I alluded to it in my financial year-end to-do checklist article, but open enrollment for the Affordable Care Act has already begun and is quickly coming to a close. Yes, the ACA lives on, and with the Biden administration fully supporting it, it is not only safe from meeting its demise through executive or legislative changes (until at least January of 2025), but it has been significantly improved by just about every measure.
In fact, the American Rescue Plan Act of 2021 added a number of enhancements to ACA plans, including additional cost sharing savings and subsidies, and proposed new legislation could add even further enhancements. There are now more enrollees in ACA marketplace plans than ever before. And there are also now more ACA plan choices than ever before.
Registration for ACA plan coverage in 2022 has already started at healthcare.gov, and the deadline to sign up within the open enrollment period to begin insurance coverage on January 1, 2022 is December 15th for most states (with exceptions noted below). New this year: for coverage starting February 1, 2022, open enrollment is extended to January 15, 2022 in most states. If you were enrolled prior to open enrollment, don’t rely on auto-enrollment – with all of these changes and enhancements, it’s critical to shop around every enrollment period so that you can get the best value.
If you are not already covered by health insurance, I strongly recommend signing up for an ACA plan. I’ve provided resources and answers to a number of common questions about ACA enrollment below.
What’s New for the Affordable Care Act in 2022?
Voters in Missouri and Oklahoma passed Medicaid expansion ballot measures in 2020, and those states brought the total number of states with Medicaid expansion up to 38 (+DC). Oklahoma and Missouri finally launched Medicaid expansion in their states, and that will be active for 2022.
You can now check your Medicaid eligibility as well as subsidy and cost sharing status here. For those who do not qualify for Medicaid, there is still a good chance that you will be eligible for a subsidized private health insurance plan through an ACA exchange. The American Rescue Plan added significant additional subsidies and even increased income threshholds for those who are eligible for subsidies. According to the U.S. Centers for Medicare & Medicaid (who runs the ACA), healthcare.gov plan prices will decrease, on average, and
four in five consumers will be able to find health care coverage for $10 or less per month.
The subsidy threshold for 2022 now includes help for many households over 400% of the federal poverty levels (FPL) for the first time. Before the American Rescue Plan, ACA subsidies were limited to those earning between 100 – 400% of FPL. If you earned over 400% of FPL, you had to pay the full premium amounts, without subsidies. Additionally, federal cost-sharing reductions (aka “CSRs”) are available to reduce the out-of-pocket costs for eligible enrollees. Once reduced out-of-pocket maximums are met, costs are covered 100%. CSRs are available on noted “silver” plans only.
10 states offer some variation of funding assistance on top of the federal assistance: California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, and Washington State.
In addition to likely cost savings, consumers will also have more plan choices in 2022:
On average, PY22 enrollees have access to between 6 and 7 QHP (Qualified Health Plan) issuers, and over 107 QHPs, both of which are greater than all previous years. Additionally, 2% of PY22 enrollees have only one available QHP issuer, which is the lowest percentage since PY16.
And, finally, while there is no longer a federal ACA mandate, 5 states have now implemented a health care coverage mandate: CA, D.C., MA, NJ, and RI.
What Does the ACA Cover?
Aside from pre-existing condition coverage and coverage of a certain percentage of your total health care costs (up to 100%) once your deductible is met, and 100% once your out-of-pocket maximum is met, ACA plans all cover the following 10 essential health benefits at any time:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
What are the Open Enrollment Dates?
For the 33 states that use the federal healthcare.gov site, open enrollment is Nov. 1 – Dec. 15, 2021 for plan effective date of January 1, 2022. New this year, citizens of those same states will have an additional 30 days to register for a plan effective date of February 1, 2022 (with a registration deadline of January 15, 2022). States with their own exchanges (listed below) have varying open enrollment periods, with 2 even having a later deadline for a March 1, 2022 effective plan start date. They are as follows:
|State:||Jan. 1, 2022 Effective Deadline:||Feb. 1, 2022 Effective Deadline:||Mar. 1, 2022 Effective Deadline:|
|California:||11/1/21 - 12/31/21||1/1/22 - 1/31/22||n/a|
|Colorado:||11/1/21 - 12/15/21||12/16/21 - 1/15/22||n/a|
|Idaho:||11/1/21 - 12/15/21||n/a||n/a|
|Kentucky:||11/1/21 - 12/15/21||12/16/21 - 1/15/22||n/a|
|Maine:||11/1/21 - 12/15/21||12/16/21 - 1/15/22||n/a|
|Maryland:||11/1/21 - 12/15/21||12/16/21 - 1/15/22||n/a|
|Massachusetts:||11/1/21 - 12/15/21||12/16/21 - 1/23/22||n/a|
|Minnesota:||11/1/21 - 12/15/21||12/16/21 - 1/15/22||n/a|
|Nevada:||11/1/21 - 12/31/21||1/1/22 - 1/15/22||n/a|
|New Jersey:||11/1/21 - 12/31/21||1/1/22 - 1/31/22||n/a|
|New Mexico:||11/1/21 - 12/23/21||12/16/21 - 1/15/22||n/a|
|New York:||11/1/21 - 12/15/21||1/1/22 - 1/15/22||1/16/22 - 1/31/22|
|Pennsylvania:||11/1/21 - 12/15/21||1/1/22 - 1/15/22||n/a|
|Rhode Island:||11/1/21 - 12/23/21||1/1/22 - 1/31/22||n/a|
|Washington (D.C.):||11/1/21 - 12/15/21||12/16/21 - 1/15/22||1/16/22 - 1/31/22|
|Washington (State):||11/1/21 - 12/31/21||1/1/22 - 1/31/22||n/a|
Some of these dates may be subject to change, so check with your state’s exchange for any updates.
It’s also worth noting that you may be eligible for a special enrollment period with a qualifying life event. There are a number of insurance options for newly uninsured individuals, including ACA plans, outside of the open enrollment period.
Where do I Enroll?
Healthcare.gov. If you’re in one of the states (+DC) with its own marketplace, you will be redirected from there. It’s important that you ONLY sign up for a plan by starting at healthcare.gov. If you sign up through a 3rd party, you likely will not be eligible for premium subsidies and you might be signing up for a garbage plan.
If I Currently Have a Plan, Do I Need to Sign Up Again?
If you currently have a plan, it is strongly recommended that you log in to review your options for next year and either renew or switch plans. As noted earlier, there are many new qualified plans and premiums, subsidies, and cost sharing will likely differ, per plan, each year. Additionally, premium subsidies may change based off of your income and the plans you choose. You will want to update your income and household information appropriately.
Who Should Sign Up for a Marketplace Plan?
My recommendation: everyone who does not have employer sponsored insurance (either directly or through a family member, including your parents, if you are under age 26), Medicaid, CHIP, or Medicare.
Why Should I Sign Up for a Marketplace Plan?
Because your health and financial solvency is at stake. Even the healthiest among us are just one unforeseen event or imperfect gene away from medical costs that could bankrupt us. Additionally, marketplace plans provide subsidies to almost everyone who purchases a plan on the exchanges. If you buy insurance outside of the exchanges, you will not receive subsidies.
What do I Need to Sign up for a Plan?
The Centers for Medicare and Medicaid Services (CMS) has put out a checklist of the information needed for marketplace applications.
Where Can I Get Help Signing up for a Plan, if Needed?
If you have questions about signing up or want to talk through your options with a trained professional, call 1-800-318-2596 or visit https://localhelp.healthcare.gov/#/.
Let’s get everyone enrolled at healthcare.gov!