You can enroll in Marketplace health insurance during the open enrollment periods through State-Based Marketplaces (SBMs) and healthcare.gov. Texas uses the federally-ran marketplace. According to the United States Department of Health and Human Services (HHS), over 13.6 million citizens enrolled in health insurance coverage via the ACA health insurance Marketplace for 2022. The HHS report has it that over 9.3 million shoppers enrolled in Marketplace health coverage in the 33 states using healthcare.gov to obtain health coverage, while nearly 3.9 million were through the 18 SBMs.
People often ask: When is open enrollment for health insurance? Generally, the open enrollment period starts as the year winds up. It is a time when you can effect changes on your health insurance plan purchased via the Affordable Care Act's (ACA's) health insurance Marketplace. The Affordable Care Act (ACA), also known as Obamacare, was enacted to help subsidize health insurance coverage costs for qualified individuals through cost-sharing reductions and premium tax credits. Generally, to qualify for the ACA subsidies, you must meet the following benchmarks:
|State||Marketplace Name||Telephone Number|
|California||Covered California||1 (800) 300-1506|
|Colorado||Connect for Health Colorado||1 (855) 752-6749|
|Connecticut||Access Health Connecticut||1 (855) 805-4325|
|DC||DC Health Link||1 (855) 532-5465|
|Idaho||Your Health Idaho||1 (855) 944-3246|
|Kentucky||Kynect||1 (855) 459-6328|
|Maine||CoverME.gov||1 (866) 636-0355|
|Maryland||Maryland Health Connection||1 (855) 642-8572|
|Massachusetts||Massachusetts Health Connector||1 (877) 623-6765|
|Minnesota||MNsure||1 (855) 366-7873|
|Nevada||Nevada Health Link||1 (800) 547-2927|
|New Jersey||Get Covered New Jersey||1 (833) 677-1010|
|New Mexico||beWellnm||1 (833) 862-3935|
|New York||New York State of Health||1 (855) 355-5777|
|Pennsylvania||Pennie||1 (844) 844-8040|
|Rhode Island||Health Source Rhode Island||1 (855) 840-4774|
|Vermont||Vermont Health Connect||1 (855) 899-9600|
|Washington||Washington Healthplanfinder||1 (855) 923-4633|
For Texas and other states using the federal ACA exchange (national health insurance Marketplace), the open enrollment period for 2023 starts November 1, 2022, and runs through January 15, 2023. While most states using their State-Based Marketplaces (SBMs) for ACA-compliant health insurance policies have also set their 2023 open enrollment period to align with the ACA exchange, others vary slightly. You can contact your SBM to confirm the actual 2023 ACA open enrollment period if you live in any of those 18 states. If you intend to enroll for an individual health insurance plan via healthcare.gov and want coverage to begin by January 1, 2023, it is advised that you enroll latest by December 15, 2022. Coverage begins February 1, 2023, if you enroll between December 16, 2022, and January 15, 2023.
For individuals eligible for Medicare benefits, Medicare open enrollment 2023 begins October 15, 2022, and ends December 7, 2022. The Medicare open enrollment period goes by various names, including Medicare fall open enrollment, Medicare Annual enrollment period, and annual election period (AEP). The following are some of the things you can do during the Medicare open enrollment period for 2023:
Change Medicare Advantage plans
Switch from Original Medicare Parts A and B to a Medicare Advantage plan, or vice-versa
Cancel your prescription drug coverage
Change from your current Part D prescription drug plan to another or enroll in a plan
Although you can find a list of the documents needed for an individual health insurance Marketplace application on healthcare.gov, some documents you might be asked to provide include:
Proof of Citizenship - The list includes a birth certificate, a U.S. passport, and a state-issued driver's license
Immigration Information (for immigrants) - The list includes a green card (permanent resident card), employment authorization card, a refugee travel document, and a re-entry permit, among others
Proof of Annual Income - For instance, you will be required to provide a state or federal tax return with your pay stub or wages and tax statement
Generally, ACA plans purchased through the insurance Marketplace during ACA open enrollment are usually eligible for tax subsidies. While one subsidy helps reduce out-of-pocket costs, the other helps lower premiums. You may qualify for these subsidies if your annual income is between 100% and 400% of the federal poverty level. The lower your wages or income, the more subsidy you enjoy. Typically, 2023 subsidies for ACA will be based on your 2022 income level compared to the 2021 federal poverty level.
