In 2023, key health care policy changes significantly influenced the health insurance landscape, leading to a historic level of enrollment for the 2024 coverage year. As of January 24th, an astonishing 21.3 million people had selected individual health insurance plans through the Marketplaces. This milestone includes 4.9 million enrollments through s) in 18 states plus the District of Columbia—a number that shatters the previous record of 16.3 million sign-ups set just a year earlier.

The surge in enrollments is, in part, a ripple effect of policy adjustments that culminated in 2023. Notably, a large number of individuals who were recently terminated from Medicaid have now opted for health plans via the Affordable Care Act (ACA) exchanges. It’s estimated by the federal government that about 2.7 million of these individuals are eligible for subsidies to help cover the cost of ACA plans.

Looking back to January 31, 2020, the U.S. government’s declaration of a Public Health Emergency (PHE) in response to the emergence of COVID-19 set off a chain of regulatory actions to bolster the country’s healthcare system. These actions mandated federal and state health agencies to adapt their operations, simplifying the process for Americans to secure needed health insurance and care. Although the PHE concluded on May 11, 2023, the laws enacted during the health crisis continued to assist more people in obtaining subsidized health insurance through the ACA marketplaces. In addition to those measures, the Families First Coronavirus Response Act (FFCRA) played a crucial role for Medicaid. This act ensured continuous Medicaid coverage for enrollees starting January 1, 2020, for the duration of the PHE, without losing benefits due to eligibility redetermination.

The issue commonly referred to as the “family glitch” has was also addressed in 2023. This “glitch” was a result of how the Affordable Care Act (ACA) used to assess the affordability of health insurance plans based on the price of coverage for the employee alone, ignoring the higher costs of insuring the entire family. As a result, if an individual’s employer-provided insurance was considered affordable for just the employee, their family members were ineligible for financial aid to help pay for marketplace insurance plans, despite family coverage often being prohibitively expensive. This situation impacted about 5 million people, most of whom were in low-income households. With the resolution of the “family glitch,” now millions of family members, especially those from lower-income backgrounds, including women and children, can access federal subsidies to help cover their insurance premiums and deductibles. This reform has expanded the availability of affordable and comprehensive health coverage options for families, particularly during the open enrollment period.

The continuation of enhanced tax credits from the American Rescue Plan Act (ARPA) played a significant role in increasing enrollment numbers. The ARPA expanded and enhanced premium tax credits available to individuals and families purchasing health insurance through the Affordable Care Act (ACA) Marketplaces. The enhancements include lower premium contributions and increased eligibility for subsidies.

These enhanced tax credits have made health insurance more affordable for many individuals and families, incentivizing them to enroll during the open enrollment period. The availability of larger subsidies and reduced premiums has attracted more people who previously found insurance costs prohibitive.

By lowering the financial burden and expanding access to affordable coverage, the continuation of enhanced tax credits from the ARPA has helped drive an increase in enrollment numbers during the open enrollment period. It has provided individuals and families with the opportunity to secure comprehensive health insurance at more affordable rates, leading to improved healthcare coverage and peace of mind.

Since state-based exchanges (SBEs) understand their populations’ unique needs, they are granted the autonomy to determine their own Open Enrollment Period (OEP) timelines. This adaptability recognizes that states are best positioned to set an OEP schedule that aligns with the needs and behaviors of their residents, which may contribute to improved access to health care and potentially higher enrollment rates.

For example, states like California (January 31), District of Columbia (January 31), Idaho (December 15), Massachusetts (January 23), New Jersey (January 31), New York (January 31), Pennsylvania (January 19), and Rhode Island (January 31) have tailored their OEP deadlines to better suit their constituents. This flexibility allows them to expand health insurance offerings and support initiatives that could lead to increased enrollment for the 2024 coverage year.

Some of the more impressive record-breaking stats come from state-based exchanges, such as:

Minnesota, MNsure: MNsure, Minnesota’s health insurance exchange, experienced a record-breaking enrollment period for 2022 coverage. The total number of sign-ups on MNsure reached 156,721, surpassing the previous record of 149,972 set in 2016. MNsure saw a significant rise in new customers, with over 23,000 individuals signing up for coverage for the first time. The platform also experienced a higher number of renewals, with more than 133,000 individuals re-enrolling in health insurance plans for 2022. The enrollment period was extended by one week due to the COVID-19 pandemic, providing more time for individuals to enroll and contributing to the overall record-breaking numbers.

Nevada (Nevada Health Link): Nevada Health Link achieved a remarkable milestone by enrolling 99,312 Nevadans in health insurance plans, marking the second-highest total in the state’s history, as stated in a recent news release. This represents a 3% increase compared to last year’s enrollment figures. Notably, officials had previously revealed record-breaking enrollment numbers of over 100,000 at the beginning of 2022.

New Jersey (GetCovered NJ)*:According to statistics provided by New Jersey’s Department of Banking and Insurance, the state achieved a significant milestone in open enrollment. As of December 31, 2023, over 320,000 people enrolled in health coverage through the state’s marketplace, surpassing the previous year’s enrollment numbers and setting a new New Jersey record.

*New Jersey’s open enrollment period ends on January 31.

New Mexico (BeWell NM): BeWell NM, New Mexico’s state-based exchange, saw a substantial increase in enrollment.  Thier OE concluded on Jan. 16, with a record-breaking 56,447 residents enrolling in medical insurance plans. According to BeWellnm, this marks an increase of 12,000 compared to the previous year, with an additional 1,500 people enrolling on the final day.

Pennsylvania, Pennie®: More than 419,832 Pennsylvanians have enrolled through Pennie as of 1/24.

Virginia, Virginia’s Health Insurance Marketplace*:  The Virginia State Corporation Commission (SCC) reported a nearly 14% increase in health insurance enrollments during Virginia’s first open enrollment period. More than 400,000 Virginians signed up for health care coverage on Virginia’s Insurance Marketplace from Nov. 1, 2023, to Jan. 16, 2024. This achievement highlights the marketplace’s mission to offer health care plans that meet the needs of all residents.

Washington, Washington Health Benefit Exchange: During the open enrollment period that began on November 1, an impressive number of over 272,494 Washingtonians either renewed or newly signed up for health insurance plans through Washington Healthplanfinder, surpassing previous records.

Stay tuned for final open enrollment numbers.