The 2024 open enrollment season has officially ended, with a record over 21 million individuals enrolling in coverage through the health insurance marketplaces. This marks the marketplaces’ most robust enrollment season to date and comes as they celebrate over ten years of providing individuals and families with access to health insurance.
Over their history, marketplaces have worked continuously to improve their ability to provide affordable, reliable, and quality coverage to their populations. The 19 states that operate their own marketplaces, or state-based marketplaces (SBMs), drive innovation by leveraging flexibility and data to innovate to improve efficiencies and address local, population-specific needs. Over the past year, SBMs also collaborated with Medicaid agencies to support the millions of individuals going through Medicaid redeterminations triggered by the end of the public health emergency who are no longer eligible for Medicaid coverage.
In looking closer at the 2024 enrollment season, several takeaways emerge:
Marketplaces are a critical bridge to coverage, with a record number of new individuals enrolling in marketplace plans this season.
This year, marketplaces served as a critical bridge to coverage for a record 5 million new individuals across all states, including many individuals transitioning from Medicaid programs. Many factors (such as new jobs, self-employed entrepreneurship, part-time work, and changes in family size) can impact household status and, therefore, eligibility for insurance programs. Individuals and families not eligible for affordable employer-sponsored insurance or programs such as Medicare or Medicaid need access to affordable insurance options – marketplaces fill that coverage need.
SBMs experienced high enrollments, especially among key target populations, including the historically uninsured.
Early data indicate significant growth in enrollment across many of the SBMs this year. Over 5 million individuals enrolled across the 19 SBMs; nearly half report record-high enrollment this season. Enrollment growth was particularly notable among young adults (18–27-year-olds), older adults (55+, “pre-retirees”), and low-to-middle-income populations (individuals making $15,060 per year or more). These are key populations that typically face higher rates of being uninsured and are often challenging to engage due to cost of coverage barriers.
SBM coordination with state Medicaid agencies resulted in record transitions from Medicaid to SBM marketplaces.
Marketplaces have worked closely with their Medicaid partners to develop and execute strategies to effectively transition those who are no longer eligible for Medicaid to private health insurance available through the marketplaces. These creative strategies included data-driven outreach campaigns, improved integration and coordination across eligibility systems, leveraging special enrollment periods, and enabling auto-enrollment between programs. As a result of these efforts, SBMs experienced significantly higher enrollment of individuals who no longer qualified for Medicaid programs.
The enhanced premium tax credits ensured access to marketplace coverage for millions across the country.
The enhanced premium tax credits initially enacted under the American Rescue Plan Act (ARPA) reduced the cost of marketplace plans for millions of individuals and families nationwide, enabling many to access more robust coverage at limited out-of-pocket cost, providing them access to care and protection against medical debt. The enhanced tax credits reduce available premiums to less than $10 per month for many low-income families, including plans for as low as $0–1 per month for those below 150% FPL (individuals making $22,545 or less per year). Lower premiums were critical to providing access to more affordable coverage for individuals and families, including those new to marketplaces and those no longer eligible for Medicaid. These credits also factored into growth in marketplace enrollments across middle-class populations, who prior to ARPA faced an eligibility cliff preventing their access to premium tax credits to ensure that they pay no more than 8.5 percent of income for marketplace coverage.
SBMs continue to pioneer new means of improving access to coverage, such as new and targeted affordability initiatives.
Marketplaces continue to lead innovation on how best to leverage and target limited state dollars to support their consumers. In 2024, California implemented a new cost-sharing reduction program to mitigate out-of-pocket costs for low-income enrollees. Massachusetts extended its ConnectorCare program to reach individuals and families up to 500% FPL via a two-year pilot program, shoring up access to coverage for its middle-class families. Washington State is reporting increased enrollments across its Cascade Care Savings program that provides monthly plans for $10 or less to those under 250% FPL.
Data from this enrollment season are still emerging, and the National Academy for State Health Policy is conducting a deeper analysis of data from the SBMs. Additional information will be shared as we work to understand SBM trends, innovations, and the impacts on the populations they serve.
