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Medical Insurance ACA Marketplace

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What’s changing about Affordable Care Act benefits in 2023?

#1: Standardized plan options will help make shopping easier.

Not all changes have to make things more difficult for you, right? When you’re shopping for a health plan, you’ll want to consider several factors, including:

  • Your cost-sharing amounts, whether that be coinsurance (a percentage of the total cost) or copayments (the amount you pay for each visit)

  • Your plan’s monthly bill (premium)

  • Your plan’s provider networks

  • Your plan’s quality ratings

As of 2022, nine state-based marketplaces help make comparison shopping easier by including standardized plans that offer the same basic features at each metal level. (The metal categories of ACA plans reflect the percentage of your average in-network medical costs that will be covered: For bronze, it’s 60%; for silver, it’s 70%; for gold, it’s 80%; and for platinum, it’s 90%.)

So every standardized bronze plan in a given market has the same deductible and the same coinsurance and copay amounts, for example. This lets you focus more easily on things such as your monthly bill and whether the plan has your doctors when comparing plans.

For the 2023 plan year, however, all insurance companies that sell plans on the federal marketplace will have to offer standardized plans. This means they’ll have to offer standardized plans for each service area, plan type (such as HMOs), and metal level (bronze, silver, gold and platinum) where they also offer non-standardized plans. And those standardized plans will be highlighted on the website to make shopping easier.

If you have standardized plans available, you may not need to comparison shop as much for your plans as you did in the past.


#2: Your plan will have to guarantee you reasonable access to providers.

Since the ACA was signed into law in 2010, insurance companies offering health plans have had to offer “adequate” provider networks. That means if you buy a plan, your health care network would have to be large enough to provide you with reasonable access to in-network health providers.

The rules will get even clearer in 2024, when appointment wait times take effect. Starting then, you must be able to get an appointment with a primary care doctor within 15 business days and an appointment with a specialist within 30 days.


#3: If you live in a hard-to-reach area, you may have more health care options.

Just as you can expect reasonable access to health care providers, in 2023 a new rule will address what are known as essential community providers (ECPs). These are providers that focus on low-income and medically underserved individuals. 
Historically, qualified health plans had to contract with at least 20% of the ECPs in their service areas. As of 2023, that number increases to 35%. 


#4: Your health plan may have to be a little more generous.

The ACA metal categories — bronze, silver, gold and platinum — have everything to do with the percentage of what you’ll pay. For example, bronze plans generally cost the least on a monthly basis, but you’ll have to pay more when you need care. The opposite is true of platinum plans. Since these percentages are hard targets to hit precisely, insurance companies have some leeway. In other words, a plan could qualify for silver status if it covers between 66% and 72% of average costs.

Starting in 2023, insurance companies will have a little less wiggle room. Plans at each metal level must fall within plus or minus 2 percentage points of the target. Plans that fall short of that mark will have to offer you better benefits.


#5: You won’t be denied coverage for old bills that are past due.

Previously, an insurance company could decline coverage if you owed them monthly bills that were past due. You would’ve had to pay them along with your first bill for the new plan year.

That will no longer be the case, although past-due bills can still be referred to a collection agency. The idea is that denying you coverage goes against what the ACA stands for in the first place: guaranteed health benefits. That’ll give you added protection that you didn’t have before.

Biden-Harris Administration Announces Record-Breaking 16.3 Million People Signed Up for Health Care Coverage in ACA Marketplaces During 2022-2023 Open Enrollment Season. Millions of working families saved an average of $800 on their health insurance premiums last year.

The new laws allow those higher earners to qualify for subsidy that would not have in previous years. Example 2018 a couple making $70,000 a year would receive no subsidy and if they received one they would be on the hook from the IRS to pay it all back. Now in 2023 Married couples making $180,000 can still receive a subsidy and if they made less than $90,000 could choose a $0 premium plan option.

Additionally if your employer sponsored insurance to add family members is about 9.12% of your income then your family can apply for health care on the ACA Marketplace and qualify for a subsidy.

10 Facts You Didn’t Know About Obamacare


1. Obamacare made some big changes to health insurance plans

There's a lot more to the Affordable Care Act than health insurance, subsidies for lower-income households, and the expansion of Medicaid.


2. Minimum essential coverage includes all marketplace coverage. It does not include short-term health insurance.

These requirements include:

  • Hospitalization services.

  • Ambulatory services.

  • Urgent and emergency care.

  • Prescription medications.

  • Maternity and breastfeeding support.

  • Laboratory services.

  • Preventative and wellness benefits.

  • Mental health and drug abuse services.

  • Pediatric services, including dental and vision care for kids.



3. The majority of Obamacare subsidies go to the middle class

Despite the popular misperception that Obamacare just helps the poor, the facts say otherwise. Between 2015 and 2024. These subsidies go to families earning $47,000 to $94,000 per year, the heart of the middle class.


4. Obamacare does not give health insurance to illegal immigrants

Illegal immigrants are not eligible to receive subsidies to buy health insurance on the exchanges.


5. You can ONLY purchase qualifying private medical insurance during open enrollment. Usually fro November 1 through January 30. The only exception is if you’ve recently had a major life change like moving, getting married, or losing your job.


6. You can’t be charged more based on gender or health status, and you can’t max out annual or lifetime dollar limits.


7. When you choose a health plan, in most cases you’ll have to keep that specific plan until the next open enrollment period. Make sure to choose a plan that meets all your needs.


8. No matter what plan you get, most basics – like an annual checkup, immunizations, preventive tests, and more – will be covered with no out-of-pocket costs.


9. As the law stands now, the “employer mandate” says that large employers with over 50 full-time equivalent employees had to cover their full-time workers starting in 2016.


10. If your employees health insurance for a spouse or family cost more than 9.12% of your income then they can obtain insurance on the ACA Marketplace with a subsidy. I have a client who’s insurance from work was estimated at $1,200 per month for his wife and child. The insurance obtained from Elkin Insurance had a lower deductible and cost approximately 10% of his employers coverage.


You will want to have a personal agent who will help enroll you in the right plan for your needs. The agents at Elkin Insurance do not charge you for enrolling. E get paid directly from the insurance company. They have helped thousands enroll in health plans. Why not let them help you?

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