Open Enrollment for 2023 Individual Insurance: What You Need to Know

Open enrollment for 2023 individual market coverage—both in the exchange and off-exchange—began November 1, 2022, and will continue until January 15, 2023 in most states. This article will explain how open enrollment works and what you need to know if you're enrolling in health coverage for 2023.

Although open enrollment continues through mid-January in most states, enrollments generally had to be completed by December 15 in order to have coverage effective January 1. Some state-run exchanges have later deadlines for January 1 effective dates, and some have set their own enrollment deadlines, either earlier or later than the January 15 deadline that applies in all states that use HealthCare.gov as their exchange platform. These states are discussed in more detail below.

The individual market has stabilized over the last several years, with mostly modest rate changes and new insurers joining the marketplaces in many states. Both of those trends generally continued for 2023. But average rate increases were a little larger than they had been over the past few years. And there were some notable insurer exits for 2023, in addition to numerous insurers entering markets or expanding their coverage areas.

The federal government is continuing to not fund cost-sharing reductions, but that's no longer an uncertain factor for insurers, since they know what to expect. In nearly all states, insurers are adding the cost of CSR to silver plan premiums, which results in larger premium subsidies. In many cases, bronze and gold plans are particularly affordable due to the disproportionately large subsidies that can be used to offset the premiums.

People who aren't eligible for premium subsidies can pick a non-silver plan, or, in many states, a silver plan sold outside the exchange, and avoid having to pay premiums that include the cost of CSR. But the American Rescue Plan's subsidy enhancements are still in place for 2023, thanks to the Inflation Reduction Act. So subsidy eligibility extends to more people than it did prior to mid-2021.

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Record-High Navigator Budget for 2023

In the fall of 2017, the Trump administration sharply reduced HealthCare.gov's marketing budget and cut the budget for Navigator organizations (enrollment assistance) by 41%. The Navigator budget had been $63 million in the fall of 2016, and was reduced to $36 million in 2017.

In July 2018, CMS announced another drastic cut to the Navigator funding budget, reducing it to just $10 million across all 34 states that received grants. That amount remained steady in 2019 and 2020, with another $10 million distributed to Navigator organizations in the weeks leading up to the open enrollment periods for 2020 and 2021 health plans.

But the Biden administration drastically increased the Navigator funding budget, announcing a record-high $80 million in Navigator grants in August 2021, spread across 30 states. (The number of states that rely fully on the federally-run exchange, and thus receive federal Navigator funding, has dropped to 30, as more states have opted to run their own exchanges.)

And in the summer of 2022, Navigator funding reached a new record high, with organizations in those 30 states receiving nearly $100 million in federal funding.

The $100 million was distributed to 59 Navigator organizations, allowing a record-high number of Navigators to provide enrollment assistance during the open enrollment period in the fall of 2022.

The ostensible justification for the Navigator funding cuts in previous years was based on the fact that Navigators have enrolled a fairly small percentage of the people who have signed up for private plans in the exchanges, and on the assumption that as time goes by, people need less help with the enrollment process.

But public awareness about the enrollment process remains fairly low among people who are uninsured and those who buy their own coverage. And although Navigators don't enroll large numbers of people in private plans, their assistance is invaluable when it comes to Medicaid enrollment (which isn't counted when the groups are judged in terms of their total enrollments).

And many Navigator organizations also partner with volunteer enrollment counselors, but the enrollments facilitated by those volunteers also are not counted. In short, the assistance provided by Navigators is more than it appears at first glance, and the drastic funding cuts in prior years reduced the amount of available assistance. Fortunately for consumers, the availability of enrollment assistance is now at record-high levels.

With all that in mind, let's take a look at what you need to know for 2023 if you buy your own health insurance in the individual market.

Timing

In most states, if you need to buy individual market coverage—on or off-exchange—for 2023, you'll have almost 11 weeks to complete your enrollment or make changes to your existing coverage. In almost all states, open enrollment runs from November 1 to January 15, although enrollments in most states have to be completed by December 15 to have coverage that starts January 1.

There are 18 fully state-run exchanges that run their own enrollment platforms and thus have the option to set their own open enrollment schedules. When the federal government opted to extend the open enrollment period through January 15 (this started with the open enrollment period for 2022 coverage), they clarified that state-run exchanges could still have longer enrollment windows, and could also elect to have an earlier enrollment deadline, as long as it wasn't prior to December 15.

Most of the state-run exchanges have opted for a January 15 or January 31 deadline for open enrollment. But there are some other deadlines in the mix for 2023 coverage, including one state (Idaho) that opted for a December 15 deadline. And as noted above, most states are using a December 15 deadline if you want your coverage to start January 1 (enrollments after December 15 will generally have a February or March effective date), but some state-run exchanges have later deadlines for that as well.

