.

• Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.

• Household size and income (if you’re planning to apply for premium subsidies or cost-sharing reductions). A wide range of documentation can be used to prove your income, including pay stubs, W2s, your most recent tax return, etc.

• Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).

• If you want to enroll in a catastrophic plan and you’re 30 or older, you’ll need a hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).

Medicaid enrollment is year-round

Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.

(Note that until April 1, 2023, states are not disenrolling people from Medicaid unless the enrollee requests it. But starting in April 2023, the pandemic-related Medicaid continuous coverage requirements will end, resulting in a significant number of people losing their eligibility for Medicaid. The loss of coverage will trigger a special enrollment period, allowing them to enroll in other coverage, either through an employer, the individual/family market, or Medicare, depending on what coverage they’re eligible to select.)

Monthly enrollment opportunity if your household income doesn’t exceed 150% of the poverty level

In September 2021, the Biden administration finalized a new monthly enrollment opportunity for people who are subsidy-eligible and whose household income doesn’t exceed 150% of the federal poverty level. This enrollment opportunity will remain in place for as long as the American Rescue Plan’s subsidy structure (which grants premium-free benchmark plans to people at this income level) remains in place. That’s at least through the end of 2025, thanks to the Inflation Reduction Act.

In some states, additional state-funded subsidies result in premium-free benchmark plans even at incomes above 150% of the poverty level. So there are a few states (NJ, NM, VT, and WA) that have opted to extend the low-income special enrollment opportunity to households with higher incomes. But there are also a few state-run exchanges (ID, MD, and NV) where the low-income special enrollment period does not appear to be available as of 2023.

Native Americans can enroll year-round

Native Americans can enroll in plans through the marketplace year-round. Here’s more about special provisions in the ACA that apply to Native Americans.

Special enrollment period if you have a qualifying event

If you have a qualifying event during the year, you’ll have access to a special enrollment period (SEP). Qualifying events include marriage (assuming at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (assuming you already had coverage prior to your move).

Here’s a full guide to all of the qualifying events that trigger special enrollment periods in the individual market, including details about the specific rules that apply to each of them.

Short-term health insurance

Under general federal rules, short-term health insurance plans can have initial terms of up to 364 days and a total duration of up to 36 months, including renewals. But the majority of the states have more restrictive limits on the availability of short-term plans, and those state limits supersede the federal rules.

You can visit our short-term health insurance page to check your state’s guidelines.

There is no federal government penalty for being uninsured in 2023, but you still need coverage!

The ACA’s federal individual mandate penalty has been $0 since the start of 2019, and that will continue to be the case for 2023. People who are uninsured do not face a penalty, unless they’re in a state that has its own individual mandate and a penalty for non-compliance. Four states and DC impose tax penalties for not having health insurance:

• Massachusetts

• New Jersey

• California

• Rhode Island

• District of Columbia

Yes! In every state, you can browse the available plans anonymously before you create an exchange account. If you want to see rates and plan options, the information is available – online, in-person, and by phone. Here are some tips for finding it:

• Pricing for 2023 plans was available by late October 2022. You’ll want to select the option for “Affordable Care Act plans” when you’re using the shopping tool. But as noted above, if you’re also in need of a short-term plan to cover you until your ACA-compliant plan takes effect, you can also get quotes for those plans if you select the option for “short-term plans and alternatives” (keeping in mind that these should be thought of as a bridge plan until your ACA-compliant plan takes effect, rather than a replacement).

• ‘Window shop’ anonymously on your state exchange (if you’re in DC or one of the 17 states that run their own exchanges) or HealthCare.gov’s plan browsing page (if you’re in one of the other 33 states). The window shopping tools that are available through the exchanges are anonymous and do not require you to enter any identifying information; they offer a quick and easy way to get a good idea of what’s available to you. You can enter an estimate of how much you expect to earn in 2023, and the shopping tools will show you the amount of premium subsidy (premium tax credit) you’ll be eligible to receive.

• Consult with a trained advisor. Set up an appointment with a Navigator or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs. (See below for more information about the enrollment assisters who can help you.)

• Talk with your health care providers. This is helpful especially if you’re considering a policy change during open enrollment. You’ll want to know which provider networks include your doctors, and whether any network changes are planned for the coming year.

