ACA Open Enrollment 2024 Guide
Open enrollment for 2024 Marketplace coverage started November 1 in most states. Here’s what you need to know.
What is the Affordable Care Act’s open enrollment?
The Affordable Care Act’s (referred to as ACA or Obamacare) open enrollment period is the annual window during which individuals and families can compare the various health plans that are available and select the one that will best fit their needs for the coming year.
The open enrollment period typically runs from November 1 through January 15, but the dates vary in some states that run their own exchanges. And since January 15, 2024 is a federal holiday, HealthCare.gov has extended the end of open enrollment until January 16, 2024 in the 32 states that use HealthCare.gov.1
The open enrollment window applies to plans sold through the Marketplace/exchange as well as plans purchased off-exchange.
Outside of open enrollment, you can only sign up for ACA-compliant individual and family health insurance (or switch to a different plan) if you experience a qualifying life event that triggers a special enrollment period.
How much could you save on 2024 coverage?
Compare health plans and check subsidy savings.
When is open enrollment for my state?
In the majority of the states, open enrollment for 2024 coverage will run from November 1, 2023 through January 15, 2024 or January 16, 2024. (As noted above, the January 16 deadline is applicable in states that use HealthCare.gov, due to the federal holiday that falls on January 15). But some state-run exchanges have different schedules. You can see the deadlines for each state here.
How to enroll in the Marketplace
Once open enrollment begins, you can enroll in an ACA-compliant individual and family health insurance plan – or make changes to your existing coverage – through the Marketplace in your state.
- If you have specific doctors or medical facilities you want to use, check to see if any plans have them in-network. If you take any medications, check to see if any plans have them in their formularies and what the out-of-pocket costs will be.
- If you want help with the process, assistance is available via local insurance brokers and Navigators, as well as enhanced direct enrollment entities.
Here’s what you’ll need for each enrollee:
- Name, Address, Social Security Number (Here’s why it’s required.) and Birth date
- Citizenship or legal residency status. (Proof may be required.)
- Payment information for the first month’s premium. (Setting up automatic payments for future months can help you avoid an inadvertent lapse in coverage.)
- If you’re 30 or older and want a catastrophic plan, you’ll need a hardship exemption.2
- Many applicants are eligible for financial assistance.3 If you’re applying for subsidies, you’ll also need the number of people on your tax return and your total household income. (The Marketplace may require proof of your income through a variety of documentation,4 and coverage details about any employer-sponsored coverage available to you.)
- You can do this yourself or have a broker, Navigator, or enrollment assister help you with the process.
- You can apply online, over the phone, submit a paper application, or enroll in-person with a local broker, Navigator, or enrollment assister.
- You will not need to answer any medical history questions. But be sure that the plan you’re selecting has your medical providers in-network, covers your medications, and has out-of-pocket costs that you’ll be able to manage.
- Log into your Marketplace account after you’ve completed the process, to make sure everything is in order.
- Watch your email and mail for communications from the Marketplace and your new insurer. (For example, you may be asked to provide documentation to verify income or legal residency).
- Once your policy and ID cards arrive in the mail, read through all of it and reach out to your broker, Navigator, or the health plan if you have questions.
Frequently asked questions about Obamacare open enrollment
Who is eligible for Marketplace enrollment?
To be able to enroll on the ACA’s Marketplace:5
- You must live in the United States.
- You must be a U.S. citizen or national or be lawfully present.
- You must not be incarcerated.
- You can not be enrolled in Medicare coverage.
DACA recipients have historically not been allowed to enroll through the Marketplace, but the Biden administration has proposed a rule change that would allow them to enroll starting in November 2023.6
Who is eligible for financial assistance when buying coverage through the Marketplace?
But eligibility for financial assistance is different. Being eligible to enroll in the Marketplace is not the same as being eligible for financial assistance. In short, the income-based subsidies available through the Marketplace/exchange are reserved for people who aren’t eligible for Medicaid, zero-premium Medicare Part A, or coverage offered by an employer that’s deemed affordable and comprehensive. (Here’s how to determine whether employer-sponsored coverage is affordable to you.)
What is a premium subsidy and how do I get financial help during open enrollment?
Premium subsidy rules are designed to ensure that subsidy-eligible individuals won’t pay more than 8.5% of their household income in premiums for the benchmark (second-lowest-cost Silver) plan in the Marketplace.7 (The percentage of household income that people are expected to pay can be much lower – as low as 0% – depending on their income.)7
You can use our subsidy calculator to get an idea of whether you’re eligible for premium subsidies, and if so, how much those subsidies could be.
Premium subsidies are a refundable tax credit.8 You may qualify for a subsidy based on your projected household income for the year you apply for coverage. And then you’ll need to reconcile that with the IRS when you file your tax return for that year, based on your actual income.9
Marketplace cost-sharing reductions (CSR)10 are another type of Obamacare subsidy. CSR assistance is designed to ensure that people with low to moderate incomes can afford to receive health care services. (And enrollees who qualify for CSR will often also qualify for premium subsidies.)
