10 Things to Know About the ACA Exchange System

5. Exchanges, insurers and agents are intent on helping the low- and moderate-income enrollees now being ejected by Medicaid apply for exchange coverage.

Congress made it easier than usual for consumers to stay enrolled in Medicaid during the COVID-19 pandemic emergency.

Now that the official U.S. emergency period has ended, many of the enrollees who were helped by the emergency period provisions are losing their coverage.

Many exchange sites have prominent homepage messages aimed at the people moving out of Medicaid.

The National Association of Benefits and Insurance Professionals — the group formerly known as the National Association of Health Underwriters — has been sending out press releases and taking other steps to try to promote its free agent-finder web tool.

NABIP CEO Jessica Brooks-Woods said NABIP believes that licensed agents and brokers are the best people to help consumers who are losing Medicaid coverage evaluate their options.

"They have the knowledge and expertise to assist people with re-enrolling in Medicaid, if eligible, or to claim all subsidies to which they may be entitled through the exchanges," Brooks-Woods said.

6. Prices are up.

Analysts at KFF have estimated the full, unsubsidized price of the typical exchange plan will increase about 5% in 2024.

In recent years, the effects of state subsidy programs helped hold down the cost of coverage. COVID-19 also helped, by scaring patients away from leaving their homes to get preventive care and routine sick care.

Now, overall inflation has increased, and that's pushing up prices.

COVID-19 is no longer reducing use of care.

America's Health Insurance Plans has created a guide that explains some other reasons for health care and health insurance cost increases, such as increases in health care providers' staffing costs, rising prescription drug costs, and hospital and health care provider consolidation.

7. The prices clients actually pay for exchange coverage may not go up.

For about 80% of exchange plan users, the premium tax credit subsidies reduce cash payments for health insurance to less than $10 per month, CMS officials say.

8. Out-of-pocket costs can be high.

One problem for relatively affluent clients who use exchange plans to fill in coverage gaps and get no subsidies is that 2024 annual deductibles can be as high as $9,450 for an individual and $18,900 for a family.

9. Many exchanges are cross-selling.

Covered California indicates that it offers dental and vision plans at the top of the homepage.

Your Health Idaho offers dental plans, vision plans, short-term health insurance and help for employers with giving workers cash they can use to buy their own individual coverage through plans based on health reimbursement arrangements.

10. Providers of products other than individual health coverage are tying some marketing efforts to the ACA open enrollment period calendar.

Liberty HealthShare, a Canton, Ohio-based organization that offers a Christian health sharing ministry, or access to a group of people who have agreed to try to share costs through a voluntary, religiously oriented arrangement that's exempt from the usual ACA rules, put out a press release Wednesday to announce that it's launching a low-cost, catastrophic health cost sharing program for young adults under 35.

Health sharing ministries are not insurers. They do not have to meet any ACA coverage standards or other federal insurance standards.

Unlike an issuer of ACA-compliant, state-regulated major medical insurance, they can underwrite applicants based on health status or lifestyle.

They can also impose preexisting condition coverage exclusions, coverage waiting periods, limits on coverage and other limits and rules that violate ACA coverage rules.

But, because of the limitations, and the uncertainty involved with offering a program based on member contributions, the monthly share contribution starts at just $89 per month for an individual, and applicants sign up to join the ministry at any time of the year, according to the ministry.

The Centers for Medicare and Medicaid Services offices in Woodlawn, Maryland. Credit: Jay Mallin/Bloomberg