The State of the ACA Market in 2024

The marketplace had another historic year! Record enrollments, new Affordable Care Act carriers, and additional consumer protections defined the success of the under-65 marketplace.

It’s not too late to add these valuable under-65 health insurance plans to your portfolio! 2024 is the perfect time to start selling ACA coverage. Here’s why.

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Current Marketplace Data

As Americans feel the stress of increasing costs, access to affordable health care remains a necessity. More Americans turned to the marketplace for health care coverage this year than ever before. For the 2024 Open Enrollment Period (OEP), 21.3 million people enrolled in marketplace health care coverage. This year, five million people enrolled ACA coverage for the first time!

Marketplace Consumer Enrollment

As more states transition to a state-based marketplace (SBM) to better meet the needs of residents, a significant portion of enrollments came from these avenues. This OEP, 4.9 million consumers enrolled through their state’s marketplace — that’s about 23 percent of total enrollments!

A total of 18 states and Washington, D.C. host their own marketplace. Virginia began their transition to a SBM in 2023, but is still hosted on the federal platform. Georgia was granted approval to transition to an SBM for the 2025 plan year.

Note: Ritter offers support in both the federal marketplace and several state marketplaces. Our ACA Sales team is active in: AL, AR, AZ, CO, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MO, MS, NC, NE, NH, NJ, NY, OH, OK, PA, SC, TN, TX, UT, VA, WV, WI.

New Carriers Available in the Marketplace

For the 2024 plan year, many carriers expanded their coverage or entered the marketplace for the first time. The map below shows how many ACA carriers are available in each U.S. county. There were 859 counties that had more than five ACA carriers to choose from! That’s about 27 percent of counties in the country!

Source: CMS.gov

Additionally, several new carriers entered the marketplace in several states: California, Colorado, Delaware, Indiana, Maryland, Nevada, New Jersey, New Mexico, Oklahoma, Pennsylvania, South Carolina, Utah, and Wisconsin.

Trends

Because of this new growth in the marketplace, ACA enrollment in 15 states — Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Iowa, Louisiana, Mississippi, North Carolina, Ohio, South Carolina, Tennessee, Texas, and West Virginia — has more than doubled since 2020. Texas has even tripled their marketplace enrollment since 2020! According to KFF, the states with the most growth have these factors in common: previous high uninsured rates before the IRA protections, have not expanded Medicaid, and are on the federal platform.

It’s likely the large number of uninsured Americans in these states wanted health care coverage and, with the enhanced subsidies, were finally able to afford it.

New for 2024

The following are significant changes that will affect clients who have marketplace coverage.

Auto-Reenrollment Savings

The marketplace began offering savings to clients who automatically re-enroll in the same plan. Encourage your clients to sign up for auto-reenrollment if they are satisfied with their coverage and anticipate no significant changes. They will be eligible for savings with this election.

If your client does not select new coverage and their plan is discontinued, they will be crosswalked to a new plan offered by the same insurer. This new plan will have a network and premium similar to their old plan, providing access to the same providers for the same cost or a lower cost! This can be beneficial for clients who qualify for subsidies but choose a Bronze plan. A Silver plan with subsidies is often more affordable than a Bronze plan.

While auto-reenrollment can be a great feature, we recommend always reviewing your clients’ coverage with them before the OEP to ensure it’s the best option for them. Offer excellent customer service and assist your clients with finding coverage, enrollment, and submitting ACA documentation.

Additional Time to Submit Proof of Income

Clients must submit their estimated household income for marketplace coverage each year. The original deadline for this submission was 90 days. However, if your clients need more time to submit their proof of income forms, the marketplace will automatically grant them a 60-day extension. This means that clients have a total of 150 days to submit documentation.

For Individuals Turning 26

Individuals turning 26 will officially have until the next open enrollment period to enroll in a new coverage option after leaving their parents’ marketplace plan. They will be permitted to stay on their parents’ marketplace coverage through the end of the calendar year, rather than their birthday month.

Recapping the Past Year

In last year’s evaluation of the ACA market, we looked at some of the upcoming objectives. Here’s how they panned out.

The Medicaid Unwinding

The Medicaid unwinding began in April 2023. Clients who were enrolled in a Medicaid plan but no longer qualified after the end of the COVID-19 Public Health Emergency (PHE) were disenrolled from Medicaid. These clients had to find other health coverage. As a result, many people chose to elect marketplace coverage.

