The Brief

For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It's time to compare benefits and prices, and consider changing to a new plan, or enroll for the first time.

Open enrollment starts Wednesday for the ACA's federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.

In most states, open enrollment lasts through Jan. 15, although some states have different time periods. California's, for example, is longer, open until Jan. 31, but Idaho's runs from Oct. 15 to Dec. 15. In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.

Health policy experts and brokers recommend all ACA policyholders at least look at next year's options, because prices — and the doctors and hospitals in plans' networks — may have changed. Here's what else you need to know.

People bumped from Medicaid may be eligible, and could make it another record year for signups

ACA plans are now well entrenched — an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the COVID pandemic remain available, and some states have boosted financial help in other ways.

In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. If you're one of those ousted, be aware you could be eligible for an ACA plan. You can sign up as soon as you know you're losing Medicaid coverage — even outside of the open enrollment season.

Assistance from brokers comes with new strings

An important caution: Don't wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be asked to certify that they voluntarily agreed to brokers' assistance and that their income and other information provided by brokers is accurate.

It's a good protection for both parties, said broker Joshua Brooker, founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.

"Brokers will need to stop what they are doing right at the end before they click 'submit' and wait for the consumer to sign a statement saying they reviewed the policy," Brooker said.

Your premiums could go up — shop around

While some health plans are lowering premiums for next year, many are increasing them, often by 2% to 10%, according to a Peterson-KFF Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.

Premiums, and whether they go up or down, vary widely by region and insurer.

Experts say that's a big reason to log on to the federal website, healthcare.gov, in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia that run their own. Changing insurers might mean a lower premium.

"It's very localized," said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. "People should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers."

Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.

Household income is also a factor. Subsidies are on a sliding scale based on income.

Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden's Inflation Reduction Act, passed last year.

Online calculators, including one at healthcare.gov, can provide subsidy estimates.

You may qualify for lower deductibles and copays

In addition to the premium subsidies, most ACA enrollees qualify for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or about $75,000 for a family of four, or about $36,450 for a single-person household.

ACA plans are grouped into colored tiers — bronze, silver, gold, and platinum — based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.

Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace will automatically switch eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.

There are safeguards built in, said insurance expert and broker Louise Norris, so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces — California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington — have enhanced their cost-sharing reduction programs by extending eligibility or increasing benefits.

Some 26-year-olds will get to stay on parents' plans longer

Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents' plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were codified into regulation.

States that run their own markets can set similar rules, and some already allow for longer periods on a parent's plan.

Networks may be small — check that your doctors are covered

Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.

It's also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.

"The general message is, don't assume anything and make sure you check to see who is in the network," Norris said.

Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.

What we still don't know

A few things remain uncertain as the end of the year approaches. For example, the Biden administration proposed this summer to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.

Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn't final.

Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status — a group known as "Dreamers."

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

An East Hollywood nursing home that nearly lost its license this year because of repeated state citations for deaths of residents at the facility was cited again last month after another person died.

The California Department of Public Health cited Brier Oak on Sunset after a 92-year-old resident bled to death on Sept. 27. Staff members had continued injecting her with blood thinners over a 40-hour period in violation of clinical guidelines.

It’s an AA citation, the most severe the department issues when violations of care standards are determined to be a substantial factor in someone’s death. The facility faces a $120,000 fine.

These kinds of citations are rare. The department has recently issued, on average, fewer than 20 AA citations yearly across more than 1,200 skilled nursing facilities in California.

Brier Oak has received three AA citations for patient deaths since late 2022.

State regulations require authorities to suspend or revoke the licenses of any facilities that get two AA citations within a period of 24 months.

The state Public Health Department began that process with Brier Oak in May based on resident deaths in 2022 and 2024. But officials dropped that effort later because they say they determined the two patient deaths had occurred 26 months apart — just outside of the two-year window.

A spokesperson for the company that owns Brier Oak told LAist it has appealed the first two citations and is considering whether to appeal the third.

Advocates for nursing home residents say the recent death could have been avoided if the state had taken action.

“There were red flags, and a lot of these red flags existed prior to the death of this poor resident,” said Tony Chicotel, senior staff attorney with  California Advocates for Nursing Home Reform.

The state said Brier Oak has until Dec. 19 to notify the department if it intends to appeal.

What led to the patient deaths?

In the recent death at Brier Oak cited by the state, multiple communication and technical failures by nursing staff led to the patient bleeding out over a period of 40 hours, according to the citation.

The 92-year-old patient was immobile and had been prescribed a blood thinner called heparin to help prevent blood clots from forming. But once a patient is bleeding, those injections make bleeding worse, and potentially fatal.

When nursing staff found bright red blood in the resident’s diaper the day before she died, Brier Oak failed to follow established processes for documenting the bleeding or communicating it to a nurse practitioner or medical doctor, according to the citation.

Nurses told state authorities they delayed informing physicians because they “get mad” when contacted in the middle of the night.

The facility’s staff also failed to fully assess the patient to determine the possible causes of the bleeding and or to properly monitor the issue during crucial periods, according to the citation.

She suffered four internal bleeding episodes over 40 hours and continued to receive blood thinner injections.

The citation says a nurse practitioner at Brier Oak told state licensing authorities later that if she’d been informed about the patient’s ongoing bleeding, she would have stopped the blood thinner and sent her to a hospital.

