Nov 1, 2022 - Health

ACA sign-ups begin with millions likely to duck big premium hikes

Illustration of a red cross on a billboard with a "SALE" sticker.

Illustration: Lindsey Bailey/Axios

Open enrollment for Affordable Care Act coverage begins today, with enhanced subsidies that Congress renewed through 2025 expected to cushion the blow of premium increases for millions of Americans.

The big picture: Health costs are steadily climbing due to inflation and a post-pandemic surge of demand for medical services.

  • But the more than 12 million Americans now receiving subsidies will likely benefit from them again in 2023, including those making more than 400% of the federal poverty level.
  • The amount people pay in premiums will also be limited to 8.5% of their income.
  • And the Biden administration finalized rules to fix a glitch that had been preventing some families from getting subsidized health insurance.

Yes, but: For those who don't qualify for subsidies, premiums will increase more than in past years for marketplace plans.

  • "We're seeing a return to regular services," Chiquita Brooks-LaSure, administrator at the Centers for Medicare and Medicaid Services, told reporters on Monday.

Be smart: The cost pressures in the individual market are also being felt in the commercial sector, where health care costs are causing employers to grapple with higher premiums and tough decisions around benefits.

One mitigating factor is the absence of the so-called "family glitch," which kept people offered health insurance through their employer from accessing ACA marketplace subsidies to cover their families, even if they met eligibility requirements.

  • This fix could mean about 1 million families may benefit from marketplace coverage, Brooks-LaSure told reporters. An estimated 5 million people were affected by the glitch.
  • Even if families can enroll in marketplace plans, "the question is whether they will actually want to," Cynthia Cox, vice president at the Kaiser Family Foundation, told Axios.

By the numbers: In 2022, marketplace enrollment reached its highest level since 2015, with nearly 17 million people signed up.

  • This trend could continue, Cox said. And the anticipated end of the COVID-19 public health emergency could also mean some Medicaid enrollees who drop off program rolls and qualify for ACA plans.
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