Pennsylvania, New Jersey and Delaware open ACA enrollment as premiums climb: What to know

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There is just one annual window when people can compare health insurance plans on Affordable Care Act marketplaces and make changes to their coverage: open enrollment.

People who buy plans during this period will generally have coverage start on New Year’s Day or shortly after the new year begins.

Residents across the Delaware Valley can review options on state marketplaces such as Pennie in Pennsylvania and Get Covered NJ in New Jersey, or use the federal exchange at HealthCare.gov if they live in Delaware.

Many shoppers will notice higher prices after insurers filed premium increases across the region, but state officials are still encouraging people to enroll.

“Financially, having coverage protects you from high medical costs and medical debt in the event of an accident or illness,” said Devon Trolley, executive director of Pennie. “It also allows you to stay healthy enough to work and continue providing for yourself and your family.”

Who can enroll, and what does coverage include?

Most U.S. citizens and some lawfully present immigrants, including refugees and asylees, can shop for and purchase plans through ACA marketplaces, especially people who do not have access to employer-sponsored coverage.

Open enrollment is the only time of year when people can make changes to their plans unless they experience a qualifying life event, such as losing a job or employer coverage, moving, getting married or divorced, having a child, or experiencing a change in immigration status.

Marketplace plans can cover individuals or families. Copays, deductibles and other out-of-pocket costs differ by plan, but coverage generally includes hospitalization, prescription drugs, primary and specialty care, maternity care, mental health services and treatment for preexisting conditions.

Plans must include vision and dental benefits for children, and some plans also provide those benefits for adults. If they do not, adults may be able to purchase separate vision and dental plans through the marketplace.

What do ACA plans cost?

Buyers should be prepared for higher premiums. Insurance officials said overall costs for plans sold on ACA marketplaces and state-based exchanges like Pennie and Get Covered NJ will rise for a second straight year because of changes in federal subsidies and broader growth in health care use.

In Pennsylvania, average premium increases range from 1.4% to 35% across carriers and plans, though the final price depends on the specific policy. The Pennsylvania Insurance Department reviewed the requests and finalized the rates in September.

“PID’s rate review process requires insurers to justify every dollar that they propose to charge with data that supports the rate,” said Michael Humphreys, the state insurance commissioner. “Our actuaries pushed back this year and blocked certain increases, totaling almost $95 million that Pennsylvanians would have paid in premium.”

Average premium increases in New Jersey range from 15.3% to 35.7% across ACA plans, according to finalized rates published last month.

What any person pays next year will depend on the insurance carrier, the plan selected and the county where they live, since some insurers sell in only certain parts of the state.

Age, income and household size also affect eligibility for tax credits and other forms of financial help that can lower monthly premiums.

Who qualifies for help with premiums?

Households and individuals who expect to earn below a certain income level next year may qualify for federal premium tax credits, which are applied automatically and reduce monthly payments for eligible customers.

State officials said about 9 in 10 Pennsylvanians who buy coverage through Pennie qualify for some kind of savings.

“Many people pay under $100 a month for comprehensive policies that would otherwise cost six or seven times that amount,” Trolley said.

In New Jersey, an estimated 8 in 10 people also qualify for federal premium tax credits or other assistance that can help reduce deductibles, copays and other out-of-pocket expenses.

Still, financial aid has become more limited in recent years after the expiration of enhanced pandemic-era premium tax credits.

The temporary federal subsidies, approved in 2021, lowered monthly premiums for many people and helped drive record ACA enrollment. Congress did not extend those boosted credits.

Since then, monthly premiums have risen for many people nationwide, and millions have dropped ACA coverage, according to an analysis by KFF, a nonpartisan health research group. State data show about 214,000 Pennsylvanians have canceled Pennie plans since last November.

Trolley said open enrollment remains a good time to check whether newly available assistance could make coverage more affordable.

“Don’t assume that it’s out of reach before you go and check for yourself,” she said.

Deadlines, scam warnings and help with enrollment

Open enrollment begins in nearly every state at the same time, but the final deadlines vary and can determine when coverage takes effect.

In Pennsylvania, people who buy a plan or change coverage through Pennie by Dec. 15 will have coverage start on New Year’s Day. Those who enroll by the final deadline will see coverage begin on Feb. 1.

People in Delaware and other states that use HealthCare.gov face the same deadlines.

In New Jersey, shoppers who finalize plans by Dec. 31 will have coverage begin on New Year’s Day. Anyone who makes changes by the final deadline will have coverage start on Feb. 1.

Officials are also warning consumers to watch for scams during open enrollment, when fraud cases tend to rise and “bad actors know that people are particularly vulnerable,” Humphreys said.

“Pennsylvanians can avoid fraudulent sales schemes by being cautious of unexpected calls, especially callers claiming to be from Social Security or Medicare, who then go on to ask very personally identifiable questions,” he said. “Check insurance licenses of those that may seek to sell you coverage.”

Help is available in every state. Pennie works with assisters and certified experts across Pennsylvania who can provide support in person, by phone and online, and the state marketplace also operates a customer service line.

Get Covered NJ also offers help through a network of certified assisters and brokers, along with a customer call center.

In Delaware, the Department of Insurance directs residents to support resources and enrollment help available through HealthCare.gov.