While half of Americans get healthcare coverage from their employer, a rocky job market and increasing healthcare costs may push more people toward government-backed plans — and there are just two weeks left to enroll.
The Affordable Care Act (ACA) marketplace is a government-provided platform where uninsured Americans can purchase individual and family health plans, and often receive subsidized premiums depending on their income. Over 40 million Americans are covered under ACA as of 2023, according to the U.S. Department of Health and Human Services, setting a record since the ACA’s inception in 2010.
Whether you’re out of a job, losing coverage from your parents or find your employer-sponsored health plans to be unaffordable, the ACA marketplace is available as a resource. December 15 marks the last day to enroll if the buyer wants their coverage to start as early as January 1. However, Americans can still enroll until Jan. 15, but their coverage won’t kick in until Feb. 1.
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While the ACA marketplace can initially seem intimidating, it was built to be an intuitive process, explains Robert Spector, senior director of growth and strategy for individual and family plans and state public programs at Blue Shield of California.
“The ACA presents health plan options and how much they cost to individuals and families, doing a really good job of helping explain the differences in the plans and the benefits,” says Spector. “The analogy I always use for people is to think about open enrollment in the workplace: Your employer says, ‘Hey Rob, you’re welcome to choose from these three health plans and this is how much it will cost you.’ The ACA uses the same concept.”
Spector clarifies that users aren’t looking at 1,000 different plans at once — depending on one’s state, the ACA marketplace will provide a list of questions, from their annual income to how often the user accesses care or needs prescription medicine. From there, the user will be directed to plans that best fit their profile.
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ACA plans are divided into four tiers. Bronze plans feature the lowest premiums and highest care costs; plan members should expect to cover 40% of care costs with each doctor visit or treatment. (Spector notes that bronze plans tend to be high-deductible health plans; on average, a member would have to spend around $6,000 out-of-pocket before the insurance carrier started helping cover costs.) In contrast, top-tier platinum plan members pay the biggest premiums but only pay for 10% of their care. In between sit silver and gold plans, which may be more realistic options for buyers, says Spector.
“Bronze plans may be cheap to buy but expensive to own,” he says. “I generally encourage people to look into a silver plan, which in some cases have the same monthly price as bronze, but you incur a lot less out-of-pocket costs when you get care.”
For those interested in buying a silver or gold plan, Spector warns against letting the initial premiums scare them. The ACA offers financial assistance in the form of tax credit subsidies for those making the same or less than the federal poverty line, which for 2024 falls at $30,000 for a family of four. A premium that was $500 a month could become $10, depending on the member’s eligibility. According to Covered California, the state’s ACA marketplace, 66% of its members are eligible for a $10 premium or less; nearly half could get a silver plan for that price.
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However, in order to receive these subsidies, the member cannot qualify for Medicare, Medicaid or the Children’s Health Insurance Program, or have access to affordable coverage through an employer. Employer coverage is considered unaffordable if the premium accounts for 8.39% or more of one’s household income.
Those who are eligible for premium subsidies and are under a silver plan can also qualify for cost-sharing reductions, which means they would have lower out-of-pocket costs, making the deductibles as well as the percentage of care one pays for after meeting their deductible more comparable to gold or platinum plans. ‘
Spector advises anyone interested in purchasing an ACA health plan to start now. With consistent standards across costs and quality of care, ACA plans may even outperform employer-sponsored ones, he notes.
“There’s an assumption that these are inferior plans, but from my experience, that’s just flat-out wrong,” says Spector. “You’re getting large networks and comprehensive, affordable care.”