ACA Marketplace enrollment already at record 15 million

On Dec. 20, 2023, federal officials announced sign-ups for health insurance through HealthCare.gov hit a record 15 million. This screen shot shows the front page of the website to enroll.
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HealthCare.gov enrollment for 2024 has set a new record for insurance available through the Affordable Care Act (ACA) Marketplace.

On Dec. 20, the U.S. Centers for Medicare & Medicaid Services (CMS) and the administration of President Joe Biden announced the latest enrollment figure of 15 million people. Based on enrollment through Dec. 15 for HealthCare.gov and through Dec. 9 for state-based Marketplaces, federal analysts forecasted total enrollment will top 19 million people.

“Millions of Americans signing up for health care coverage under the Affordable Care Act is good news. It means more Americans have the peace of mind of knowing that going to the doctor won't empty their bank account,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a news release. “The Biden-Harris Administration will continue working to expand health care coverage and lower prescription drug costs, so taking care of your health is not a luxury.”

The deadline for coverage starting Jan. 1, 2024, was Dec. 15, and that day had the single largest daily enrollment ever with more than 745,000 people signing up, according to CMS. If the total reaches 19 million, that would be at least 7 million more people than when the president took office.

“Individuals will also benefit from a highly competitive Marketplace,” the CMS announcement said, with more than 90% of HealthCare.gov enrollees able to choose among three or more plans.

More changes could be in the works for 2025. In November, CMS proposed “more robust, affordable health coverage options,” including routine adult dental services as an essential health benefit. CMS will take public comments on that proposal until Jan. 8, 2024.

CMS stated: Many people are eligible for Medicaid and the Children’s Health Insurance Program (CHIP). However, those who are no longer eligible for Medicaid or CHIP should visit HealthCare.gov to see if they are eligible to enroll in a health plan.

It was unclear exactly how the Medicaid “unwinding” starting April 1 this year would effect HealthCare.gov insurance figures. As of Dec. 13, at least 12.57 million Medicaid enrollees were disenrolled across the 50 states and Washington, D.C. That data is an undercount due to lags when states report the figures, according to the “Medicaid Enrollment and Unwinding Tracker” published by KFF.

The unwinding happened when states began redetermining people’s Medicaid eligibility. That happened when the “continuous coverage” requirement ended as the COVID-19 pandemic eased, according to the Center for Budget and Policy Priorities (CBPP), a nonpartisan research group that also has analyzed Medicaid disenrollment.

CBPP published a report in Health Affairs that claimed the unwinding “is shining a light on our fragmented health coverage system.” Federal and state lawmakers could enact solutions to challenges that make it difficult for people to enroll and stay in Medicaid, CHIP and Marketplace coverage.

The Marketplace open enrollment period on HealthCare.gov generally runs from November 1 to January 15. In 2024, Jan. 15, the usual enrollment deadline, is a federal holiday so the deadline is extended to midnight Tuesday, Jan. 16 (which is 5 a.m. EST on Jan. 17) Consumers who meet the deadline will have coverage that starts Feb. 1, 2024.