The annual open enrollment interval for Affordable Care Act (ACA) Marketplace protection kicks off November 1 in most states. A lot of new and ongoing coverage modifications will affect the Marketplace in 2024, together with particular enrollment alternatives tied to the Medicaid “unwinding,” persevering with enhanced monetary help, and administrative flexibilities designed to scale back limitations to enrollment. Below is a abstract of those and different current insurance policies that customers might encounter this yr.
Ongoing Medicaid “Unwinding”: March 31, 2023 marked the finish of Medicaid’s steady protection requirement, which was applied as a safeguard to stop Medicaid enrollees from shedding their well being protection through the COVID-19 pandemic. As of April 2023, states have been conducting eligibility redeterminations for everybody presently on their Medicaid rolls—triggering the biggest protection transition occasion because the ACA. Some people who’re disenrolled from Medicaid shall be eligible for monetary help on the Marketplace. You can discover solutions to ceaselessly requested questions on transitions from Medicaid to personal medical health insurance on the Navigator Resource Guide, obtainable in English right here and Spanish right here.
Ongoing Unwinding Special Enrollment Opportunity: To assist facilitate transitions between Medicaid and the Marketplace through the unwinding interval and alleviate gaps in protection, the Centers for Medicare & Medicaid Services (CMS) created a brand new particular enrollment interval (SEP) on HealthCare.gov, titled the “Unwinding SEP.” With this SEP, eligible customers are capable of apply for Marketplace protection at any time between March 31, 2023, and July 31, 2024, offered their Medicaid or CHIP protection expired throughout that very same time interval. After submitting an software, eligible customers can have 60 days to pick out a Marketplace plan, and their new protection will start the primary day of the month after they choose a plan. State-based Marketplaces (SBMs) can select whether or not to implement related enrollment flexibilities through the unwinding. You can discover out in case your state provides prolonged enrollment alternatives for customers shedding Medicaid by contacting your state’s Marketplace.
Enhanced Financial Assistance and Special Enrollment Opportunities Still Available: Thanks to the Inflation Reduction Act, eligible Marketplace enrollees can proceed to profit from enhanced premium tax credit score (PTC) subsidies in 2024. Under the improved premium credit, folks with incomes as much as 150 % of the federal poverty degree (FPL) can enroll in a benchmark plan with a $0 premium. Families with incomes over 400 % of the federal poverty degree have their premium contribution capped at 8.5 % of their family revenue. In addition, people and households with family revenue below 150 % of the FPL stay eligible for a month-to-month particular enrollment interval if their premiums could be $0 after making use of tax credit. The SEP is on the market to eligible Marketplace enrollees in most states. However, state-based Marketplaces (SBMs) can select whether or not or to not implement this low-income SEP, so examine along with your state Marketplace to substantiate that it’s provided in your state.
Proposed Coverage Expansion for DACA Recipients: Individuals granted deferred motion below the 2012 Deferred Action for Childhood Arrivals (DACA) program are presently not eligible to enroll in Marketplace protection. This exclusion may change below a pending federal rule proposed by the Biden administration in April of 2023. The new rule proposes to replace the parameters of “lawfully current” residency used to find out Marketplace eligibility to incorporate DACA recipients. If finalized, the rule would additionally enable DACA recipients to enroll in Basic Health Programs presently provided in New York and Minnesota, in addition to obtain PTCs and cost-sharing reductions (CSRs) on the Marketplace. However, till the rule is finalized, DACA recipients are usually not eligible to buy protection via the Marketplace.
Modified Automatic Re-Enrollment Policies: To assist enhance uptake of reasonably priced silver plans, CMS has modified its automatic re-enrollment hierarchy for the federally facilitated Marketplace (FFM), and allowed SBMs to comply with swimsuit. Under the earlier re-enrollment course of, enrollees on the FFM who’re eligible for cost-sharing discount subsidies (CSR) and presently enrolled in a bronze degree plan could be mechanically re-enrolled in a bronze plan. For plan yr 2024, this group will as an alternative be enrolled in a silver degree plan of the identical product. The silver plan can have the identical supplier community, CSRs, and a premium equal to or decrease than that of the enrollee’s bronze plan (after premium tax credit are utilized). In addition, enrollees whose present certified well being plan (QHP) isn’t obtainable in plan yr 2024 shall be mechanically re-enrolled into a brand new plan with an identical supplier community.
