Millions of Americans are Qualifying for Free Health Insurance

In the majority of the states, open enrollment for 2024 coverage ran through January 15, 2024. But some state-run exchanges have later deadlines, and in Idaho, open enrollment ended altogether on December 15, 2023.

Enrollments in most states needed to be completed by December 15, 2023 in order to have a plan that took effect on January 1. But there are several states where the deadline for a January 1 effective date was later:

• In Massachusetts and New Mexico, the deadline for a January 1 effective date was December 23.
• In New Jersey, Maryland, California, Rhode Island, and Nevada, the deadline for a January 1 effective date was December 31.

In nearly every state, enrollments completed after December 15 (or the alternate deadline listed above, for states that differ) but before the end of open enrollment had a February 1 effective date, although there are generally a few states where a March effective date is possible during the latter part of open enrollment if the state allows the enrollment window to extend beyond mid-January.

Enrollments in most states needed to be completed by December 15, 2023 in order to have a plan takes effect on January 1. But there were some exceptions:

• In Massachusetts, Rhode Island, and New Mexico, the deadline for a January 1 effective date was December 23.
• In New Jersey, Maryland, California, and Nevada, the deadline for a January 1 effective date was December 31.

The chart below shows the start and end date for open enrollment each state. Other than the states listed above, the deadline for a January 1 effective date was December 15, even in states that have extended final enrollment deadlines.

You can enroll in a health insurance plan online, over the phone, or in-person. But regardless of the method, if you’re enrolling in a plan through the exchange, you’re going to need to have the following information on hand for each enrollee:

• Name, address, email address, social security number, birthday, and citizenship status. (Proof of lawful residency status may be required).
• Payment information that the insurer will be able to use to charge your premiums (this will generally be bank account information, but some insurers will allow automatic payments by credit card).
• A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary (covered drug list), so you’ll want to check to see which one will best cover the medications you need.
• Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.
• Household size and income (if you’re planning to apply for premium subsidies or cost-sharing reductions). A wide range of documentation can be used to prove your income, including pay stubs, W2s, your most recent tax return, etc.
• Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).
• If you want to enroll in a catastrophic plan and you’re 30 or older, you’ll need a hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).

here is no federal government penalty for being uninsured in 2024, but you still need coverage!

The ACA’s federal individual mandate penalty has been $0 since the start of 2019, and that will continue to be the case for 2024. People who are uninsured do not face a penalty, unless they’re in a state that has its own individual mandate and a penalty for non-compliance. Four states and DC impose tax penalties for not having health insurance:

• Massachusetts
• New Jersey
• California
• Rhode Island
• District of Columbia

If you were already enrolled in an ACA-compliant health plan through your state’s marketplace, was it possible to just let that plan automatically renew for 2024? In most cases, yes, assuming your plan continues to be available. But letting your plan auto-renew is not in your best interest.

Auto-renewal was an option for nearly all exchange enrollees for 2024, although there are some enrollees whose 2023 plan is no longer available in 2024 (for example, enrollees with Oscar Health in Colorado and Arkansas, and Bright Health enrollees in any state).

If you had a plan through the exchange that is no longer available in 2024, the health plan or the exchange (if the insurance company is exiting the area altogether) likely selected a new plan for you. This is better than becoming uninsured, but it’s always best to select your own replacement plan, rather than relying on an algorithm that an insurer or the exchange will use.

And even if your health plan continues to be available, relying on auto-renewal is not in your best interest. No matter how much you like your plan, it pays to shop around during open enrollment and see if a plan change is worth your while.

Here is why:

• In most states, you have limited opportunities to pick a new plan after your coverage is auto-renewed. The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. Since open enrollment now extends into January in nearly every state, enrollees in most states have until at least January 15 to pick a new plan if they ended up deciding that the auto-renewed option wasn’t the best choice after all. If you decide to make a change in the latter part of open enrollment, your auto-renewed plan will cover you in January, and your new plan will take effect in February. But after January 15, in most of the country, you will not have another chance to change your coverage until the following year, unless you experience a qualifying event.
• Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. If the cost of the benchmark plan changes, premium subsidy amounts in that area will also change. The benchmark plan for 2024 may or may not be the same plan that held the benchmark spot in 2023. In some areas, there are different insurers offering plans for 2024, and regular annual price changes can result in fluctuations in terms of which plan occupies the benchmark spot. Shopping around for a different plan — as opposed to letting your plan auto-renew – might result in substantial savings. This article illustrates examples of how this works, based on real enrollees’ experiences with 2021 and 2023 coverage. And this article is another example of how subsidy changes can have a drastic impact on net premium changes, and why comparison shopping is so important.
• If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining. If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for the coming year), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years, or if you failed to reconcile your premium subsidy on the prior year’s tax return.
• (Note that throughout the COVID pandemic, the exchanges have not discontinued premium tax credits for people who failed to reconcile a prior year’s premium tax credit with the IRS. The federal government announced in 2023 that this would continue to be the case for 2024, meaning that premium subsidies for 2024 are still available — assuming the person is still subsidy-eligible — even if the person hasn’t reconciled a prior year’s premium subsidy with the IRS. Starting with 2024 coverage, however, the government has proposed a rule change that would result in discontinued subsidies if the person has failed to reconcile prior premium tax credits for two consecutive years.)
• If your plan was discontinued at the end of 2023, auto-renewal resulted in the exchange or your insurer picking a new plan for you. They tried to assign you to the plan that most closely matched the coverage you had in 2023, but selecting your own new plan is a better option, and is more likely to result in coverage that meets your needs and budget.
• Auto-renewal might result in a missed opportunity for a better value. Even if the plan you have in 2023 was the best value when you selected it, there may be different plans available for 2024. Provider networks and benefit structures can change from one year to the next, as can premiums. You might still decide that renewing your 2023 plan is the best option for 2024. But it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering the other available options.