Open Enrollment: Opportunity for Consumers to Find More Affordable Health Coverage — and for Policymakers to Consider Additional Improvements

It’s Open Enrollment season, the time of year when millions of Americans turn to health insurance Marketplaces to enroll in individual health coverage or review their current plans. For the 5.6 million adults ages 50 to 64 who are uninsured, this Open Enrollment Period (which runs from November 1, 2023 to January 15, 2024 in most states) offers an important opportunity to get coverage for 2024. For the over 5 million older adults already enrolled in individual coverage, it’s a good time to compare plan benefits, providers, and prices to find the best plan for them.

Open enrollment season also highlights recent changes that have helped improve health care affordability for people who have or need individual health coverage. And for policymakers, it’s a good time to step back and examine how this part of the health care system can continue to be strengthened.

Marketplace plans are more affordable for millions of older adults

Cost is one of the biggest considerations for people when it comes to obtaining health insurance. In fact, the cost of coverage (including premiums, deductibles, and copays) is a major reason people go uninsured. Fortunately, millions of lower- to moderate-income Americans became eligible for more affordable health coverage under the American Rescue Plan Act of 2021 (ARPA), which expanded tax credits that lower (and sometimes eliminate) the cost of premiums for people enrolled in Marketplace plans. Under ARPA, average premiums for Marketplace plan enrollees ages 50 to 64 decreased 16 percent — or $954 per year. The subsequent Inflation Reduction Act of 2022 extended ARPA’s tax credit expansions through 2025, which means millions of enrollees will continue to have more affordable coverage options during open enrollment.

Further, over 1 million Medicaid beneficiaries ages 50 to 64 could lose their coverage this year and next due to the end of COVID pandemic-era protections that prohibited states from disenrolling people from Medicaid during the Public Health Emergency. Many of those consumers could be eligible for subsidized Marketplace coverage, and the federal government has announced a temporary Special Enrollment Period that will allow them to continue to enroll in Marketplace coverage through July 31, 2024.

Policymakers can build on recent improvements

Open enrollment is also an important opportunity for federal and state policymakers to assess older adults’ access to Marketplace plans. Recent legislative changes have helped improve health coverage affordability in this part of the health care system, but challenges remain. Marketplace plan enrollees who are not eligible for expanded tax subsidies will see an average premium increase of 5% in 2024. And the expanded tax subsidies are technically a short-term fix, available only through 2025 without new legislation.

Looking ahead, there are a variety of additional options that policymakers can use to continue to improve health insurance access and affordability. A new PPI report series explores policy options to help improve access to affordable coverage, which could also help reduce coverage disparities that persist by income and race/ethnicity.

For example, policymakers could make ARPA’s enhanced premium tax credits permanent. They could also consider increasing subsidies for reducing cost sharing (i.e., premiums, deductibles, etc.) or expanding reinsurance to improve coverage affordability. Policymakers could close the Medicaid coverage gap and limit the sale of “skinny” plans that do not offer comprehensive health benefits. Streamlined, targeted, and well-funded outreach and enrollment efforts could facilitate more enrollment in coverage, including among underserved groups.

Consumers agree action is needed. An AARP survey found that 7 in 10 adults ages 40–64 see reducing the cost of health insurance premiums and out-of-pocket costs as the most important affordability issue for policymakers to address. As open enrollment season continues, policymakers can and should continue to build on recent progress by pursuing a variety of policy options to expand and improve access to affordable health coverage for older adults.

To find your state’s Marketplace, browse coverage options, and sign up for coverage, visit: www.healthcare.gov. Be sure to check the enrollment deadline for your state.