If any of your clients were affected by the Medicaid unwinding, they should have received a Special Enrollment Period (SEP) to elect different coverage. This SEP will remain active until November 30, 2024. Qualifying clients do not have to submit documentation testifying a qualifying life event.

The End of the COVID-19 PHE

The COVID-19 Public Health Emergency (PHE) officially ended on May 11, 2023. This caused some services (such as COVID vaccinations and testing) to no longer be covered by health plans. As a result, some beneficiaries may have had to find other coverage options.

Remember, if your clients could not sign up for marketplace coverage at the end of the COVID-19 PHE, they are able to sign up for it if they lost coverage in the last 60 days or are expecting to lose coverage in the next 60 days. Making them aware of this general SEP is just one way you can protect your clients.

Protecting Consumers

Consumer protections were prioritized by the Biden administration in 2023. Even Medicare beneficiaries benefitted from enhanced consumer protections last year. Biden frequently spoke of his support for the ACA and intention to keep funding intact. He also named affordable health care as one of his administration’s priorities, saying, “healthcare is a right, not a privilege.”

After passing the Inflation Reduction Act, the federal marketing budget for the ACA has increased significantly. For example, President Biden is proposing $43.1 billion to be spent over the next 10 years. More individuals have and will continue to discover that they are eligible for a marketplace plan.

The Marketplace Final Rule for 2024 expanded consumer protections by requiring agents to maintain documentation of client consent. We’ve created templates and documents that make it easy for agents to maintain these records.

What to Look Forward to Next

At Ritter, we like to keep tabs on the future of the ACA market. We’re predicting that the following issues will impact clients the most in the coming year.

Cost-Saving Reductions

We anticipate that cost-saving reductions will be a priority of President Biden and the marketplace in 2024. KFF surveyed more than 1,000 adults, and three in four expressed concern about affording unexpected medical bills. Reducing overall health care costs is one of the issues at the front of the ACA market. Enhanced ACA subsidies from the Inflation Reduction Act are scheduled to continue through 2025.

Three in four adults are concerned about affording unexpected medical bills.

Lower prescription drug costs are also on the horizon for 2024. In his 2023 ACA anniversary address, the president recognized the reduced cost of insulin and his intention to maintain the momentum of lowering prescription drug costs for Medicare, lowering them for the marketplace as well.

The 2024 Presidential Election

The upcoming election may affect the ACA and clients who receive marketplace health care coverage. Historically, there have been changes in what the ACA marketplace looks like under different presidents. While we believe the ACA is here to stay, we will continue to monitor significant market changes and report the ones you need to know.

Significant Market Changes

We’re also likely going to see some market changes that may impact coverage costs and how beneficiaries will receive coverage.

Changes in Unsubsidized Premiums

Agents should keep updated client information on file to be able to accurately calculate subsidies to accurately estimate how much a client will pay for their plan.

KFF anticipates that unsubsidized premiums will increase by an average of five percent.

Changes in Preventative Service Coverage

In March 2023, a judge in Texas ruled that requiring insurers to cover some preventative services violates constitutional and religious freedoms. As a result, we may see new limitations on some preventative care options. Clients would have to pay more for treatments for HIV, birth control, and others. The most impacted treatment would be PrEP for HIV.

Please be aware, the Biden administration has an active appeal against this ruling and nothing is final.

More State-Based Marketplaces Available

Additionally, we’ll see more states leave the federal marketplace to start their own SBM. Georgia and Virginia attempted to leave the marketplace in 2023, but were not successful in time for the OEP. They are transitioning to an SBM later this year. Georgia will become an SBM in fall 2024 and Virginia does not have an estimate at this time.

Why Sell ACA Coverage in 2024?

If you’re not already selling ACA coverage, this is an incredible year to add these plans to your portfolio. Record-breaking enrollment and reduced prescription drug costs contribute to the great demand for marketplace coverage. KFF reports that the majority of the Americans want to see the ACA expanded rather than repealed or scaled back! This year certainly looks like a great time to add under-65 insurance options to your product portfolio.

At Ritter, we want to see you succeed and we’re dedicated to providing the tools, resources, and knowledge you need to grow your business. We have an experienced sales team and a competitive portfolio of contracts. If you’re not already a Ritter agent, it’s free to sign up!