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ACA health insurance enrollment period opens


Analysts offer reasons for price changes and potential record numbers of people signing up.

health insurance concept: © -

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The open enrollment period has begun for patients who get health insurance through the Marketplaces created through the Affordable Care Act (ACA).

President Joe Biden was optimistic in his Nov. 1 statement for the 2024 registration period starting that day and running through Jan. 15, 2024. Starting last week, the president and the U.S. Department of Health and Human Services (HHS) encouraged people to begin analyzing costs and benefits of plans at

The president touted the Inflation Reduction Act (IRA), his economic plan of August 2022, for helping consumers save an average of $800 a year on health insurance premiums. His statement said four out of five people “can find quality coverage for less than $10 a month.”

“We’ve made record-breaking progress in expanding coverage and lowering health care costs for American families, saving them money and giving more Americans the peace of mind that comes with affordable health insurance,” the president’s statement said. “I urge everyone to visit today to renew their coverage or shop for a plan.”

For the first time, plan year 2024 will include mental health facilities, substance use disorder treatment centers, and rural emergency hospitals in provider networks, according to HHS. “These changes will increase provider choice and access to care, especially for low-income and medically underserved communities,” the HHS announcement said.

What’s in store

HHS and its Center for Medicare & Medicaid Services (CMS) published findings about the plan year 2024:

  • There are 32 Marketplaces. Eight states have more qualified health plan (QHP) issuers participating in plan year 2024 than 2023, while 23 states have counties with more QHP issuers. That is due to new insurers entering and existing ones expanding their service areas.
  • 11 states have counties with fewer QHP issuers for 2024 than 2023.
  • 96% of enrollees have access to at least three QHP issuers, up from 93% for 2023.
  • The average lowest-cost silver plan is $0 for a 40-year-old with household income of 150% of the federal poverty level. That is based on applying the federal Advance Payments of the Premium Tax Credit.

“As a result of the ARP and the IRA, there are far more expansive changes to after-APTC premiums for a 40- year-old and a family of four,” the CMS findings said. The statement referred to the IRA and the American Rescue Plan Act, the 2021 economic plan approved to counter the economic effects of the COVID-19 pandemic.

Prices going up

For 2024, inflation is pushing up costs of unsubsidized premiums in the ACA Marketplaces, according to health policy research foundation KFF. Premiums will rise by an average of 5% for the second-lowest cost silver plan, which serves as the benchmark for calculating subsidies, and by 6% for the lowest-cost bronze plans, according to KFF.

AHIP, the trade organization representing American health insurance plans, noted other factors affecting health insurance prices:

  • Increasing provider costs.
  • Hospital and provider consolidation.
  • Prescription drug prices.

Those “are not expected to slow down in 2024, meaning health care costs will continue to increase for consumers,” said the AHIP analysis, “Factors Influencing 2024 Individual Market Premiums.”

AHIP noted at least two other factors. Antiobesity drugs have sparked huge interest across the nation. COVID-19 vaccines will revert to the private market as federal supplies run out, with Pfizer and Moderna signaling booster shot prices will go up. Both could have an upward effect on premiums.

Analyst forecasted premiums will be flat or will rise by single digits, which could contribute to potential record enrollment in 2024.

Who’s involved

The White House announced record enrollment of almost 16.4 million for 2023; KFF pegged the figure at 15.7 million, still the most since the Marketplaces went online for 2014.

KFF noted more than 9.5 million people have been disenrolled from Medicaid and the Children’s Health Insurance Program, and more may be in coming months.

“Some may find themselves eligible for Marketplace subsidies, further boosting enrollment in the coming year, though there may be challenges in ensuring people losing Medicaid are aware of their options for coverage through the Marketplaces,” said the KFF analysis, “What to Watch in the 2024 ACA Open Enrollment.” also listed Medicaid disenrollment as a factor in 2024 sign-ups, citing a federal government estimate that 2.6 million people could qualify for financial help to lower the cost of a Marketplace plan.

The Biden administration has proposed allowing Deferred Action for Childhood Arrivals (DACA) recipients to enroll in Marketplace plans. If enacted, that could lead to an estimated 580,000 people qualified, according to

Learn more

If your patients have questions, has published an online “ACA Open Enrollment 2024 Guide.”

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