November 24, 2022
  • November 24, 2022

Overview of the 2023 open registration period

By on October 31, 2022 0

Ahead of the tenth open enrollment period under the Affordable Care Act (ACA), markets are on their strongest footing yet. Marketplaces saw record number of listings, largely thanks to enhanced subsidies initially made available under the American Rescue Plan Act (ARPA), then extended through 2025 under Inflation Reduction Act. This premium assistance, along with Medicaid’s continued coverage requirements during the COVID-19 public health emergency, has contributed to a record uninsured rate and increase in market listings among people of color.

In all states except Idaho (where enrollment has already begun), the 2023 open enrollment period begins November 1, 2022. Enrollment season runs through January 15, 2023 in all 33 states who use HealthCare.gov and many 18 states with state-based markets. While consumers can enroll until mid-January, those who want health insurance that begins on January 1, 2023 must generally register by December 15, 2022, although some of the state-based markets have later deadlines.

Ahead of the open enrollment period, the Centers for Medicare and Medicaid (CMS) released a new fact sheet and Data on HealthCare.gov market premiums and insurer participation for 2023. The fact sheet highlights operational issues such as key enhancements to HealthCare.gov and CMS outreach and education plans; other resources include a information note on plan choice and premiums, files for public useand quality assessment data.

Premiums, insurer participation and deductibles for 2023

Overall, 2023 premiums will increase by 4 percent for a 27-year-old for a silver referral market plan sold through HealthCare.gov. This is a reversal of past years where premiums have fallen – with a 3% drop for 2022, a 2% drop for 2021, a 4% drop for 2020 and a 2% drop for 2019. The average unsubsidized benchmark plan premium for a 27-year-old will be $382/month in 2023 (compared to $368/month in 2022). Despite the 2023 premium increase, the average benchmark premium is still 6% lower for 2023 than it was for 2019.

The CMS also emphasizes the impact of improved subsidies, which are saving millions of people a lot. As is now the case since 2021, those whose income is below 150% of the federal poverty level ($19,320 for an individual and $32,940 for a family of three) are eligible for a retirement plan. premium market of $0 (or almost $0). The amount an individual must contribute to premiums increases on a sliding scale as income increases, but premium contributions are broadly capped at no more than 8.5% of household income until 2025.

With the enhanced grants, about 64% of enrollees can find a plan for $10/month or less for 2023. Many can also use the enhanced grants to purchase a more generous silver or gold plan, which means lower deductibles for many. registered.

CMS Briefing Note highlights the impact of these savings by age and income. For example, the premium contribution for a 27-year-old whose income is 150% of the federal poverty level is reduced from $57/month before ARPA to $0/month after ARPA. And a family of four whose income is 500% of the federal poverty level will have their premium contribution reduced from $1,064/month before ARPA to $510/month in 2023. In fact, 6% of enrollees eligible for the grant for 2022 had an income over 400% of the federal poverty level and therefore would not have been eligible for market grants prior to ARPA. (These are all averages; premiums vary by location, insurer, income, and family size.)

Some families could see savings again thanks to a rule for 2023 that fixes the so-called “family problem.” The change means that spouses and dependents of some low-wage workers could once again be eligible for market subsidies for 2023. Federal officials expect the number of people receiving subsidized market coverage increases by about 1 million people as a result of this change. Assistants, such as agents, brokers and navigators, can help families determine if they are eligible and assess the benefits (or complexities) associated with using this new coverage option.

The participation of insurers also continues to increase. Seven more insurers will offer market coverage through HealthCare.gov for 2023 than this year, bringing the total number of participating insurers to 220 for 2023. Of the 33 states using HealthCare.gov, 11 states will have more insurers in 2023 versus 2022, and 22 states will have at least one county with more insurers. On average, enrollees have access to between 6 and 7 insurers and more than 113 qualified health plan options, including more gold and platinum plans than in previous years. Although county coverage has generally expanded for 2023, 16 states in HealthCare.gov have counties with fewer insurers for 2023 than in 2022. Only 1% of enrollees in 2023 have access to a single insurer; this is the lowest percentage in the history of the market.

In a change from recent years, market insurers must offer standardized plans alongside their non-standardized market plans. These standardized plans represent approximately one-quarter (28%) of the total plans available to enrollees at HealthCare.gov for 2023. Of the average of 113 available plans, enrollees have access, on average, to more than 28 standardized plan options .