CSR subsidies result in lower out-of-pocket costs, including lower deductibles and copays. For applicants with eligible incomes, these subsidies are automatically incorporated into all of the available Silver-level plans. But if you’re eligible for CSR subsidies and you buy a metal plan other than a Silver plan, you’ll forfeit this advantage
In addition to federal premium subsidies and CSR subsidies, some state-run Marketplaces offer their own subsidies.
I have Medicare. Can I buy supplemental insurance through the ACA Marketplace during open enrollment?
No. It is unlawful for someone to sell you a Marketplace plan (or an individual/family plan outside the exchange) if you already have Medicare, even if you only have either Medicare Part A or Part B.11 So if you’re enrolled in Medicare, the Marketplace open enrollment period does not apply to you.
How is open enrollment for 2024 coverage different from last year?
During the open enrollment period for 2023 coverage, enrollment reached a record high, with more than 15.7 million people signing up for coverage through the Marketplaces nationwide.12
The record-high enrollment was driven in large part by the subsidy enhancements created by the American Rescue Plan (ARP), and those subsidy enhancements will continue to be available in 2024.
For 2024 coverage, there are a few changes that enrollees should keep in mind:
- Healthcare.gov’s automatic re-enrollment protocols have changed somewhat,13 to allow the exchange to move a CSR-eligible enrollee from a Bronze plan to a Silver plan, if the Silver plan would have an equal or lower premium and the same provider network and product type (HMO, PPO, EPO, etc.) as the Bronze plan. This protocol can be used regardless of whether the Bronze plan continues to be available for 2024. The idea behind this change is to maximize the benefits that enrollees can receive, but it’s still in each person’s best interest to log into their account and select their own coverage for 2024. Read why letting your individual health insurance plan automatically renew may not be in your best interests.
- In some states, there are new insurers joining the exchange for 2024, including Indiana, Maryland, Colorado, California, Nevada, Oklahoma, New Mexico, Utah, Pennsylvania, New Jersey, South Carolina, Wisconsin, Kansas, Ohio, and Delaware.
- In other cases, insurers are leaving the exchange for 2024. For example, Oscar Health is leaving the exchange in California,14 and Cigna is leaving the Marketplace in Kansas and Missouri.15 Piedmont Community Healthcare is exiting the individual market in Virginia,16 and there is also an insurer exiting the Marketplace in Michigan.17 One of Louisiana’s insurers has been acquired by another, reducing the number of participating insurers by one.18
- 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.
- Some states are offering new or enhanced state-funded subsidies for 2024, including California,19 Colorado,20 Maryland,21 Massachusetts,22 and New Mexico.23 Read more about states that offer their own health insurance subsidies.
- Virginia will be using a new exchange platform, instead of HealthCare.gov.24 (Georgia had also sought approval to operate its own state-based exchange platform, but CMS delayed Georgia’s implementation until the fall of 2024.)25
- Medicaid expansion takes effect in North Carolina on December 1, 2023. North Carolina Marketplace enrollees with income from 100%-138% of the poverty level are eligible for subsidies for private plans in 2023, but will transition to Medicaid eligibility for 2024.26
- Agents and brokers assisting with enrollments in states that use HealthCare.gov are required to document that the enrollee has consented to the agent/broker’s assistance, and maintain a record of the consent on file for ten years.27 The consent can be obtained via an audio recording or a written document,28 and must include, at a minimum, the date, the consumer’s name, the agent/broker’s name, and an explanation of the attestations in the eligibility application.29
- The Biden administration has proposed a rule change that would allow DACA recipients to be able to enroll in coverage through the exchanges starting November 1, 2023.6
Is there a penalty for not having insurance?
Should I let my existing ACA-compliant health plan renew?
In a nutshell, this author says no. Auto-renewal or automatic re-enrollment (when a plan is terminating) for the coming year’s coverage is available through the Marketplaces in every state. However, in the opinion of this author, it may not be in your best interest to rely on automatic renewal. Selecting your own plan for 2024 is better than relying on auto-renewal or a Marketplace algorithm that will select a new plan on your behalf.
You’ll want to pay close attention to any notices you receive from your health plan and Marketplace, as they will let you know how your benefit details, monthly premium, and premium subsidy (if applicable) are changing for 2024. You’ll also want to carefully compare the other options available in your area, as they may not be the same as the options that were available for this year.
Who can help me enroll in an ACA-compliant / Obamacare health insurance plan?