Once open enrollment ends, you won't have an opportunity to enroll or make changes to your coverage for 2023 without a qualifying event.

If your insurer exits the market in your area at the end of 2022, you can pick a new plan up until December 31 and the coverage will take effect January 1. You'll also have a special enrollment period for the first 60 days of 2023, during which you can pick a new plan. Overall, there are more participating insurers for 2023 than there were for 2022, but there are some notable insurer exits, including Bright Health, which has pulled out of the individual/family market altogether after the end of 2022.

No New Enrollment Platforms For 2023

There is a health insurance exchange/marketplace in each state, although most states use the federally-run platform at HealthCare.gov instead of running their own exchange. In the first few years that the exchanges were operational, several states made changes, switching between HealthCare.gov and their own websites.

For 2018 and 2019, there were no changes; all of the states continued to use the same enrollment platforms they had used in 2017. For 2020, Nevada stopped using HealthCare.gov and transitioned to a state-run enrollment platform. For 2021, Pennsylvania and New Jersey stopped using HealthCare.gov and debuted their own state-run enrollment platforms. And for 2022, Kentucky, Maine, and New Mexico all began using their own enrollment platforms instead of HealthCare.gov.

But for 2023, there were no platform changes. The 33 states that used HealthCare.gov in 2022 have all continued to do so for 2023, and the rest of the states have all continued to run their own exchange platforms. But there's no wrong door in terms of finding the exchange itself: If you start at HealthCare.gov and your state runs its own exchange, you'll be directed to the state-run exchange platform.

Family Glitch Fixed

In October 2022, the federal government finalized a rule change to fix the "family glitch." The new rules are effective for the 2023 plan year, and make some families newly eligible for premium subsidies in the exchange.

Under the old rules (ie, the "family glitch" rules), an entire family would be ineligible for subsidies in the marketplace if their offer of employer-sponsored coverage was considered affordable for just the employee—regardless of how much it cost to enroll the whole family.

Under the new rules, the exchange conducts two affordability tests in situations like that: One to determine whether the employee's offer of employer-sponsored coverage is affordable, and another to determine whether the family's offer of coverage is affordable. If the employee's coverage is affordable but the family's is not, the family members (but not the employees) are potentially eligible for subsidies in the exchange.

Actual subsidy eligibility will still depend on the cost of the benchmark plan in the exchange for the family members, relative to the household's income. But some families will find that they are newly eligible for subsidies for 2023.

Available Coverage

The November 1 through January 15 open enrollment window applies to individual market coverage that's compliant with the Affordable Care Act (ACA, aka Obamacare), both on and off-exchange. But only a very small segment of the population is enrolled in individiual market coverage.

As of early 2022, there were 13.8 million people enrolled in plans through the exchanges/marketplaces nationwide. And there are likely fewer than 2 million people enrolled in off-exchange plans (there were a little more than 2 million as of 2019, but that has almost certainly declined now that the American Rescue Plan and Inflation Reduction Act have temporarily eliminated the income cap for subsidy eligibility in the exchanges).

There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are separate from the enrollment periods that apply in the individual market, and are not affected by Navigator funding, timing changes, the type of exchange a state uses, or state-specific extensions.

People who have grandmothered or grandfathered individual market coverage are also not affected by any changes related to open enrollment. Those plans are no longer available for purchase and thus do not have applicable open enrollment windows.

However, if you have a grandmothered or grandfathered plan, it's absolutely in your best interest to see how it compares with the ACA-compliant plans that are available for 2023, particularly if you'd be eligible for premium subsidies or cost-sharing subsidies in the exchange. And keep in mind that the American Rescue Plan's subsidy enhancements and elimination of the "subsidy cliff" (through at least 2025) mean that you might be eligible for subsidies now, even if you weren't in previous years.

What to Know Before Enrollment

It's particularly important that you pay attention to the communications you receive from the exchange—or from your insurer if you have off-exchange coverage. Make sure you understand how much your premium will change for the coming year, and if you have a premium subsidy through the exchange, be sure you're looking at how much your after-subsidy premium will change, since that's the amount that you actually pay each month.

Pay attention as well to the coverage details summarized in the renewal information you get from your insurer and/or the exchange. Insurers can terminate a plan at year-end and "crosswalk" or "map" enrollees to a new plan with similar—but not identical—benefits. Exchanges can also do this if an insurer is leaving the exchange altogether.

Due to the extended enrollment window that's available in most states, there will still be an opportunity to pick a different plan after the start of 2023. So if your plan renews with a premium that's higher than you expected, or if your doctor is no longer in-network, you'll likely still have a chance to pick a different plan after January 1, with an effective date of February 1.

But this will be a very limited opportunity, extending until only mid-January in most states. So it's important to pay close attention to the details of how your plan might be changing, and act quickly to select a new plan if that's your preference.

