A screenshot of www.healthcare.gov
Open enrollment for Affordable Care Act health insurance kicks off. Here’s what you need to know
By Nicole Leonard/WHYY
Starting Tuesday, thousands of residents in the Delaware Valley will be able to sign up for new health insurance plans, or review their existing ones, through Affordable Care Act marketplaces.
The annual open enrollment period serves people who either don’t get health insurance coverage through their employers, or who can’t afford the health insurance offered through their jobs.
State insurance officials say residents can expect to see more plan options offered by newly participating insurance companies, continuing subsidies and tax credits, and expanded eligibility for financial assistance and plans for families.
“The percentage of folks who are insured today is significantly higher than it was just a few years ago,” said Delaware Insurance Commissioner Trinidad Navarro. “We had a record number of people who signed up [last year] and we’re hoping to see that again for 2023 as well.”
New Jersey Department of Banking and Insurance Commissioner Marlene Caride said COVID-19 has changed the way people view health insurance, and how they might need it as the pandemic continues.
“Unfortunately, it took the pandemic to open up our eyes to see how important health insurance is,” she said.
Insurance carriers and plans
At least two states — Delaware and New Jersey — will add new insurance carriers to their ACA marketplaces.
Aetna CVS Health and AmeriHealth Caritas join returning ACA insurer Highmark Blue Cross Blue Shield Delaware to offer a total of 30 plans to residents in Delaware on the federal enrollment site, Healthcare.gov.
“It’s the best time now since I’ve been in office that we have multiple options for citizens here in the state of Delaware,” Navarro said.
In New Jersey, Aetna joins existing insurers AmeriHealth, Horizon Blue Cross Blue Shield of New Jersey, Oscar Health, and Ambetter from WellCare of New Jersey. All offer plans on Get Covered New Jersey, the state-based marketplace launched in 2020.
In Pennsylvania, eight insurers offer plans on Pennie, the state’s health insurance marketplace. The number of insurers will differ depending on where in the state a person lives, but at least two carrier options will be available in every county.
Financial aid and tax credits
A majority of residents eligible for ACA plans in the Delaware Valley will qualify for some type of financial help, experts said. That aid largely comes in the form of tax credits that lower an enrollee’s monthly premium cost, and is determined based on a person’s annual household income.
“Through recent changes to the Affordable Care Act, the amount of subsidies that consumers are qualified to receive have increased at basically every level of income,” said Zach Sherman, executive director at Pennie.
Sherman said the average tax credit among Pennsylvania enrollees was around $500 a month in previous years.
Subsidy amounts and income eligibility expanded with passage of the American Rescue Plan Act and the Inflation Reduction Act during the COVID-19 pandemic.
The subsidy “cliff” has also been temporarily eliminated. It previously limited financial aid to people making under 400% of the federal poverty level, which is about $54,000 a year for an individual. Now, enrollees with higher incomes can qualify for subsidies if their premium costs are more than 8.5% of their household income.
“Folks [who], in the past, may not have qualified for financial help, they might qualify today,” Caride said. “So, it’s always important to go back and look at the plans.”
The “family glitch” fix
A new federal policy under the Biden administration also addresses what has been dubbed the “family glitch,” an issue that has left workers and their family members unable to afford either their employer-sponsored health insurance or ACA plans.
Previously, employees and their families who were offered insurance through their jobs could elect instead to choose a plan through the ACA, and they’d qualify for subsidies only if the employer-sponsored insurance costs were found to be unaffordable, as determined by the IRS.
But this determination only considered insurance costs for the individual employee — it didn’t factor in the higher costs charged for covering a spouse or children.
“For families, they’ve been kind of locked out,” Sherman said. “Their employer plan is too costly, and based on the way affordability is calculated, when they went to Pennie or the [ACA] marketplace, they’ve been ineligible for the subsidies.”
The new federal policy now requires affordability calculations to include the costs of adding family members to insurance plans, which means more families are expected to qualify for ACA subsidies.
Enrollment help and assistance
States have several options to help people apply and enroll in ACA plans. Cost calculators, premium estimates, and comparison tools are available online through the states’ marketplace websites and Healthcare.gov.
Pennsylvanians can reach a statewide call center at 1-844-844-8040 for more help. Pennie also offers assistance experts, usually based at community health organizations, who can help people virtually or in person.
The state partners with about 3,000 licensed insurance brokers who provide specific advice on plan selections based on a person’s health needs and financial situation.
Get Covered New Jersey has 17 navigator centers placed throughout the state to help people enroll in plans. A statewide call center offers assistance in both Spanish and English.
In Delaware, patient navigators are available at Westside Family Healthcare in Wilmington and at other locations throughout the state to help residents sign up for plans.
Open enrollment deadlines
Open enrollment for all ACA marketplaces and exchanges begins Nov. 1. Final deadlines differ by state and coverage start dates depend on when someone enrolls in their plan.
Navarro recommends that people not wait until the deadline to enroll.
“When you wait to the last minute, you’re often rushed,” he said. “And it leads to unforeseen errors in signing up.”
In Delaware and Pennsylvania, the final enrollment deadline is Jan. 15. People who enroll early by Dec. 15 will get health insurance coverage starting New Year’s Day. Residents who enroll after Dec. 15 and by the final deadline will see coverage start on Feb. 1.
New Jersey’s open enrollment period is slightly longer at three months. Residents have until Dec. 31 to sign up for health insurance coverage that will begin on the first day of the new year. Anyone who enrolls after that, but by the final deadline of Jan. 31, will get health coverage starting on Feb. 1