Open Enrollment Guide

Open enrollment is the period each year when health insurance plans are required by law to accept applications from new plan enrollees regardless of their health history. This also is the time when you can choose to stay with your existing health plan for the coming year if it still meets your needs.

New for the 2023 plan year

You may be eligible for substantial subsidies to help you pay your premiums. (Congress increased the size and availability of premium subsidies in 2021’s American Rescue Plan Act, and extended those subsidies in 2022’s Inflation Reduction Act.) The net result: insurance is more affordable for almost everyone who buys coverage on ACA’s individual Marketplace.

  • Individuals and families earning up to 150% of the Federal Poverty Level (FPL) are eligible for silver tier health insurance with $0 premiums and significantly reduced deductibles and copays.
  • Individuals and families earning between 150-400% of the FPL will get substantially larger premium subsidies than in previous years.
  • Individuals and families earning above 400% of the FPL – who were previously ineligible for premium subsidies due to income – will now be eligible for subsidies such that limit their premiums for a benchmark silver plan to no more than 8.5% of their annual income.
  • More than a third of consumers receiving premium subsidies will be able to purchase gold tier coverage for a $0 premium.

Important note: premium subsidies are only available to purchase health plans sold on the ACA Marketplaces. Start your search at healthcare.gov.

The “family glitch” has been fixed. In prior years, Marketplace consumers could not receive premium subsidies if coverage offered by their employer was defined as “affordable”—defined as less than 9.61 percent of an employee’s individual income. Affordability, however, was measured against the cost of individual coverage. This meant that family members were ineligible for subsidized ACA coverage if one parent had an offer of affordable employer-sponsored single coverage, even when the employee’s cost to cover additional family members was not affordable. A rule change fixing this “family glitch” is now in place. For 2023, dependents can now qualify for ACA subsidies if family coverage available through a breadwinner’s employment is unaffordable.

Additional news to bear in mind when you use your 2023 health insurance

A new federal law went into effect in 2022, protecting patients from surprise medical bills. This means that if you receive emergency care from out-of-network providers – or if you receive care (emergency or not) from an out-of-network provider at an in-network facility – you cannot be charged more than your in-network costsharing. Note that these protections do NOT apply to ground ambulance services.

Your how-to list for the Open Enrollment Period (OEP)

  • Timing. If you get insurance through your job, check with your human resources department to find out when your company’s open enrollment period begins and ends. If you get your health insurance through the ACA Marketplace, the OEP will run from Nov. 1, 2022, to Jan. 15, 2023. However, to get coverage that begins on January 1, you must sign up by Dec. 15th.
    • For people with Medicare coverage, open enrollment runs from Oct. 15- Dec. 7.
    • Enrollment in Medicaid, for those eligible, is open 365 days a year.
  • Costs.
    • Don’t just focus on premium costs! Make sure to consider what your OOP spending will be under the plans available to you (deductibles, co-pays, coinsurance).
    • If shopping on healthcare.gov, don’t be put off by ”list” prices. Most purchasers will qualify for tax credits that lower the cost of premiums. Depending on income, you may also be eligible for assistance with your OOP spending, so long as you purchase a silver-tier plan.
  • Scope of Coverage. When reviewing potential health plans, read all plan provisions carefully. Check that your providers are in-network; research whether your products are covered; beware of copay accumulator adjusters. 

Be an active participant

Don’t simply auto-renew your existing coverage: shop around and compare all your options. If purchasing your own health plan on the individual market, start your search at healthcare.gov. Avoid short-term health plans, health sharing ministries, and other forms of non-ACA-compliant coverage: these “skinny” plans do not provide sufficient coverage OR financial protection.