The ninth open enrollment period for the ACA (Affordable Care Act) is underway. It started on November 1st, 2021, and will be extended all the way to January 15th, 2022. This 2022 enrollment is open to some of the 18 states that use state-based marketplaces and those that use HealthCare.gov. As a consumer, you have until the deadline to enroll, but if you want the health insurance set to start on January 1st, 2022, you need to enroll by December 15th, 2021.
Marketplaces are continually evolving, and some critical changes are expected in the new year. For instance, the Centers for Medicare and Medicaid (CMS) recently released new data and a fact sheet on insurance participation and marketplace premiums for HealthCare.gov in 2022. In addition, the American Rescue Plan also increased and expanded eligibility for premium tax credits for people enrolled in marketplace health plans. This made financial assistance available to more people and in larger amounts. These enhanced benefits will continue for the 2022 plan year.
Here are more changes that you need to look out for;
1. Different Enrollment Dates
The current open enrollment period is longer. Previously, it only lasted six weeks in HealthCare.gov states, but it will now be running for more than 12 weeks. You should, however, note that signing up late will only delay your medical coverage. So, if you’d like your coverage to begin on January 1st, 2022, make sure you sign up by December 15th. If you sign up later than this, your coverage will start on February 1st, 2022.
State-run marketplaces will also have the flexibility to increase or decrease their open enrollment periods. For instance, the Idaho open enrollment period will be ending on December 15th, 2021, while in other states such as California and the District of Columbia, it will be ending on January 31st, 2022
2. Changes in Premiums and Plan Choices for 2022
Every year, marketplace plans premiums change. For instance, in 2018, due to silver loading, the premiums significantly increased. They then experienced a 2% decline in 2019, followed by a 4% decline in 2020 and a 2% decline in 2021. In 2022, the premiums are expected to experience a 3% decline, but in some state-run marketplaces, the average qualified health plan premiums may increase.
There’s also an expected increase of the participating marketplace insurers. For instance, the total HealthCare.gov states will now be 213 as 32 more insurers will start offering marketplace coverage. The benchmark plan, which is the 2nd lowest silver plan that’s often used to base marketplace subsidies, is often impacted by the level of insurer competition.
In 2022, consumers that are in HealthCare.gov states will have more than 80 qualified health plans next year, compared to 46 in 2021.
3. Continuation of Market Subsidies
It’s expected that the better marketplace subsidies will continue, decreasing the net premium for consumers. These subsidies were enacted under ARPA (American Rescue Plan Act), which was implemented in 2021 and will continue to 2022. It caused an increase in premium tax credits and also now fully covers the enrollment costs for the benchmark silver plan for those that have an income of up to 150% FPL. Previously, these consumers had to pay over 4% of the average household income to access the plan. In addition, there are also cost-sharing subsidies for consumers of up to 150% FPL that reduce the copays and deductibles for zero-premium silver plans.
The American Rescue Plan Act also extended the premium tax credit eligibility for consumers with more than 400% FPL. They now have to contribute at most 8.5% of their income towards the benchmark silver plan. You should, however, note that these premium tax credits are temporary, and they may change after 2022 not unless they are made permanent by legislation that is now pending in congress.
4. Increased Enrollment Period for Low-Income Earners
From 2022, consumers whose income is up to 150% FPL ( $32,940 for a family of 3 and $19,320 for one person annually) can enroll throughout the year. The new enrollment opportunities will be offered monthly, and the plan choices will have significantly reduced deductibles as well as zero-premium plans. If you’d like to sign up, you’ll have to prove that your income is at or below the above range before you can complete your application.
The marketplace will conduct the income verification in real-time, and you may have to submit additional documents in no more than 90 days. HealthCare.gov will also require documentation if you indicate that your 2022 income will be significantly lower by $12,000 or 50% (whichever is more) than what was recently reported on the deferral income tax return.
Even though the open enrollment period is always the best time to sign up for annual coverages, the extended periods give you an opportunity to hop on premium-free plans throughout the year.
5. Opening of New State-Run Marketplaces
Previously only 15 states used state-based marketplaces, and this Fall, 3 more will be launched; New Mexico, Maine, and Kentucky. Around 173,000 consumers in these states had already signed up for the HealthCare.gov plans, but their data will be transferred to the new marketplace. They’ll also be advised on how to enroll for 2022 coverage and how they can access their accounts.
6. More Availability of Enrollment Help
Previously, funding for Navigators had been halted due to massive funding cuts that averaged at 84%. They have now been restored and are providing enrollment help to consumers. Navigators are typically certified enrollment experts who offer free help to consumers looking for subsidies, need help signing up for Medicaid, and are shopping for coverage options. There will be twice as many in 2022, and there’ll be more resources, including language translation services, remote assistance, and extended hours.
You can easily find the nearest program through the “Find Local Help” section on the HealthCare.gov site.
7. Some Recent Changes Will Be Changing Back
You should note that some changes that were made in 2020 will be changing back. For instance, the temporary repayment holiday that was a part of the pandemic relief act saved people that filed their 2020 tax return from paying excess premium tax credit. The holiday is now over, and the repayment requirement is back, so if you underestimate your income in 2022, you’ll end up owing more taxes.
The Biden Administration also made changes to the public charge rule that made it difficult for immigrants to apply for health coverage under the fear that it could get them deported.
8. Implementation of Supreme Medical Bills Protection
Currently, most marketplace plans don’t cover non-emergency care from providers outside their network as they’re either EPOs or HMOs. Those that cover these services often result in customers paying for balance billing charges. Well, this will change in 2022 as a new federal law will be enacted. This law aims to eliminate surprise medical bills, and from January 1st, 2022, all marketplace plans will be required to cover emergency services at the in-network rate. Partners that are outside the network will also be prohibited from billing more than they charge under their plan for in-network cost-sharing.
9. Strong Recommendation for Active Renewal
Most states will automatically enroll you in your current plan or a similar one if you don’t update your application for 2022. This practice has been happening during the last 3 OE periods, and around 40% of regular marketplace participants were re-enrolled. While this move is aimed at encouraging renewal, it may put you at a disadvantage. For instance, if there’s a change in the benchmark plan due to more insurers, the value of the tax credits can change as they are tied to the plan.
If you didn’t take advantage of the American Rescue Plan Act subsidies when they came online, then you risk missing out on them in 2022 if you don’t actively review your plan. Even though the marketplaces automatically adjusted subsidies for most enrollees at the end of COVID-SEP, they couldn’t help if you were already in a zero-premium bronze plan. So, at the end of the 2021 open enrollment period, over 800,000 HealthCare.gov consumers were enrolled in a zero-premium bronze plan while they would have been best suited in a silver plan thanks to the new ARPA subsidies.
Make sure you update your application during this period even though your income still hasn’t changed so that you can view your financial assistance options. Otherwise, the extended open enrollment period will only give you a short time to make changes.
Will These Changes Result in New Enrollment Records
The above changes are expected to set new enrollment records. This is especially because federal officials are streamlining the application process and refreshing the HealthCare.gov site so that it has more resources that consumers can use to apply and enroll. In addition, the new guiding information section on the site will help you better understand the enrollment steps and improve your overall shopping experience. For instance, you’ll be able to compare out-of-pocket costs and deductibles beyond the premiums.
Healthcare Solutions Team is a wholly-owned subsidiary of the National General Insurance Group and Allstate Insurance Company.