Deductibles for HealthCare.gov plans will increase significantly for 2023, though CMS attributes the changes to the requirement to offer standardized plans. Deductibles generally increase each year, but standardized plans must meet certain cost-sharing requirements, including standard deductibles (ranging from $0 for the Platinum plan and CSR Silver plan to 94% to $9,100 for the Bronze) and standard annual disbursement maximums. (ranging from $1,700 for the 94% silver CSR plan to $9,100 for the bronze plan), among other limits on reimbursable expenses, and offer more pre-deductible services. For Bronze plans, the median individual deductible will increase to $7,471 for 2023, up 8% from $6,933 for 2022. Gold plan deductibles will increase to $1,684 for 2023, up from $1,398 in 2022 , an increase of 20%. Deductibles for Silver plans with no cost-sharing reduction are expected to increase from $5,166 for 2022 to $5,388 for 2023. And deductibles for Silver plans with actuarial values ​​of 73% and 87% will also increase from 2023 compared to 2022.

Market operations

During the 2023 open enrollment period, CMS will emphasize continued access at reduced costs, highlight standardized plan options, and streamline HealthCare.gov operations. Marketing and awareness funds will be spent on traditional broadcast and targeted digital ads; CMS will also continue to develop content in multiple languages ​​and partner with cultural marketing experts to expand outreach efforts. CMS continues the Coverage Champions Program and announced themed action weeks to highlight outreach to specific communities (e.g. rural communities, gig workers, etc.). Strong outreach, marketing and education is needed to raise awareness of the open enrollment period and the continued availability of enhanced grants (which were originally scheduled to expire at the end of 2022).

CMS is also touting its largest investment of $98.9 million in funding for the navigation program. These funds are going to 59 navigation grant recipients to support education and enrollment in 30 states leading up to and during plan year 2023. More than 4,900 assistants will be available to assist consumers in addition to more than 56,000 agents and brokers already trained to do so. CMS will continue the “Help on Demand” feature to allow consumers who wish to be contacted by an agent or broker to remain on HealthCare.gov while providing contact information.

Aside from these investments, HealthCare.gov’s operations appear relatively similar to previous years. Automatic re-enrollment will occur as in previous years, although enrollees are strongly encouraged to return to HealthCare.gov to update their information and actively enroll in a new market plan. Members who automatically re-enroll with a new insurer before the December 15 deadline will be eligible for a Special Enrollment Period (SEP) and will have until December 31 to choose a different plan starting January 1. And those who automatically re-enroll from January 1 can use the first two weeks of January to evaluate their plan and choose to choose a new plan with coverage that begins February 1.

Unlike previous years, CMS will release enrollment snapshots every two weeks (instead of weekly like previous years). This change will allow CMS to compile data from state-based markets in addition to state data from HealthCare.gov, providing data at the national level.

Some of the functionality changes on HealthCare.gov reflect recent policy changes. For example, CMS has developed new content to help educate consumers about the new standardized plan options, including the pre-deductible benefits they offer and how to enroll. CMS also updated the HealthCare.gov app to ensure that family members previously affected by the family issue can be determined eligible for Market Grants.

Separately, CMS published new direction confirming the continuation of a monthly SEP for low-income consumers. Low-income SEP was passed into a 2021 rule and is available to individuals and dependents who qualify for advance premium tax credits and whose household income is less than 150% of the federal poverty level . Under the 2021 rule, SEP is only effective when that population qualifies for the maximum advance premium tax credits (i.e., when Congress sets taxpayer contribution at 0% ). The new guidelines make no substantive changes except to affirm the continuation of low-income SEP until 2025.

Finally, federal officials continue to streamline the app, refresh the HealthCare.gov website, and add new resources to help consumers apply and register. In addition to the changes listed above, this year’s app will include new “guidance information” to help consumers compare plans and better estimate their income for 2023. The plan comparison tools include new tips and reminders, additional information on deductibles (i.e., summary deductible drug costs), and enhanced provider and drug search functions. HealthCare.gov also includes new income estimation tools that reflect multiple sources of income and fluctuations in income over time, and officials have redesigned Marketplace Eligibility Notices to be simpler and easier. more friendly.