Open enrollment period

HealthCare.gov enrollees have more health plan options in 2025 compared to previous years, yet the average benchmark plan premium in states that use the federal enrollment platform increased modestly, according to CMS.

In most states, the open enrollment period for Affordable Care Act marketplace coverage runs from Nov. 1, 2024, to Jan. 15, 2025. Out of the 31 states that are using HealthCare.gov, eight have more Qualified Health Plan (QHP) issuers in 2025 than in 2024, and 97% of enrollees have access to three or more issuers, compared to 78% in 2021. Seven HealthCare.gov states have counties with a single QHP issuer in 2025, compared to nine states in 2024. Georgia stopped using HealthCare.gov in 2024 and transitioned to a state-run exchange, and Illinois is scheduled to move to a state-based marketplace for the 2026 plan year.

In recent letters to two federal watchdog agencies, Republican leaders of key House committees demand an investigation into “widespread” improper enrollment in Affordable Care Act exchange plans, citing the findings of a paper from Paragon Health Institute, a right-leaning think tank.

Health policy experts who spoke to AIS Health agree that that there are incentives for enrollees — and the brokers who help them find coverage — to estimate their income in such a way that they will qualify for the richest ACA subsidies. However, they aren’t convinced that there’s large-scale enrollment fraud taking place.

In their paper, the Paragon researchers estimate that 4 million to 5 million people are improperly enrolled in $0-premium (or fully subsidized) ACA exchange plans as of 2024, costing taxpayers between $15 billion and $20 billion.

Uninsured rates among Black, Latino, Asian and Native American communities plummeted from 2010 to 2022, as more people gained health care coverage through federal health care programs and employer-sponsored plans, according to reports released by HHS.

The uninsured rate for Black Americans under age 65 dropped from 20.9% to 10.8% between 2010 and 2022, and the rate dropped from 32.7% to 18.0% for Latino Americans during that time. Meanwhile, the uninsured rate went from 16.6% to 6.2% for Asian Americans, Native Hawaiians and Pacific Islanders (AANHPI), and from 32.4% to 19.9% for American Indians and Alaska Natives (AI/AN).

Medicare Advantage enrollment grew by 350,000 members during the 2024 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a 31% drop from last year, which saw 507,000 sign-ups from February to May, and it reflects a slowdown in MA growth also seen in the Annual Election Period (AEP).

CMS recently said it received tens of thousands of complaints from people who were enrolled in Affordable Care Act marketplace plans without their consent by unscrupulous brokers during the first three months of this year. That led the National Association of Benefits and Insurance Professionals (NABIP), a broker trade group, to criticize CMS for its handling of the situation and claim that all brokers had been unfairly blamed by the agency.

But one industry expert says that there is “plenty of blame to go around” for the unauthorized enrollments, which can result in financial harm to plan members and insurers alike.

Over the first 10 years of the Affordable Care Act marketplaces, enrollment nationwide has almost tripled, from 8 million individuals in 2014 to 21.4 million in 2024, according to an HHS report.

While the ACA initially envisioned the marketplaces to be developed by states, it also provided states with the option to participate in the federally facilitated marketplace, HealthCare.gov. In 2014, 14 states and the District of Columbia chose to operate their own state-based marketplaces (SBMs). In 2024, there are 19 SBMs.

More than 21.4 million people have signed up or were automatically re-enrolled in Affordable Care Act marketplace coverage during the 2024 open enrollment period, a 31% increase compared to 2023 OEP, according to CMS.

About 16.4 million people enrolled through HealthCare.gov in the 32 states that use that platform, and another 5.1 million enrolled across 18 states and the District of Columbia, which use their own marketplaces. More than 5.2 million people signed up for marketplace coverage for the first time, a 41% increase compared to 3.7 million during the 2023 OEP.

Every state except Maine saw membership growth in 2024, ranging from 0.2% in the District of Columbia to 80.2% in West Virginia. From 2023 to 2024, 44 of the 51 states reported signup increases of at least 10%, and seven states saw surges of more than 50%. Compared to 2021, marketplace enrollment increased over 150% in six states: Georgia, Louisiana, Mississippi, Tennessee, Texas and West Virginia.

More than 21 million people selected or were automatically reenrolled in health plans during the most recent Affordable Care Act open enrollment period (OEP). That’s according to one of four reports issued by HHS on March 22 marking the 10-year anniversary of the ACA. HHS also said that 5.1 million more people signed up for coverage during the 2024 OEP compared to the 2023 OEP, representing a 31% increase. Another report found that over 45 million people now have coverage thanks to the creation of the ACA marketplaces and Medicaid expansion -- “the highest total on record.”

The Oregon Health Authority (OHA) on March 14 began a review of UnitedHealth Group’s proposed acquisition of Amedisys Inc., a home health provider. Amedisys disclosed the OHA’s review in a March 19 Securities and Exchange Commission filing. UnitedHealth made a $3.26 billion unsolicited offer for Amedisys last June, shortly after Amedisys had agreed to merge with Option Care Health, Inc., a home infusion provider. Amedisys’s shareholders approved the UnitedHealth deal in September, but the transaction is subject to regulatory approval. In a preliminary analysis published this month, the OHA wrote “this transaction has the potential to reduce competition in Oregon’s market for home health and hospice services and other health care markets in the state.”

Over 20 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period (OEP), reaching a record for the third consecutive year, according to CMS. Over 3.7 million people who have signed up for ACA plans are new enrollees this year.

More than 15.5 million people have enrolled through HealthCare.gov in the 32 states that use that platform, and another 4.8 million have enrolled across 18 states and the District of Columbia, which use their own marketplaces.

After adjusting enrollment figures to account for the fact that there is one fewer day included in the 2024 OEP data compared to last year’s report, an ACAsignups.net analysis showed that every state except Maine and the District of Columbia saw membership growth in 2024, ranging from 2.8% in Hawaii to 78.8% in West Virginia. A total of 10 states reported signup surges of more than 50%.

After merger talks fizzled in September, Elevance Health, Inc.’s agreement to acquire Blue Cross and Blue Shield of Louisiana is back on, according to the New Orleans Times-Picayune. The companies had put the $2.5 billion deal on hold due to rising opposition, but the Times-Picayune reported the companies filed a new application on Dec. 14 with the Louisiana Dept. of Insurance. The structure of the deal is largely unchanged, although the companies agreed to expand the board of directors for the Accelerate Louisiana Initiative, a nonprofit foundation. The companies expect the transaction will close during the first quarter of 2024.

More than 19 million people have signed up for coverage via Affordable Care Act exchange plans for next year, according to the most recent data from CMS. The enrollment figures are as of Dec. 15 for the 32 states that use the HealthCare.gov website and through Dec. 9 for the 18 states and Washington. D.C., that have state-based marketplaces. More than 15.3 million had signed up for plans in states using the HealthCare.gov platform, a 33% increase from last year. In addition, more than 745,000 people signed up on Dec. 15, the largest single-day record since HealthCare.gov launched on Oct. 1, 2013.