The open enrollment period for 2022 individual and major medical coverage starts today — and this will be the first ordinary enrollment period to take place during the administration of President Joe Biden. Related: New CMS guidelines will extend ACA open enrollment, boost fees for insurers Early signs suggest that plan sales could increase sharply, especially in states that use the HealthCare.gov exchange plan enrollment and account administration system. |

The enrollment calendar

The individual major medical open enrollment period will run through Dec. 15 in states that use HealthCare.gov to run their Affordable Care Act public exchange programs and other states that use the HealthCare.gov calendar, and until later dates in some other states. The Affordable Care Act drafters created the public exchange system to serve as an online supermarket for commercial health insurance, in an effort to hold down the cost of coverage for all by encouraging young, healthy people to get themselves covered even when they see no reason why they might need to visit a doctor. The open enrollment period calendar also encourages younger, healthier people to get covered. That's the time of year when people can sign up for individual major medical coverage without showing they have what the government classifies as a good reason to be shopping for coverage. The theory is that putting some limits on when people have an easy time signing up for coverage may push some healthy consumers to pay premiums, by raising the possibility that they might break a leg or have a heart attack at a time when getting covered is difficult, or impossible. States typically apply the same enrollment calendar to individual coverage sold outside the ACA exchange system, to avoid creating incentives that might push sicker people toward exchange plans, or away from exchange plans. The individual major medical open enrollment period is separate from the Medicare Advantage plan and Medicare Part D prescription drug plan annual enrollment period, which runs from Oct. 15 through Dec. 7. |

The current picture

The administration of former President Donald Trump inherited the ACA exchange system and HealthCare.gov from the administration of former President Barack Obama. Trump administration officials emphasized the need to make the system and its marketing programs more efficient. The Biden administration has made expanding exchange plan enrollment part of its strategy for helping patients and health care providers through the COVID-19 pandemic. The administration supplemented the usual open enrollment period with a special enrollment period that ran from Feb. 15 through Aug. 15. Paid enrollment increased to 12 million as of August, up 15% from the total in August 2020. For the five states with the biggest percentage increases in enrollment between August 2020 and August 2021, see the slideshow above. |

The future

Here are five predictions for the current individual major medical open enrollment period. |

1. More agents and brokers will be helping people buy coverage.

A HealthCare.gov agent and broker registration database shows that 62,792 people have registered to serve as HealthCare.gov producers for 2022, up 34% from the total registered for the 2021 plan year as of Oct. 29, 2020. |

2. HealthCare.gov will have a smaller footprint.

Same-state enrollment may be strong at HealthCare.gov this year, but overall enrollment totals could be lower, because Kentucky, Maine and New Mexico will all be running their own individual major medical exchange programs for 2022. The Kentucky program is called kynect, the Maine program is called CoverME.gov and the New Mexico program is called beWellnm. Kentucky and New Mexico both ran their own individual exchange programs in some years in the past. |

3. Consumer buzz may be about the same as it was last year.

The U.S. Department of Health and Human Services let states choose between providing ACA exchange services for their residents, relying entirely on the HHS HealthCare.gov system, or managing their own exchange programs while paying HealthCare.gov for support services. Google Trends can provide a crude indicator of public interest in a topic, by showing how search activity for various terms has changed over time. Google Trends activity for HealthCare.gov in Florida, the exchange program's biggest market, is about the same as it's been in the final week before the open enrollment period started in earlier years. Similarly, in-state search activity for Covered California, the state with the biggest state-based exchange, and in other states with state-based exchange programs, such as Colorado and Connecticut, appears to be similar to what it was in late October in earlier years. |

4. Sales growth could be especially strong in the South.

Health insurers and public health agencies in Democratic strongholds have helped make HealthCare.gov a big success in Florida, even though the state has had Republican governors who have been cool toward the exchange system. About 2.2 million Florida residents get their coverage through the ACA exchange system. The exchange system has had a much smaller market share in many other Southern states with Republican governors. Thanks in part to Biden increases in marketing support and worries about the COVID-19 pandemic, however, Georgia, South Carolina and Texas all recorded exchange enrollment growth rates of 25% or higher between 2020 and this year. That kind of momentum could continue to shape enrollment trends in 2022. |

5. COVID-19 could change things.

A carrier with a large ACA public exchange presence, Molina Healthcare, noted that a big COVID-19 surge hit exchange plan enrollees harder than Medicare enrollees in August, because exchange plan enrollees were less likely to be vaccinated. If similar trends surface over the next few weeks, that could affect how much marketing support carriers devote to exchange plan enrollment.