If you think you might need help selecting a plan or enrolling, it's wise to make an appointment ahead of time with a broker or Navigator in your area or to find out what organizations in your community will have certified enrollment counselors on hand during open enrollment (here's a list of Navigator organizations in states that use HealthCare.gov).

What If I Have Coverage Through My Employer?

The open enrollment changes and provisions described above apply only in the individual health insurance market, so they don't affect people who get health insurance coverage from their employers. But if you have employer-sponsored health insurance, your open enrollment period may overlap with the individual market's open enrollment period.

Many employer-sponsored health plans hold their open enrollment periods in the fall, so that coverage changes can be effective on January 1 of the coming year. That's not always the case, however—your employer might have a plan that doesn't follow the calendar year, so your open enrollment might be a different time of the year. 

Open enrollment for employer-sponsored plans is usually shorter than the enrollment window used in the individual market, but your employer will communicate the key dates that apply to your plan. Your employer may hold meetings for employees to prepare for open enrollment, or they may send personalized information to each employee. If you have questions, now's the time to ask. If you're unsure of any of the terminology used to describe the plans, ask for help before you make a decision.

Employees often stick with the same plan from one year to the next simply due to inertia—even when a better option becomes available. If your employer offers more than one plan option, it's worth your while to carefully consider each plan during open enrollment.

Look at how much you'll pay in premiums (the amount that will be deducted from your paycheck), and how much you'll pay in out-of-pocket costs when you need medical care. Think about your recent healthcare spending, and consider any expenses you expect to incur in the coming year. If one of the other plan options will present a better value than the one you have now, open enrollment is your opportunity to switch plans, and your employer likely has a process in place that will make it easy to do so.

If you or any of your family members take prescription drugs or see a particular doctor, make sure you double-check the covered drug lists (formularies) and provider network details for each of the plans your employer offers. If you switch plans and then find out after the new plan takes effect that your medications and/or doctor aren't covered, you'll have to wait until the next year's open enrollment to switch plans again.

What If I Miss Open Enrollment?

After open enrollment ends, your opportunity to enroll in health insurance coverage for 2023 will be limited. You'll be able to sign up mid-year if you experience a qualifying event (eg, loss of coverage, the birth or adoption of a child, etc.), and in most cases, that applies to plans purchased in the exchange or directly from an insurance company.

But it's important to note that some of the qualifying events, including moving to a new area or getting married, only trigger a special enrollment period if you already had minimum essential coverage in place before the qualifying event.

So if you miss the open enrollment period for 2023 coverage and don't experience a valid qualifying event later in the year, you won't be able to sign up for an individual market major medical health insurance plan until the next open enrollment period starts again in the fall of 2023 (coverage, in that case, would be effective January 2024).

Medicaid and CHIP enrollment are year-round, however, for those who are eligible. And Native Americans can enroll in health plans through the exchanges year-round as well. The federal government has also finalized a year-round open enrollment opportunity for people who have household income that doesn't exceed 150% of the poverty level, which is available through at least the end of 2025.

Summary

Open enrollment for 2023 individual/family coverage runs from November 1, 2022 through January 15, 2023 in most states. This is an opportunity for people to purchase health coverage or switch to a different health plan. The open enrollment period applies both on-exchange and outside the exchange. Each state is using the same exchange platform that it used in 2022, with 33 states using HealthCare.gov and the other 17 states and the District of Columbia running their own exchange platforms.

The premium subsidy enhancements that were created by the American Rescue Plan have been extended by the Inflation Reduction Act, so they are still available for 2023. And the family glitch has been fixed, making some families newly eligible for premium subsidies in the exchange when their offer of employer-sponsored coverage is unaffordable.

A Word From Verywell

Open enrollment is your opportunity to select the best plan to fit your needs. And the American Rescue Plan's subsidy enhancements have made individual/family health insurance much more affordable than it used to be. If you haven't checked your coverage options recently, you might be surprised by how much more affordable the plans are now.

The individual mandate penalty no longer applies, unless you're in a state that has its own mandate and penalty (for 2023, this is DC, Massachusetts, New Jersey, Rhode Island, and California). But going without coverage isn't recommended. If you do go uninsured, you likely won't have an option to get coverage until 2024, and you'd be left uninsured if a medical emergency were to arise mid-year.

Premium subsidies continue to cover the large majority of the cost of coverage for most exchange enrollees, and bronze or gold plans will continue to be particularly inexpensive in many areas for people who qualify for premium subsidies (since the cost of CSR is generally being added to silver plan rates, and subsidies are based on the cost of a silver plan). Open enrollment runs from November 1 to January 15 in most states, and it's your opportunity to sign up for a plan and take advantage of those premium subsidies if you're eligible. So if you know someone who buys their own health insurance, spread the word!

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