The national Affordable Care Act and state-run Marketplace websites have subsidy calculators for ACA Marketplace plans to help determine how much to pay for available individual health insurance policies in your location after the subsidy. Although complicated, the subsidy calculator for ACA is developed to ensure that you do not pay beyond 10% of your income for a silver-level health plan on the ACA Marketplace.
If you plan to purchase health policy through the national ACA Marketplace during the 2023 health insurance open enrollment period, you can contact their customer service at 1 (800) 318-2596. Otherwise, you can contact the SBMs on the customer service telephone numbers listed on their websites.
No, Obamacare does not end in 2023. Although earlier due to expire in 2022, Obamacare will now extend through 2025 following President Joe Biden's approval of the Inflation Reduction Act of 2022 (IRA). The enhanced Marketplace subsidies, first adopted under the American Rescue Plan Act (ARPA), were scheduled to end in 2022. However, Congress has approved the extension of these enhanced subsidies for another three years, until 2025. Among other critical investments included in the Inflation Reduction Act is a notable investment in health care; the IRA lowers the cost of prescription drugs. With this three-year extension, premium tax credits (PTCs) will remain in place for 2023, 2024, and 2025 plan years.
If the enhanced subsidies for ACA were not extended, the number of Americans without health insurance would increase considerably. About 3 million Americans could have lost their health insurance coverage and became uninsured by 2023. Additionally, over 10 million people would have had their PTCs reduced or lost them altogether. Furthermore, an estimated 9 million Americans would have had their health insurance costs increase by over $400 annually per individual. But for the ARPA subsidies for ACA, health insurance premium payments in 2022 for Americans in the 33 states adopting healthcare.gov would have been at least 53% higher. People living in the 18 states operating their own SBMs would have also paid more in premiums amidst the soaring inflation.
For Texas residents and the rest of Americans looking to enroll in ACA plans during the 2023 open enrollment period using healthcare.gov, the dates for Obamacare enrollments are as follows:
If you miss the ACA open enrollment deadline, you may still apply for health insurance through the special enrollment period (SEP) if you experience a qualifying life event. Generally, if a life event qualifies you for a special enrollment period (SEP), you only have up to 60 days to enroll in a health insurance plan. However, if you fail to get a plan within this 60-day window, you would have to wait till another open enrollment in fall the following year to enroll in a ACA health insurance plan.
Also, if you miss an open enrollment period and do not qualify for a special enrollment period, you may consider purchasing a short-term health insurance plan. Typically, you can buy short-term coverage outside the open enrollment period for 185 to 364 days, and in most states, you can reapply for it for up to 36 months.
Short-term health insurance plans are only designed to bridge the gap in health coverage temporarily. They do not cover pre-existing medical conditions like the ACA Marketplace plans and are only recommended for healthy persons. Your best option if you miss an OEP and choose not to purchase a short-term health insurance plan (if not eligible for SEP) is to wait till the next OEP begins.
Contact a knowledgeable and licensed health insurance agent for more details.
The passage of the Inflation Reduction Act (IRA) marks the continuation of the Affordable Care Act premium subsidies in 2023 through 2025 for health plans purchased through the ACA health insurance Marketplace. The extension of the ACA enhanced subsidies will no doubt provide millions more people relief, especially considering the rising inflation. Have you ever asked: what is ACA subsidies? ACA subsidies help pay health insurance premiums for low-income families who might otherwise not be able to afford health insurance. These subsidies are available as tax credits to individuals whose net income does not exceed 400% of the federal poverty level.