You can certainly choose to select a plan and complete the enrollment process on your own, through the Marketplace/exchange website (or via an enhanced direct enrollment entity if you’re in a state that uses HealthCare.gov).36
But if you prefer to have help with the process, it’s available for free online, over the phone, and from people in your community:
- Health insurance Navigators
- Provide education and outreach about the Marketplace and available health plans, help applicants determine whether they qualify for subsidies or Medicaid, and assist in the enrollment process.
- Can generally provide assistance after you enroll, helping with issues like eligibility appeals and how to utilize your health coverage.
- Are funded by the federal government in states that utilize a federally run exchange, and by the states that run their own exchanges.37
- Certified application counselors (CACs)
- Similar to Navigators, but 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.38
- CAC funding can come from a variety of state and federal sources, and CACs are often volunteering their time to help people enroll in health coverage.
- Insurance brokers and agents
- Licensed by the state and certified by the Marketplace/exchange.
- Can help consumers determine subsidy or Medicaid eligibility, and they can also make plan recommendations based on a client’s particular situation.39 (Navigators and CACs cannot do this).
- Provide ongoing assistance for questions and problems regarding billing, utilization, claims, and appeals.
- Generally carry errors and omissions insurance.
- “Biden-Harris Administration Launches Window-Shopping Ahead of 11th ACA Marketplace Open Enrollment Period” Centers for Medicare and Medicaid Services, October 2023
- “How to pick a health insurance plan” HealthCare.gov, Accessed September 2023
- “Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average“ CMS.gov, March 15, 2023
- “How do I resolve a data matching issue?“ HealthCare.gov, Accessed September 2023
- “A quick guide to the Health Insurance Marketplace®” HealthCare.gov, accessed August, 2023
- “Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children’s Health Insurance Programs” Federal Register, April 26, 2023
- “Internal Revenue Bulletin: 2021-35” IRS.gov, August 30, 2021
- “Premium tax credit” HealthCare.gov, Accessed September 2023
- “If my income changes and my premium subsidy is too big, will I have to repay it?” healthinsurance.org, Oct. 20, 2022
- “APTC and CSR Basics” CMS.gov, June 2023
- “Medicare & the Health Insurance Marketplace” Medicare.gov, September 2022
- “Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average” CMS.gov, March 15, 2023
- “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024” CMS.gov, September 2023
- “Oscar Health will exit from California” Healthcare Dive, May 10, 2023
- ”Cigna to exit Missouri and Kansas ACA Marketplaces in 2024” HealthCare Dive. August 2023.
- Piedmont Not Participating in 2024 Individual/Family On- or Off-Exchange Plans. Piedmont Community Healthcare. October 31, 2023.
- SERFF filing USHL-133808625. Michigan SERFF. September 7, 2023.
- Vantage is Becoming Blue Cross and Blue Shield of Louisiana. Vantage Health Plan. Accessed November 1, 2023.
- “Covered California to Launch State-Enhanced Cost-Sharing Reduction Program in 2024 to Improve Health Care Affordability for Enrollees” CoveredCA.com, July 20, 2023
- “Amended Regulation 4-2-78 – Cost Sharing Reduction Enhancements.pdf” Colorado Division of Insurance, Accessed September 2023
- Young Adult Subsidy Program Expands Age Range. Maryland Health Connection. Accessed November 2023.
- Massachusetts Expands Access to Affordable Health Care. Massachusetts Health Connector. Accessed November 2023.
- “2024 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual” New Mexico Office of Superintendent of Insurance” April 13, 2023
- “State-based Exchanges” CMS.gov, Sept. 6, 2023
- “CMS letter to Georgia Access” CMS.gov, July 27, 2023
- ”Questions and Answers About Medicaid Expansion” North Carolina Medicaid Division of Health Benefits. Accessed October 2023.
- Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024. U.S. Department of Health and Human Services. April 2023.
- FAQ: 2024 Payment Notice Requirements. Centers for Medicare and Medicaid Services. Accessed November 2023.
- What are the minimum requirements for documenting consumer review and confirmation of the accuracy of eligibility application information? Centers for Medicare and Medicaid Services. September 2023.
- “Will you owe a penalty under Obamacare?” healthinsurance.org, accessed August 2023
- “Massachusetts Individual Mandate” Massachusetts Health Connector, accessed August 2023
- “New Jersey’s Health Coverage Requirement”NJ.gov, Nov. 1, 2022
- “Why Are Californians Required by Law to Have Health Insurance? ” CoveredCA.com, Feb. 16, 2023
- “Health Insurance Mandate” State of Rhode Island Division of Taxation, accessed August 2023
- “Updated Guidance For Applicable Entities Pursuant To The Individual Taxpayer Health Insurance Responsibility Requirement Amendment Act Of 2018” DC.gov, March 31, 2020
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023
- “Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period, CMS.gov, Aug. 26, 2022
- “Certified application counselor designated organization (CDO) program information CMS.gov, accessed August 2023
- “Who’s helping me complete my application? Healthcare.gov, accessed August 2023