Obamacare Open Enrollment Starts Today. Here’s What You Need To Know.

November 1 doesn’t just close the door on Halloween, it launches open enrollment on Healthcare.gov. So as you dig through left over candy—or pick through candy the kids in your life may have brought home—it’s time to check out your health insurance options.

This year, several changes to the Health Insurance Marketplace could affect your options.

First, like in previous years, more insurers are offering plans on the Marketplace. According to CMS, seven more insurers will offer 2023 plans via Healthcare.gov. This year, 11 of the 33 states that use Healthcare.gov as their Marketplace have more insurers operating this year than last year and 22 states have at least one county with more options than last year. On the other hand, 16 states that use Healthcare.gov will have fewer health insurers operating in 2023 compared to 2022.

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Almost all (92%) of enrollees have access to three or more health insurers offering Qualified Health Plans (insurance plans that are certified by the Marketplace as compliant with Affordable Care Act coverage and cost-sharing requirements). The average enrollee will have six to seven insurers to choose from and more than 113 qualified health plan options. Just 1% of enrollees will have access to only one insurer, the lowest percentage at any point in the history of the Marketplace.

On the cost side, CMS also reports that for the first time in recent years, average premiums will rise by 4% for what’s known as the benchmark plan. Average monthly premiums for a 40-year old who selects the second lowest cost silver plan on the Marketplace are $456, according to Kaiser Family Foundation (KFF), but range from $323 in New Hampshire to $841 in Vermont. Changes in average premiums also vary widely from state to state. According to KFF, average premiums are rising 15% in New Mexico but declining by 18% in Virginia.

But premiums alone don’t tell the whole cost story. Most people who enroll in coverage through the Marketplace qualify for some kind of subsidy that helps lower the total cost of insurance.

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CMS estimates that 64% of current enrollees could choose a qualified health plan for less than $10 per month after the application of Advance Payments of the Premium Tax Credit (APTC) if they stay with their 2022 plan in 2023. This figure is more than double the percentage of enrollees who could have paid so little before the American Rescue Plan Act (ARPA) of 2021, which expanded Marketplace subsidies.

For a 27-year old with income at or below 150% of the federal poverty level (FPL)—equivalent to $20,385 for an individual in 2023—will be able to get coverage for $0 in premiums. Before the American Recue Plan, the same coverage would have cost an average of $57 per month in 2021.

The Inflation Reduction Act, which became law in August 2022, extended the subsidies built into the ARPA through 2025. These subsidies fully cover the cost of enrolling in the benchmark silver plan for people earning up to 150% of FPL. The Inflation Reduction Act also continues to cap consumer contributions toward health insurance costs at 8.5% of their annual income, if they buy the benchmark silver plan. There continues to be no upper income limit on this cap. KFF has created a subsidy calculator to help people estimate how much subsidy they may be entitled to based on their age, income, family size, and location.

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Deductibles, a major component of consumer cost sharing, will go up in 2023. For bronze plans—typically the plans with the lowest premiums and least coverage—median deductibles will go up 8%, rising from $6,933 in 2022 to $7,471 in 2023. On the other end of the spectrum, Gold plan deductibles will rise 20%, from $1,398 to $1,684. These deductibles are substantially lower than those in bronze plans, but premiums tend to be higher.

Other changes on this year’s Marketplace is the resolution of the so-called “family glitch,” which did not properly factor the affordability of family coverage offered by employers. If the coverage offered to an employee were deemed affordable by Marketplace rules, but the family coverage was not, the employee’s family could not access Marketplace subsidies.

People who are already enrolled in Marketplace plans but who don’t actively choose a plan for 2023 can be automatically re-enrolled into their current plan or a similar one. It may be tempting to avoid reviewing plan options, but given new plan options and changes to the benchmark plan, the same plan may not be the best option year to year.

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Open enrollment runs between November 1, 2022 and January 15, 2023, but for coverage effective January 1, 2023, you have to sign up by December 15, 2022.