In 2022, Brier Oak received a AA citation after a 62-year-old woman died from respiratory failure in part because nurses hadn’t been trained to operate her breathing machine.

In 2024, the nursing home got another AA citation. This time, a 63-year-old woman with paraplegia and severe obesity fell from her bed and died while a nursing assistant was changing her. The assistant was alone, even though the woman’s care plan required two staff members.

Who owns Brier Oak?

Brier Oak on Sunset is primarily owned by Genesis Healthcare, a publicly-traded nursing home operator that filed for Chapter 11 bankruptcy in July.

Once the largest nursing home operator in the U.S., Genesis was facing billions in debt when it declared bankruptcy, according to court filings. That includes millions in potential damages from lawsuits related to patient care failures.

In a brief statement to LAist, a company spokesperson said it's still considering whether or not to appeal the recent citation at Brier Oak.

The citation should trigger a suspension or revocation of the facility's license, according to state regulations. The latter means it would have to close its doors. The two most recent deaths and citations at the facility occurred within the two-year window.

The California Department of Public Health confirmed it cited Brier Oak on Nov. 26.

The department said the facility submitted a required written response before a Dec. 6 deadline, showing how it will fix the problems and prevent them from happening again..

The department determined Brier Oak was back in compliance during an onsite visit last week, a representative told LAist.

Brier Oak on Sunset currently houses about 150 patients, according to state records.

A bankruptcy judge has stalled the proposed sale of Genesis Healthcare to an affiliate of one of its investors.

Experts say it’s unclear whether the state would revoke the license of an owner who is actively trying to sell and turn over operations to someone else.

It’s been a rough start to ski and snowboard season for California mountain towns. Snowfall is well below average, but Christmas could come with some of the white stuff. Here's where things stand:

Hmmm. Didn’t we just have a record storm?

Yes. That big atmospheric river that hit Southern California last month made it one of the wettest Novembers on records. But since then, it’s been unusually warm and dry, which is not good for mountain towns that depend on snow, and the outdoor enthusiasts that flock to them.

How bad is it?

California’s snowpack is about 20% of normal for this time of the year, according to the state’s snow-tracking website. Southern California isn’t quite as bad off — we’ve gotten about half our normal snowfall so far.

As for the resorts, only about 20% of the terrain at Bear Mountain in Big Bear is open. About 35% of Mammoth Mountain is open.

Can’t they just make snow?

They are, but the unusually warm temperatures have curbed resorts’ ability to make enough snow to open more terrain. “If you're blowing water into 40-degrees, it's going to stay water,” said Justin Kanton, a spokesperson for Big Bear Mountain Resort. “ So as much as people probably would want us to just crank the snow guns all day, every day up here and just get things moving, that's not really possible.”

But there’s a silver lining!

The dry weather has allowed Caltrans to make good progress toward opening Highway 38, said Evan Engle, who chairs the board of the Big Bear Chamber of Commerce. The road typically handles up to 40% of traffic up to the mountain town, Engle said. But it’s been closed since September when it got washed out by Tropical Storm Mario.

Getting it open as soon as possible is key to keeping visitor traffic manageable, and getting supplies to Big Bear.

What’s the snow outlook?

SoCal mountains are likely to see some precipitation around Christmas, said Kyle Wheeler, a meteorologist with the National Weather Service. But with temperatures not expected to drop much, it’s uncertain how much of it will be white, Wheeler said.

If you go to Big Bear: 

• If you plan to hit the slopes, get on it early, when the snow is at its best given the warm conditions. 
• No snow? There’s more to do than ski and snowboard. Check this list of winter fun events.  
• Worried about traffic? Consider going up earlier in the week. If you can’t do that, consider taking Highway 18 through Lucerne Valley. It’s a longer route if you’re coming from L.A., but less traveled, and less likely to make you car sick (fewer tight curves). 

The Los Angeles Police Department used more than 2,400 crowd control munitions in response to protests from June 6 to 14, according to a new report.

Officers used a total of 2,431 less-lethal projectile rounds and 35 canisters of tear gas over the nine days, according to LAPD reports. The department recorded 12 injuries officers caused with those weapons.

The LAPD released the missing report last week after LAist identified the use of crowd control weapons on four different days in June that had not been reported according to state law. Assembly Bill 48, which went into effect in 2022, limits when and how crowd control weapons can be used, and requires law enforcement agencies to publicly release reports on their use within 60 days.

A 30-day extension for these reports can be granted in some cases, but the LAPD released this report about three months late even if an extension was justified.

Officials acknowledged they were out of compliance on Dec. 10 before releasing the report, saying the delay “stems from the extraordinary volume and complexity of incidents” over that time.

This report is different from others

It is unusual for a crowd control report to include more than one day, and the report for June 9 through 14 covered six days and “45 sepearte [sic] non categorical use of force incidents.”

It does not describe any of those use of force incidents specifically, and the LAPD has not yet responded to LAist’s request for more detailed descriptions of those incidents.

The report also considered the entire six days to have been one continuous protest, though it included several anti-ICE protests over the week and the national “No Kings” protest on June 14.

Two reports released earlier this year for June 6 and 8 covered single days and provided more detailed descriptions of incidents where the LAPD used less-lethal munitions against protesters.