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When Can I Enroll in Marketplace Insurance?

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:

  • You are not currently incarcerated
  • You currently live in the United States
  • You earn not more than 400% (500% in 2022) of the Federal Poverty Level (FPL). If you reside in a state that have expanded Medicaid coverage, you must earn above 138% of the federal poverty level
  • You are a citizen of the United States or a legal resident
    The open enrollment period allows you to choose a suitable healthcare plan if you are enrolling for the first time. If you are not new, you can re-enroll in your current health plan or choose a new plan to replace the current one. Also, the open enrollment period allows you to make changes to your current health insurance if needed.
    You can also make some changes to your Marketplace health coverage or enroll in a plan outside the open enrollment period (OEP). If you experience certain qualifying life events outside the OEP, you can still enroll for Marketplace health insurance under the special enrollment period (SEP). Also, you can enroll in the Children's Health Insurance Program (CHIP) or Medicaid at any period of the year if you qualify; coverage can start immediately. Life events that make you eligible for SEP include:
  • Losing your current health coverage (especially if you lost the job that provided the health coverage)
  • Marriage or divorce
  • Adopting a dependent to your family or having a baby
  • Relocating to a new state
    Sometimes, the open enrollment periods for the 18 SBMs slightly vary from the period adopted by the national health insurance Marketplace. If you reside in any of these 18 states, you can look up your state's Marketplace open enrollment period on their website or contact them directly via the telephone numbers listed in the table below:
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

When is Open Enrollment For 2023

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.

Does Obamacare End in 2023?

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.

What Are The Dates for Obamacare Enrollment?

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:

  • November 1, 2022 - Open enrollment begins
  • January 15, 2023 - Open enrollment ends
  • December 15, 2022 - Make sure to enroll at the most on this date, if you want health coverage to start by January 1, 2023
    Note that ACA open enrollment for 2023 health care coverage will end on January 15, 2023 in most states, including states that run their own Affordable Care Act exchange. Enrollments done after December 15, 2022 will not take effect by January 1, 2023, but February 1. These dates are subject to change each year. Date extensions are usually announced on the Marketplace websites.

How to Get Health Insurance After Open Enrollment?

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.

ACA Subsidies in 2023

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:

  1. Advanced Premium Tax Credits
  2. Cost-Sharing Reduction Subsidy
    If you purchase ACA health insurance on the Marketplace, advanced premium tax credits (APTCs) can help pay your premiums throughout the year. If your projected income level makes you eligible for advanced premium credits, you can do any of the following:
  • Pay your health insurance premium in full and obtain your tax credit after filing your income tax return
  • Choose that your tax credit all through the year be paid to your health insurance company directly to settle your health coverage premium
    If you qualify, the cost-sharing reduction (CRS) subsidy lowers your out-of-pocket expenses for health care. Typically, it pays a portion of your copayment, deductible, or coinsurance for services covered by your ACA health insurance plan.
    Your eligibility for ACA enhanced subsidies in 2023 depends on your projected income during that year, not your income, as reported on the 2022 tax return. Hence, you must estimate your income when applying for 2023 subsidies. For instance, considering the 100%-400% of the FPL, a person must earn between $13,590 and $54,360 to qualify for ACA subsidies in 2023. Similarly, a family of four (federal poverty level varies depending on the number of people in a household) must earn $27,750 to 111,000 to be eligible.

2023 Obamacare Subsidy Calculator

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:

Will There Be ACA Subsidies in 2023?

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.

How Many People Get ACA Subsidies?

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.

When Will ACA Subsidies End?

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.

Will Congress Extend the ACA Subsidy?

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.