ACA open enrollment kicks off Nov. 1 in Pa., N.J. and Del. Here’s what you need to know

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State officials are expecting another busy year for the annual Affordable Care Act open enrollment period, which begins Nov. 1.

This is one of the only times people can shop for new plans and review their health insurance coverage for 2025.

More than 830,000 people in Delaware, New Jersey and Pennsylvania selected insurance plans as either new or returning customers last year — joining a record 21.3 million people nationally, according to the Centers for Medicare and Medicaid Services.

“Plans and prices change every year, so we do really encourage people just to come in and look,” said Devon Trolley, the executive director of Pennie, Pennsylvania’s ACA marketplace. “Maybe people want to stay with the plan that they have, but they could find something that actually works better for them.”

The number of participating insurance companies and plans vary by county. State officials say most enrollees become eligible for tax credits, special subsidies and other financial assistance.

For the first time, Deferred Action for Childhood Arrivals (DACA) recipients are eligible to enroll in health insurance plans through the marketplace.

When is open enrollment?

Open enrollment under the ACA begins Nov. 1., but final deadlines vary by state.

Residents in Delaware can shop plans on the federal marketplace at healthcare.gov through Jan. 15. For people who select plans by Dec. 15, their new health insurance coverage will kick in Jan. 1. People who select plans later in the open enrollment period will get coverage starting Feb. 1.

Get Covered New Jersey is where residents of the Garden State can shop and select plans. Open enrollment lasts through Jan. 31. For residents who select plans by Dec. 31, their new coverage will take effect on the first day of the new year. People who enroll in January will get coverage on Feb. 1.

ACA plans in Pennsylvania are available through Pennie, the state’s marketplace. Customers have through Jan. 15 to make final selections. People who enroll in insurance plans by Dec. 15 will get coverage starting Jan. 1. Residents who enroll after that date, but before the final deadline, will get coverage Feb. 1.

Plan prices and cost saving options

The actual amount someone will pay for their monthly premium depends on if they are eligible for federal tax credits, which reduce monthly premium costs. They are calculated based on someone’s income and household size during the online enrollment process and are immediately applied to monthly premium charges after plans are selected and coverage begins in 2025.

Many people received boosted tax credit amounts during the COVID-19 pandemic when Congress passed additional funding for ACA financial assistance.

After tax credits were applied, the average monthly premium in Delaware for 2024 coverage was about $147, and about 17% of all enrollees paid $10 or less a month, according to state officials.

In Pennsylvania, about nine in 10 ACA enrollees qualify for these tax credits.

“Without the tax credits, without those financial savings, a lot of the health plans would cost $500 a month,” Trolley said. “And what we see many people pay is $10, $50, $100. It’s really significant savings.”

But as pandemic-era funding runs out, state insurance officials warn that this open enrollment period for coverage in 2025 could be the last year of those enhanced, boosted tax credits if Congress does not appropriate more money going forward, which means many people could see their premium costs rise significantly in 2026.

In addition to federal tax credits, people in New Jersey can also apply for a state subsidy called the New Jersey Health Plan Savings, which also reduces monthly premium costs for eligible residents.

Justin Zimmerman, the commissioner of the New Jersey Department of Banking and Insurance, said residents will also benefit from new state laws that cap some out-of-pocket prescription costs.

“All Get Covered New Jersey health plans will cap the out-of-pocket costs of insulin at $35 a month as well as cap out-of-pocket costs for EpiPens at $25 and asthma inhalers at $50 for a monthly supply,” Zimmerman said.

New eligibility for DACA recipients

Young adults who are protected from deportation under the Deferred Action for Childhood Arrivals (DACA) program will now be able to shop and buy health insurance plans in ACA marketplaces for the first time.

They are also eligible for tax credits.

About 19,570 total DACA recipients live in Delaware, New Jersey and Pennsylvania, according to the most recent data from U.S. Citizenship and Immigration Services.

“DACA recipients are eligible based upon a new policy put in place by the U.S. Department of Health and Human Services,” Zimmerman said. “And Get Covered New Jersey will be working with navigators to reach out to this newly eligible population.”

The policy change is being challenged in a federal court case filed by Kansas and 18 other states. Another 19 states and the District of Columbia are fighting to keep the new rule, with efforts being led by New Jersey.

While the case is ongoing, local state ACA enrollment officials are encouraging DACA recipients to shop and buy plans during the annual open enrollment period so that they can secure health insurance coverage for 2025 if the Biden administration rule is upheld.

Enrollment assistance, guidance and help

Free in-person, online and over-the-phone help is available in most states. The federal ACA assistance line, which is staffed by enrollment counselors, is at 1-800-318-2596.

In Delaware, residents can look up local organizations and events on Choose Health Delaware that offer one-on-one enrollment guidance and help, or insurance agents and brokers that can assist with plan specifics and selections.

In addition to a shop and compare tool online, Get Covered New Jersey also provides help through a call center at 1-833-677-1010 and in-person at local events and centers.

“We’re also going to have this year expanded education and enrollment events at malls throughout the state where residents can get free assistance in enrolling,” Zimmerman said.

Pennie in Pennsylvania also offers free enrollment assistance online, over the phone and in-person at locations throughout the commonwealth.

Trolley said the state program is trying to increase education efforts as well as awareness about other types of health insurance being sold by third parties that may imply they are connected to Pennie and part of the ACA, when in fact they are not.

“And we hear people who come in and say, ‘I thought I bought a comprehensive plan and then when I got sick, they were nowhere to be found and they didn’t cover anything and left me with all the bills,’” Trolley said. “There are, unfortunately, those actors out there who are misleading in how they talk about their coverage.”