Diminished Coverage Requirements for COVID-19 Services: Under the CARES Act of 2020, well being insurers have been required to cowl COVID-19 diagnostic testing with out imposing cost-sharing or prior authorization necessities through the COVID-19 public well being emergency (PHE). Health plans have been additionally required to cowl the total value of as much as eight over-the-counter at-home assessments per thirty days for every plan member. Since the PHE expired on May 11, 2023, insurers are not topic to those federal necessities; as such, privately insured customers are not assured free testing. In basic, availability of free COVID-19 vaccines was not impacted by the top of the PHE. Consumers enrolled in non-grandfathered well being plans can nonetheless entry vaccines for free of charge, due to the ACA’s preventive companies safety. However, customers should guarantee they obtain vaccinations from an in-network supplier to keep away from any cost-sharing.
Updated Failure to File and Reconcile Rules: Under the ACA, Marketplace enrollees who obtain superior premium tax credit (APTCs) are required to reconcile the premium tax credit score quantity they acquired when submitting their annual tax return. Failure to reconcile (FTR) one’s APTCs may end up in the Marketplace denying premium tax credit for future protection. Due to the pandemic, FTR guidelines have been suspended for plan years 2021 via 2023. This yr, CMS up to date the FTR laws in order that Marketplaces are actually prohibited from denying or terminating an enrollee’s ATPC except the enrollee has didn’t reconcile their tax credit score for 2 consecutive years (versus the earlier commonplace of just one yr). The present pause on FTR checks will proceed in 2024, whereas the IRS works to implement the brand new rule.
More Lenient Household Income Verification Process: A brand new coverage in impact this yr modifies the Marketplace’s course of for verifying family revenue to simply accept an revenue attestation from the family when tax return information isn’t obtainable. Enrollees will now have a further 60 days to confirm their family revenue (on high of the prevailing 90 days) ought to revenue information points come up. These modifications will reduce administrative burdens on people and households if the Marketplace is unable to confirm their projected annual family revenue.
Door-to-Door Enrollment Assistance: For the primary time this Open Enrollment, Navigators and different Assisters are permitted to offer direct door-to-door enrollment help to customers upon assembly on the client’s residence. Previously, Navigators and different Assisters may conduct door-to-door outreach and training, however needed to schedule a follow-up appointment with a client to offer them with direct enrollment help. By eliminating the necessity for that additional step, the brand new coverage goals to extend the availability of well timed enrollment help and scale back limitations to Marketplace enrollment.
Expanded Price Comparison Tools: A federal legislation that went into impact in 2023 requires most group well being plans and issuers of group or particular person well being protection (together with Marketplace protection) to develop and preserve on-line worth comparability data for lined well being companies, with the objective of empowering customers to buy care primarily based on the quantity of cost-sharing they’re answerable for throughout suppliers of their plan community. While plans and issuers presently have to offer this data for 500 companies, they need to make worth data obtainable for all lined gadgets and companies as of January 1, 2024. Plans and issuers are additionally required to supply worth comparability steerage over the cellphone.
State-Based Marketplace Launching in Virginia: A brand new state-based Marketplace will change HealthCare.gov beginning this Open Enrollment in Virginia. As of November 1, 2023, eligible Virginia residents will be capable to enroll in 2024 protection and entry monetary help via Virginia’s Insurance Marketplace.
Stay tuned for extra details about Marketplace enrollment in our Navigator Resource Guide, set to relaunch on the finish of October. The up to date information will characteristic ceaselessly requested questions (FAQs), assets for numerous communities (together with FAQs obtainable in Spanish), state-specific enrollment data, the chance for navigators and customers to “Ask an Expert” advanced enrollment questions, and extra.