There are several states that offer additional subsidies beyond the federal benefits provided by the Affordable Care Act. Some of these state subsidies reduce the premiums that people pay for their coverage, and some reduce out-of-pocket costs. Here’s a summary of what’s available for 2023:

• California ($1 per month paid by the state on behalf of each enrollee)
  
  
• Colorado (additional cost-sharing reductions for some consumers, and premium subsidies for some enrollees who don’t qualify for federal subsidies)

• Connecticut (free coverage and medical care for some consumers)

• Minnesota (Basic Health Program)

• Maryland (additional premium subsidies for some young adults)

• New Jersey (additional premium subsidies for most enrollees)
  
  
• New Mexico (additional premium subsidies and cost-sharing reductions for many enrollees)

• New York (Basic Health Program)

• Massachusetts (additional premium and cost-sharing subsidies for some consumers)

• Vermont (additional premium and cost-sharing subsidies for some consumers)

• Washington (additional subsidies for standardized plan enrollees with modest incomes)

Here is why:

• In most states, you have limited opportunities to pick a new plan after your coverage is auto-renewed. The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. Since open enrollment now extends into January in nearly every state, enrollees in most states have until at least January 15 to pick a new plan if they ended up deciding that the auto-renewed option wasn’t the best choice after all. If you decide to make a change in the latter part of open enrollment, your auto-renewed plan will cover you in January, and your new plan will take effect in February. But after January 15, in most of the country, you will not have another chance to change your coverage until the following year, unless you experience a qualifying event.

• Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. If the cost of the benchmark plan changes, premium subsidy amounts in that area will also change. The benchmark plan for 2023 may or may not be the same plan that held the benchmark spot in 2022. In some areas, there are different insurers offering plans for 2023, and regular annual price changes can result in fluctuations in terms of which plan occupies the benchmark spot. Shopping around for a different plan — as opposed to letting your plan auto-renew – might result in substantial savings. This article illustrates examples of how this works, based on real enrollees’ experiences with 2021 and 2022 coverage. And this article is another example of how subsidy changes can have a drastic impact on net premium changes, and why comparison shopping is so important.

• If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining. If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for the coming year), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years, or if you failed to reconcile your premium subsidy on the prior year’s tax return.

  (Note that throughout the COVID pandemic, the exchanges have not discontinued premium tax credits for people who failed to reconcile a prior year’s premium tax credit with the IRS. The federal government announced in 2022 that this would continue to be the case for 2023, meaning that premium subsidies for 2023 are still available — assuming the person is still subsidy-eligible — even if the person hasn’t reconciled a prior year’s premium subsidy with the IRS. Starting with 2024 coverage, however, the government has proposed a rule change that would result in discontinued subsidies if the person has failed to reconcile prior premium tax credits for two consecutive years.) 

• If your plan was discontinued at the end of 2022, auto-renewal resulted in the exchange or your insurer picking a new plan for you. They tried to assign you to the plan that most closely matched the coverage you had in 2022, but selecting your own new plan is a better option, and is more likely to result in coverage that meets your needs and budget.

• Auto-renewal might result in a missed opportunity for a better value. Even if the plan you have in 2022 was the best value when you selected it, there may be different plans available for 2023. Provider networks and benefit structures can change from one year to the next, as can premiums. You might still decide that renewing your 2022 plan is the best option for 2023. But it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering the other available options.

Health insurance is complicated, and many people want or need personal assistance with the application process and with ongoing insurance utilization questions. To fill this need, there are a variety of assisters nationwide who are trained to guide people through the process of researching and enrolling in health plans, and some can provide ongoing support after the plan is purchased.

Health insurance navigators

The health insurance Navigator role was created for the purpose of providing impartial education and outreach about the exchanges and exchange health plans, helping applicants determine whether they qualify for subsidies or Medicaid, and assisting them in the enrollment process.

Navigators are not permitted to recommend one plan over another or direct consumers towards a particular policy. Instead, their job is to provide general information that consumers can use to understand what’s available to them. Navigators are paid by state and federal grant programs, and they cannot be compensated by the insurance companies.

Certified application counselors (CACs)

Certified application counselors (CACs) can also provide assistance with the enrollment process. They are similar to Navigators, but their role is more limited and their focus tends to be strictly on helping people enroll, without the more extensive assistance that some Navigators can provide.

The exchange designates local “CAC organizations” (health centers, faith-based organizations, colleges, etc.) and people who are affiliated with or employed by those organizations are eligible to serve as CACs. Navigators are funded through the exchange, but certified application counselors are not. Funding for the CAC program can come from a variety of state and federal sources though, including existing public health appropriations. And CACs themselves are often volunteering their time to help people enroll in health coverage.

Insurance brokers and agents

Insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or Medicaid eligibility, but – and this is a key difference – they can also make plan recommendations based on a client’s particular situation.

Agents and brokers continue to assist their clients after the plan is purchased, helping them sort out questions and problems regarding billing, utilization, claims, and appeals. Brokers and agents also generally carry errors and omissions insurance, and are licensed by their state department of insurance (this is in addition to their certification with the exchange; Navigators and CACs are trained and certified by the exchange, but are not licensed by the state insurance department).

For health insurance purposes, independent agents and brokers are virtually the same thing, although brokers may represent more carriers or offer different types of insurance products.