Marketplace enrollment is nearly five million higher than last year.

Federal officials touted the record-breaking figure as an indicator of the success and popularity of the program to millions of people and their families.

“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,” said Health and Human Services (HHS) Secretary Xavier Becerra in the announcement. “Once again, a record-breaking number of Americans have signed up for affordable health care coverage through the Affordable Care Act’s (ACA) Marketplace, and now they and their families have the peace of mind that comes with coverage.”

The 2024 Open Enrollment Period closed on January 16 with 21.3 million people selecting a plan from the ACA Health Insurance Marketplace. Total plan selections include more than five million people—about a fourth—who are new to the marketplaces and 16 million people who renewed their coverage. Open enrollment continues in four states and Washington, D.C., through January 31. A state-by-state breakdown on enrollment numbers can be found in a CMS fact sheet.

“These historic enrollment numbers are a testament to the need for comprehensive, quality, affordable health insurance, and we must do everything we can to protect and expand access to coverage for all people,” said Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS), in a statement. “Numbers do not lie: Not only is demand for Marketplace insurance coverage at an all-time high, but the marketplaces are delivering on the Affordable Care Act’s promise to provide the peace of mind that comes with having health insurance to millions of Americans.” 

In addition to the ACA, the Inflation Reduction Act (IRA) and the American Rescue Plan continue to keep marketplace coverage affordable, federal officials said in the press release. The IRA is the reason four in five customers were able to find health care coverage for $10 or less per month for plan year 2024 after subsidies. Additionally, the Biden-Harris administration issued almost $100 million in Navigator Awards, allowing organizations to hire staff trained to help consumers find affordable, comprehensive health coverage. These navigators have been key to helping consumers in every marketplace state.

Compared to the Open Enrollment Period last year, nearly 4.2 million more individuals with household incomes less than 250 percent of the federal poverty level (about $75,000 per year for a family of four) enrolled in 2024 coverage.

A recent KFF analysis finds that while enhanced subsidies have driven most of the enrollment growth since 2020, Medicaid unwinding is likely also contributing to 2023 to 2024 changes. Individual market enrollment was already higher by at least one million people before open enrollment began, according to the brief. But the termination of the requirement to keep people continuously enrolled in Medicaid through the end of the COVID-19 public health emergency, led many to enroll in the ACA Marketplace mid-year 2023. Others may have waited to open enrollment to make the transition, according to KFF.

CMS and HHS noted that marketplace coverage has been critical for people transitioning from Medicaid or the Children’s Health Insurance Program (CHIP) as states conduct eligibility renewals, which restarted last year. As of December 31, 2023, CMS data show that 2.4 million plan selections in states that use, or approximately 15 percent were made by individuals who were previously enrolled in Medicaid or CHIP coverage.

The end of the Open Enrollment Period doesn’t mean the end of coverage opportunities, however. Individuals eligible for Medicaid or CHIP may enroll in coverage anytime year-round. For those no longer eligible for Medicaid or CHIP, a special enrollment period is available to enroll in Marketplace coverage. Additionally, eligible individuals with household incomes less than 150 percent of the federal poverty level (approximately $22,000/year for an individual and $45,000/year for families of four) can enroll in Marketplace coverage anytime through a special enrollment period. Consumers who experience a change of life circumstance—such as marriage, birth, adoption, or loss of qualifying health coverage—may also be eligible for a special enrollment period.