9 Trends To Watch During ACA Marketplace 2024 Open Enrollment

November 01, 2023 - Going into the 2024 open enrollment season, healthcare stakeholders should be prepared for nine key trends in Affordable Care Act marketplace enrollment, according to experts from KFF.

First, stakeholders should expect unsubsidized premiums to rise due to inflation. Premiums grew on average 5 percent for the second-lowest-cost silver plan and 6 percent for the lowest cost bronze plan. Rising prices for prescriptions and healthcare services alongside growing utilization contributed to the premium boost.

The KFF experts noted that the Inflation Reduction Act’s subsidy enhancements remain in effect and can reduce the impacts of these premium increases.

Additionally, if high enrollment caught stakeholders by surprise last year, they should be more ready for a repeat in 2024. The Medicaid unwinding which left 9.5 million adults and children without coverage in 2023 might contribute to this spike.

Auto-renewal system issues, among other procedural problems, led to widespread Medicaid disenrollment. CMS reinstated coverage for 500,000 people and paused disenrollments, but the mishap could still result in a shift toward the Affordable Care Act marketplace.

Third, insurer competition will be greater in 2024 than in other enrollment periods of recent history. Despite Oscar Health and Cigna’s exits from certain markets, several states are experiencing an influx of payers in their Affordable Care Act marketplaces.

States are making changes to their coverage, so enrollees and plans in certain states should anticipate that benefits, costs, and even enrollment processes will look different in 2024. At least one state is shifting to a state-based enrollment platform, others are offering greater cost-sharing reduction subsidies or changing income or immigration limits for state subsidies.

Individuals who are at or below 250 percent of the federal poverty level and who do not make any changes to their plans during open enrollment might see their coverage change to silver plans, which offer higher cost-sharing reductions. This shift reflects changes to the auto-reenrollment policy.

Whereas, in past years, individuals who did not act during open enrollment were re-enrolled in the same plan, in 2024 states will seek to re-enroll them in a lower-cost plan. The silver plan will be provided by the same insurer and will share the original plan’s provider network.

Sixth, enrollees will have more time to submit proof of income in 2024. Previously, enrollees had 90 days to send regulators income proof. During the 2024 enrollment period, they will have a 60-day extension.

Additionally, adults turning 26 in 2024 can stay on their parents’ Affordable Care Act marketplace plans until the next enrollment cycle. In the past, states could terminate young enrollees’ parental coverage on their 26th birthday, even if the birthday fell in the middle of the year. Under the new policy, states cannot terminate coverage until the end of the calendar year.

Eighth, certain life events will allow individuals to change plans or enroll in Affordable Care Act marketplace plans even after the open enrollment period ends. Medicaid disenrollment, a natural disaster, loss of other coverage, and a pandemic can initiate a special enrollment period.

Finally, any enrollees receiving tax credits for coverage have to file tax returns to remain eligible. Those who do not file and reconcile their tax returns for two consecutive years cannot receive advance premium tax credits in the third year.