ACA individual health enrollment opens, fueled by ICHRA interest

The possibility that this may be the year when U.S. employers can provide cash that workers can use to buy their own health coverage is adding a little extra buzz to the start of the HealthCare.gov open enrollment period.

The Affordable Care Act public exchange system manager today launched the enrollment period for individual and family health plans for 2025.

The Centers for Medicare and Medicaid Services created HealthCare.gov, which is also known as the Health Insurance Marketplace, to help people sign up for commercial health coverage and use ACA premium tax credit subsidies in states that are unwilling or unable to set up their own ACA public exchange programs.

The web-based health insurance supermarket now serves the residents of 30 states, including Texas and Florida.

Another 20 states and the District of Columbia run their own local ACA exchange programs.

About 16 million people are getting their coverage through HealthCare.gov this year. If HealthCare.gov were a private web broker, rather than a government agency, its relationships might give it a market value over $3 billion.

Health insurers, agents, brokers and investors are talking more about the individual health insurance market this year, and looking more to the individual market for reasons for hope, because of upheaval in the Medicare Advantage and Medicare drug plan markets and tough competition and modest growth in the employer plan market.

Dates: At HealthCare.gov and many of the state-based exchange programs, the open enrollment period for 2025 will run from today to Jan. 15. 2025.

Idaho started the 2025 enrollment period at its exchange, Your Health Idaho, Oct. 15, but the other state-based exchanges are joining HealthCare.gov in opening their digital doors today.

The scheduled ending dates for the state exchange enrollment periods range from Dec. 16, at Your Health Idaho, to  Jan. 31, in California, New Jersey, New York and the District of Columbia.

ICHRAs: Companies like Gravie, HRASimple, Take Command Health, PeopleKeep, StretchDollar and Venteur are making major efforts this year to promote individual coverage health reimbursement arrangements, programs that let employers provide cash that workers can use to buy coverage through ACA exchange programs.

Related: ‘Cash-for-coverage’ health plans could win the elections, exec says

Google provides a Google Trends search activity tracker that shows how much users are looking for a term relative to the peak for a given period. The tracker expresses the peak activity as 100%.

Search activity for the term “healthcare.gov” during the week ending Oct. 26, the last full week before the starting of the 2025 open enrollment period, was 19% of the peak for the past five years, down from 22% during the comparable week in 2023.

For the term “ICHRA,” activity for the week ending Oct. 26 was at 100%, or at the highest level area, up from 57% during the comparable week in 2023.

HealthCare.gov’s agent and broker registration completion list shows that the number of producers registered to sell small-group ACA exchange plans has fallen to 11,772, down 22% from the total registered at the same point a year ago.

But the number registered to sell individual ACA exchange plan coverage, and possibly on track to help workers use ICHRAs, increased 15%, to 84,376.

One obstacle for ICHRA supporters may be the supply of individual policies comparable to traditional employer-sponsored health coverage. Actuaries at Axene Health Partners have argued that the individual policies available today are mostly aimed at healthy individuals hunting for bargains, not the kinds of coverage employers typically offer.

The elections: The HealthCare.gov 2025 open enrollment period is set to end five days before the end of President Joe Biden’s term in office.

Former President Donald Trump has avoided giving details about how he would handle his concerns about the current ACA framework if he returns to the White House. House Speaker Mike Johnson, a Republican, has suggested that Republicans would act quickly to change the framework.

Biden cited Trump’s opposition to the ACA as a reason to vote for Vice President Kamala Harris to become president.

Republican opponents of the ACA “would rip coverage away from over 45 million Americans, eliminate critical protections for over 100 million people with pre-existing conditions, increase premiums for women and older adults, and erode Medicaid coverage for millions of children, pregnant women, and people with disabilities,” Biden said.