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The Affordable Care Act has hit a historic milestone! Over 20 million Americans are now enrolled in individual marketplace plans – nearly 6% of the population. In 2023, there were 16.3 million individuals enrolled in these plans, which means this year’s figures jumped almost 4 million. This marks a significant turning point for health care access.

Of the new enrollees, 3.7 million are experiencing the ACA for the first time, while 16.6 million switched or renewed their plans. This trend highlights both increased awareness and ongoing satisfaction with the ACA. Since 2017, research shows the majority of the public has a favorable view of the ACA. In 2023, satisfaction levels reached 59%, which is their highest yet.

The Centers for Medicare & Medicaid Services (CMS) reported these numbers on January 10, 2024, though open enrollment for ACA lasted almost another week. At that time, the official total climbed to 20.4 million.

What Caused The Jump in ACA Enrollees?

Government subsidies and increased navigator support, funded by the Inflation Reduction Act and the American Rescue Plan, are major drivers of the enrollment surge. These efforts help Americans access affordable coverage and understand their options.

Some Medicaid eligibility changes and prior authorization challenges may also be pushing individuals to the Health Insurance Marketplace. This underscores the role of the ACA as a safety net for those facing coverage gaps.

Opportunities + Challenges for Health Care Payers

The focus on preventive care within the ACA is a boon for public health. For health care payers, the surge in members presents both challenges and opportunities:

  1. More states may develop their own health care marketplaces to ensure consistency and bolster existing ACA infrastructure. This means payers need to have a plan to build or grow their health care provider networks to win these contracts.
  2. Health plans should ensure the size of their provider network grows alongside their enrollment numbers. A strong provider network will ensure payers can retain members by meeting their needs.
  3. With so many new ACA enrollees, health plans have an opportunity to improve member and provider experiences from the start by offering crystal clear benefits and coverage explanations.

TOG is here to help you build a strategic plan that positions your health plan to gain a competitive advantage with the influx of government contract opportunities. Schedule a meeting today to learn more about TOG’s comprehensive provider network service solutions.