ACA sets record at 21.3 million enrolled for health insurance

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A record 21.3 million people enrolled in Affordable Care Act (ACA) Marketplace health insurance plans during the 2024 open enrollment period.

The U.S. Department of Health and Human Services (HHS) this week announced more than 5.04 million people were new to the Marketplace, while 16.26 million people renewed coverage. The sign-up period generally ended Jan. 16, though enrollment continues through Jan. 31 in Washington, D.C., California, New Jersey, New York, and Rhode Island.

“For decades, when it came to federal programs we could depend on to keep Americans covered, three were always top of mind – Medicare, Medicaid, and Social Security, but now it’s crystal clear that we need to add a fourth – the Affordable Care Act,” HHS Secretary Xavier Becerra said in a news release. “Once again, a record-breaking number of Americans have signed up for affordable health care coverage through the Affordable Care Act’s Marketplace, and now they and their families have the peace of mind that comes with coverage. The ACA continues to be a successful, popular, and important federal program to millions of people and their families.”

Becerra said HHS will “double down” on efforts to improve health care quality and access, as supported by the administration of President Joe Biden.

The record figure is not necessarily a surprise; enrollment had surpassed 20 million for the sign-up period from Nov. 1 to Dec. 23, blowing by the 2023 record, according to figures earlier this month published by the U.S. Centers for Medicare & Medicaid Services.

HHS touted the federal Inflation Reduction Act for subsidies that cover costs, so up to 80% of HealthCare.gov Marketplace insureds pay $10 or less per month for plan year 2024. The Biden administration spent almost $100 million on Navigator Awards for organizations to hire staff trained to help consumer find coverage.

Compared to the open enrollment period of 2022 for 2023, enrollment attracted almost 4.2 million more people with household incomes less than 250% of the federal poverty level, or about $75,000 per year for a family of four. That demonstrates that “that when coverage is affordable, people sign up,” according to HHS.

As of Dec. 31, 2023, CMS data show 2.4 million plan selections by people previously enrolled in Medicaid or the Children’s Health Insurance Program, in states using the Marketplace. As of Jan. 22, more than 15.75 million Medicaid enrollees were disenrolled, according to KFF. In April last year, states began redetermining eligibility for coverage due to the end of “continuous coverage” that was expanded during the COVID-19 pandemic, according to the Center on Budget and Policy Priorities.

In the HealthCare.gov Marketplaces, there were more than 4.22 million new and 12.13 million returning consumers. In the state-based marketplaces, there were 818,829 new and more than $4.12 million returning consumers.