This year’s Affordable Care Act enrollment is different: What you need to know

(The hill) – Open enrollment for plans available through the Affordable Care Act (ACA) Marketplace has officially begun, and this year’s enrollment period will include some new factors that could make it easier for more people to sign up for insurance.

Prospective customers now have until January 15 to enroll in ACA insurance plans. However, those who want coverage at the start of the calendar year should enroll by December 15th. Last year, enrollment reached a record number – 15.7 million – and this year it is expected to exceed that rate.

“We’re already at a record high in terms of enrollment in the ACA marketplace, and we’ve really had record highs for a few years in a row,” said Cynthia Cox, KFF vice president and program director at the ACA.

“A lot of that was due to the increased subsidies. The pandemic may also have motivated more people to purchase or maintain their health insurance.”

Several factors could drive up enrollment this year, including continued disenrollment of Medicaid beneficiaries, new enrollment mechanisms established through Healthcare.gov and greater engagement from insurers.

Flexible schedules

Most people who want to sign up for ACA insurance must enroll by December or January, but some who were disenrolled from Medicaid this year after the end of the COVID-19 public health emergency have until July 31st time to sign up, some have probably already done so.

The Centers for Medicare & Medicaid Services created a temporary “Medicaid Unwinding Special Enrollment Period” this year to anticipate widespread disenrollment. This special registration period began on March 31st.

More than 10 million people have been disenrolled from Medicaid since the phase-out period began.according to KFF. Many are still considered eligible for Medicaid but may have been dismissed due to administrative issues such as a missing address or failure to fill out required paperwork.

“A relatively small portion of these people are moving to the marketplace because many of the people who are losing Medicaid are losing it for procedural reasons,” Cox noted. “So if they reapply for Medicaid, they may find that they are still eligible for Medicaid. In addition, some people are losing Medicaid coverage – particularly if they are no longer eligible for that Medicaid coverage – because they were on Medicaid at the start of the pandemic when they were laid off and have since regained employment and employer coverage are .”

Marketplace applicants also have more time this year to submit documentation to prove their income. This data is automatically verified by sources such as the IRS and Social Security. However, if income cannot be verified, applicants are typically asked to provide the required information within 90 days.

This year, people have up to 150 days to submit this information.

New automatic re-enrollment policy

Those who are already enrolled in a plan and do not take action to renew or change their coverage will, in many cases, automatically be re-enrolled on December 16th. This has always been the protocol for ACA plans, but usually it meant a person was re-enrolled into the plan they already had.

This year, the process will be slightly different, as Healthcare.gov will consider whether participants in bronze plans — which have the lowest monthly premiums — are eligible for cost-sharing reduction plans at the silver tier, the next level up.

Deductibles and co-payments are typically lower for Silver plans than for Bronze plans. Those who earn income at or below 250 percent of the federal poverty level are eligible for cost-sharing reduction plans.

“They’ve just been tinkering with the algorithm this year to make sure as many people as possible get all the benefits they qualify for,” said Louise Norris, an insurance analyst at healthinsurance.org.

Norris called this “a good change” but warned people not to rely on automatic re-enrollment.

“No matter what, it is in your best interest to look at the plans available and choose your own, rather than relying on an algorithm to choose a renewal plan for you,” she advised.

Greater involvement of insurers

KFF has found that more insurance providers will enter new markets than exit this year. Cox says that’s because insurers have figured out how to be profitable with ACA plans.

“After the market became significantly more profitable, insurers came back or new ones were added. And so this year you’re seeing kind of a continuation of the trend that’s been going on for a number of years,” Cox said.

While applicants appreciate having more options available to them, Cox noted that it could also be a downside.

“However, it also comes to a point where there may be too many options for people,” Cox said. “It’s something of a balance where you want enough insurers participating so that there is real competition in the market. And of course at least one insurer who takes part so that the market even exists.”

Cox noted that a handful of insurers may end up offering multiple plans for each tier — bronze, silver, gold and platinum — meaning applicants will open Healthcare.gov and find hundreds of different plans available to them.

Many people who are used to getting coverage through their employer may be choosing between two different health insurance plans, so having several hundred options could prove “daunting” or “intimidating,” Cox said.

Insurers have learned to become more profitable in the ACA marketplace by, among other things, offering plans with more restrictive networks — HMOs and EPOs — to contain their costs.

Norris noted that Marketplace plans lean toward more restrictive networks, but said the network adequacy rules in place should ensure people can find the providers they need in their network.

“From a consumer perspective, I would say you should always be in control,” Norris said. “Even if you renew the same plan, don’t assume your doctors will still be in network next year.”

The ACA’s Navigator Program– which raises awareness about Marketplace plans and helps consumers fill out their applications – is also available to those who may need help in the crowded marketplace.

The Biden administration increased investment in these programs after the previous administration cut funding.

“It’s difficult when you don’t know the system and don’t know what questions to ask and what to look for,” Norris said. “I think the Navigator program is pretty robust right now. But it has also been robust in recent years.”