The NCSL Blog

05

By Jack Pitsor

The federal and state health insurance marketplaces have been open and ready for business since Nov. 1.

Siogn reads Open Enrollment AheadDespite the pending federal appeals court decision regarding the constitutionality of the Affordable Care Act (ACA), millions of Americans will shop for ACA health plans through HealthCare.gov and the state exchanges during open enrollment.

What is open enrollment?

Open enrollment is the annual period when individuals can enroll in a new health insurance plan, renew their current coverage or change their current plan. Enrollment runs from Nov. 1 through Dec. 15—though some states have extended their open enrollment periods—with coverage starting on Jan. 1, 2020.

The enrollment process varies state to state. Most individuals who buy their own health insurance plan do so through the individual insurance marketplace, or health insurance exchange, on HealthCare.gov, the federal website established by the ACA. Additionally, 12 states—California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington—and the District of Columbia maintain state exchanges where individuals enroll through a state-run website.

The federal government supports advertising and navigators to assist individuals during the enrollment process. After cuts for 2018 and 2019 open enrollment, federal funding remains the same for 2020.

Additionally, the U.S. Centers for Medicare & Medicaid Services released a new five-star quality rating system for 2020 plans sold through HealthCare.gov. Plans will display a rating between one and five stars (five is the highest)—based on certain clinical measures, member experience and a health plan’s administration. About 80% of plans offered on the individual insurance market earned three stars or more—though new plans or plans with low enrollment may not display a quality rating.

How do health plans differ from state to state?

Premiums for insurance plans offered on both the federal and state exchanges differ by state. Premiums for benchmark plans—the second-lowest-cost Silver plan in the exchange of a given area—dropped an average of 4% from 2019 to 2020, compared to a 1% decrease from 2018 to 2019.

Some states, however, experienced increases in premiums while others saw more significant drops than the national average. For example, Indiana, Louisiana and New Jersey benchmark plan premiums increased 10% or more. Premiums in six states—Delaware, Montana, Nebraska, North Dakota, Oklahoma and Utah—decreased 10% or more.

Another difference between states is the number of insurers participating in the exchanges. For the 2020 enrollment period, the average consumer in a HealthCare.gov state has three to four different insurer options, up from two to three in 2019. Twelve percent of exchanges have only one participating insurer—the lowest percentage since 2016.

For more information on the ACA open enrollment:

Jack Pitsor is a research analyst in NCSL's Health Program.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.