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Home ACA Reform ACA Open Enrollment for 2023 Plan Year Begins Today

ACA Open Enrollment for 2023 Plan Year Begins Today

4 minute read
by Robert Sheen

Open enrollment for the 2023 plan year kicks off today, November 1, and will run through January 15 of next year. As employers begin to prepare healthcare options for their workforce, it’s important to take note of the new ACA developments. 

In this piece, we discuss all of the changes the ACA saw this past year and explain how this upcoming enrollment could be the most successful.

Enrollment period by state

First and foremost, the open enrollment period that begins today is the federal marketplace that operates off healthcare.gov. A total of 33 states use this platform for offering ACA-subsidized healthcare. 

However, some states have established their own timelines. Many state-run exchanges follow the federal example, but not all. Below are outliers and their respective schedules:

  • California: November 1 to January 31
  • District of Columbia: November 1 to January 31
  • Idaho: October 15 to December 15
  • Maryland: November 1 to December 15
  • Massachusetts: November 1 to January 23
  • New Jersey: November 1 to January 31
  • New York: November 16 to January 31
  • Rhode Island: November 1 to January 31

States not listed above adhere to the federal ACA marketplace open enrollment period.

Additional healthcare options

In addition to knowing the enrollment period for the state, individuals should also be aware of the growing number of healthcare options cropping up in various states. Some insurance providers are now available in more places. For example, Cigna is expanding its offerings in Indiana, South Carolina, and Texas. 

Other insurers, like United Healthcare, are returning to the ACA marketplace after withdrawing for several years. The healthcare giant will begin selling plans in Missouri, Ohio, Mississippi, and Kansas starting in 2023, reaching a total of 22 states.

CVS’ Aetna too is looking to expand by offering coverage in four new states and select counties in California. Smaller organizations like Alignment Healthcare, are expanding as well, specifically setting up new offerings in Arizona, Florida, North Carolina, Texas, and Nevada.

Inflation Reduction Act

In July, the Inflation Reduction Act was signed into law. Among its many provisions was the extension of ACA subsidies via Premium Tax Credits through 2025. Americans will continue to receive PTCs first made available under the American Rescue Plan for no more than 8.5% of their household income. 

The expansion of PTCs is great news for the general public and bodes well for reducing the number of uninsured. That rate has already dropped from 10% to 8% over the last year and overall participation in ACA marketplaces hit a record high last open enrollment, seeing more than 14.5 million Americans sign up for coverage. Of those nearly 15 million individuals, almost 6 million were new to the ACA marketplace. 

Enrollment is on the rise

As a result of the Inflation Reduction Act becoming law, enrollment is expected to increase even further. Data issued by the Kaiser Family Foundation finds that when premiums cost less, enrollment increases, and the events of the past 12 months have guaranteed lower premiums for years to come.

In addition to the extended Premium Tax Credits from the Inflation Reduction Act, increased outreach promoting enrollment, an additional $98.9 million in funding for ACA navigators, and expanding health insurance options will all play a part in driving enrollment.

Yet another critical factor driving enrollment participation for the 2023 plan year relates to fixing what’s known as the “family glitch.” As a result of new IRS regulations, PTC eligibility now extends to families. Previously, PTCs weren’t available to family members who needed coverage, like spouses and dependents, when an individual was offered affordable coverage from their employer. 

Now, entire families are eligible for PTCs if coverage for the family costs more than 9.12% of household income under the lowest-cost employer-sponsored option. Employees may choose to opt-out of their employer’s coverage and join their family members in the ACA marketplace to save time and effort. 

With PTC eligibility more widely available, we can expect ACA participation to further increase.

Compliance more important than ever

With all these drivers facilitating ACA coverage through the marketplace and increased access to PTCs, we can expect ACA compliance enforcement to increase as a result. The reason? PTCs are triggers for the IRS identifying ACA non-compliance.  Any time an employee receives a PTC from a state or federal health exchange, it signals to the IRS to cross-reference the request with the organization’s ACA filings.  

Through this process, the IRS will be able to identify organizations not in compliance with the ACA’s Employer Mandate. The more PTCs issued, the more potential for the IRS to issue more penalties via Letter 226J. To amplify the situation, the Inflation Reduction Act also set aside $80 billion for IRS tax enforcement, including the ACA. 

While increased PTC eligibility is beneficial for Americans, it poses significant ACA risks for employers. 

Employers that need assistance with ACA compliance processes should outsource their responsibilities to Trusaic. Our full-service ACA Complete software solution offers everything you need to become 100% ACA compliant, including 1095-C form preparation, monthly tracking, safe harbor calculations, year-end ACA filings, and IRS audit defense. We’ve helped thousands of clients prevent over $1 billion in ACA penalties.

For more information about how we can help your company comply with ACA regulations, contact us today. 

To understand the requirements of the ACA’s Employer Mandate, download the 2022 ACA Essential Guide for Employers below.

Download: ACA Essential Guide

For information on ACA penalty amounts, affordability percentages, important filing deadlines, steps for responding to penalty notices, and best practices for minimizing IRS penalty risk, download the ACA 101 Toolkit.

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