The two common types of ACA subsidies are:
You can use the following subsidy calculator for ACA to determine your eligibility for subsidies. The calculator is provided courtesy of the KFF, a national health issues non-profit organization:
Following the passage of the IRA, ACA subsidies, meant to expire at the end of 2022, will continue from 2023 through 2025. ACA subsidies in 2023 are poised to offer financial support to several households in the face of difficult economic times and rising inflation.
Obamacare has reduced the uninsured rate in the United States and positively impacted Medicaid expansion. As of 2021, about 31 million Americans have benefited from ACA-related enrollments through Marketplace enrollments and Medicaid. According to a report by the HHS, in 2021, four in ten consumers enjoyed ACA subsidies for national Marketplace coverage. Over 1 million new and returning consumers got health coverage on the health insurance Marketplace, spending $10 or less monthly after advanced payments of premium tax credits (APTCs).
Following the implementation of the American Rescue Plan's (ARP) expanded APTC in April 2021, many consumers in the United States have benefited from reduced monthly premiums (subsidy) through increased PTCs. At least 2.3 million current enrollees returned to the Marketplace after the expanded APTC implementation to reduce their monthly health insurance premiums by over 40%. Those paying an average of $106 previously now pay $61 after advanced payments of premium tax credits.
In all 50 states and D.C., nearly 14.5 million consumers were automatically re-enrolled in ACA coverage during the 2022 OEP. About 89% of these enrollees qualify for advanced premium tax credits (APTCs), a form of ACA subsidy. Nearly 50% (half) of the enrollees earned between 100% and 250% of the federal poverty level, qualifying them for cost-sharing reduction subsidy and advanced premium tax credits.
Initially, ACA subsidies, which were passed as part of the American Rescue Plan Act (ARPA), were slated to last two years and end in 2022. However, the Inflation Reduction Act (IRA), passed by the Senate and signed into law by President Joe Biden, has extended the ACA subsidies for another three years through 2025. This extension is poised to provide the 13 million enrollees with temporary subsidies and save them from making out-of-pocket health insurance premium payments in 2023 through 2025. After 2025, the decision to end the subsidies, extend them for another set of years, or leave them permanently is primarily up to the United States Congress.
The United States Congress, in August 2022, passed a bill known as the Inflation Reduction Act (IRA), extending ACA subsidies through 2025. This bill has since become law to ensure continued affordable health insurance for millions of Americans.
Employers with 50 or more full-time employees (or full-time equivalent employees) are required under the ACA's Employer Mandate to offer minimum essential coverage to at least 95% of them (employees) and their dependents. They must also ensure that such health coverage is affordable based on one of the methods approved by the Internal Revenue Service (IRS) for calculating affordability.
In 2023, employers in the United States may have to contribute more to their employees' health insurance premiums as the affordability threshold hits a historic low. The affordability threshold is the highest portion of an employee's household income required to be spent on their monthly health coverage premiums, based on the least offered ACA employer-sponsored health plan. It determines an employer's lowest-premium health plan compliance with the ACA's affordability requirement and affects their potential liability for ACA shared-responsibility penalties.
Based on the growth of health plan premiums relative to income growth, the affordability threshold is adjusted yearly using the Centers for Medicare and Medicaid Services (CMS) national health expenditure data. In 2022, the affordability threshold limit was 9.61%. However, per the Revenue Procedure 2022-34 issued by the Internal Revenue Service (IRS) in July 2022, the affordability threshold for 2023 will be 9.12%, a significant drop from 2022's limit.
Under the Internal Revenue Code, Section 4980H(a), employers with 50 or more full-time employees that do not offer affordable health plans to at least 95% of their full-time employees and dependents may be subject to employer penalties. Such health plans must also provide minimum essential coverage. Any employer that offers a plan that is not affordable or does not provide minimum value is subject to penalties stipulated in Section 4980H(b) of the Internal Revenue Code.