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.

The U.S. Department of Justice has attempted to use a number of tactics in recent weeks to remove California voters they say are likely noncitizens from state voter rolls — despite the voting process having already begun.

Election security experts told LAist, however, that the federal government’s case is unlikely to succeed, and that voters should proceed filling out their ballots as normal.

“I don't think most people in the L.A. area or beyond will actually encounter any of the disruption that the administration is trying to project,” Loyola Law School professor Justin Levitt said.

The backstory

Last week, Department of Justice election officials sent a list of 20,000 California voters it says it has “high confidence” are not citizens. (L.A. County election officials said they received records on a thumb drive, which they could not open for security reasons.) Two days later, the Trump administration sued California for not complying with its request to use the list to remove any noncitizens from local voter rolls.

California on Tuesday filed an extensive response to the DOJ lawsuit, saying it “borders on the absurd.”

Separately this week, the DOJ announced it had filed charges against 28 people, accusing them of registering to vote as noncitizens.

What is the DOJ claiming?

DOJ representatives said Monday they are attempting to keep U.S. citizens’ votes from being canceled out by noncitizens.

“We have an election coming up next month,” Bill Essayli, first assistant U.S. attorney, said. “Our biggest priority is to safeguard the integrity of the election.”

Essayli suggested he may prosecute election officials who knowingly process ballots “once we’ve informed them who the non-citizens are” and indicated the DOJ is working on “many more cases.”

Regarding the list sent to state and local officials, DOJ officials also said they have “high confidence” — not complete certainty — that the people on the federal government’s list are noncitizens.

“There may be some names on there who it turns out ultimately are citizens,” Trent McCotter, acting deputy attorney general, said Monday. “We're not perfect, and that's why we've asked California to cooperate with us.”

In a court declaration filed today, L.A. County Assistant Registrar Monica Flores said the DOJ’s list is “unreliable.” Analyzing a sample of 200 records, she said a majority are not active voters, and nearly 40% of the records indicate the individual was born in the U.S.

The L.A. County registrar of voters said officials here did not comply with the request to use the federal list and began coordinating with state officials — a point DOJ officials stressed on Monday, with McCotter saying this is “an emergency of their own [California’s] creation.”

Rick Hasen, a UCLA law professor who runs the school’s Safeguarding Democracy Project, disagreed.

“The federal government didn't produce its list of voters or its methodology to California until just a few days ago, so this is not an emergency of California's own making,” Hasen said. “It is not the federal government's job to decide who is on voting rolls. That is a job that is given to states.”

A DOJ spokesperson declined to comment for this article beyond pointing to Essayli’s X social media feed.

What role will local election officials play?

In large part, Hasen and Levitt said officials will play the same role that they always have, even though more eyes will be on them. County election officials send out ballots, process and verify signatures, and reach out to voters if there are any outstanding issues. The registrar then has 13 days to report on ballots to the state, including provisional ballots and same-day registration ballots, and 30 days to finish counting them.

That said, Hasen said Essayli’s threat of possible criminal prosecution against election officials is “really dangerous” — even though he said these cases are also unlikely to succeed.

“We've got a threat of criminal prosecution against election administrators for not being aggressive enough in policing voting rolls to the Trump administration's liking,” Hasen said. “Even if they were negligent in how they policed their voting rolls, there's no criminal liability here.”

What should voters do?

Levitt, who previously worked on voting rights at the Justice Department, said he doesn’t think Trump’s DOJ is serious about the legal merits of their lawsuit against California.

“I can completely understand that people may be freaked out,” he said. “Part of what DOJ is doing is an attempt to freak people out.”

For their part, local officials have reassured voters that they should proceed to cast their ballots. In a statement, L.A. County Supervisor Janice Hahn called the DOJ’s actions “voter intimidation and a blatant attempt to undermine trust in our midterm elections.”

Levitt recommended voting as early as possible to give voters time to check their registration and resolve any issues. If you have concerns, he recommended visiting an early voting center in person.

Hasen encouraged voters to double-check the status of their ballots to ensure they’ve been processed and counted.

“We have very good ballot tracking,” Hasen said. “California is not going to simply start throwing out ballots from people who are on an unvetted federal list of supposed noncitizen voters.”

What’s the future of this lawsuit?

Hasen and Levitt said the legal problems with the federal government’s arguments can be traced back to federal law and the Constitution.

“The Constitution gives states the power to run elections subject to Congress passing laws that can override that,” Hasen said. “There's no congressional override that would give the federal government the authority to do this.”

That makes the DOJ’s case unlikely to succeed, the professors agreed.

“It's possible that a court might not even really deal with it at all,” Levitt said.

What about the people accused of voting fraud?

The charges announced this week against 28 people accused of registering or voting as noncitizens, however, may be more successful, depending on the evidence presented in each case.

“Isolated cases of alleged voter fraud occur in red and blue states alike, and they should be prosecuted wherever they occur,” a spokesperson for California Attorney General Rob Bonta said in a statement.

But Bonta noted that the 28 people charged represent 0.0001% of California’s registered voters. The percentage is about the same in L.A. County: The 12 L.A. County residents charged this week make up roughly 0.0002% of people on the voter rolls.

The Los Angeles Unified School District is preparing for possible “Super El Niño” storms that could damage schools and lead to closures, the district announced in a media release Tuesday.

District staff are clearing drains, trimming trees and checking roofs, windows and doors. LAUSD is also testing emergency equipment, including pumps and emergency lighting systems, and stocking supplies such as flashlights and drinking water.

“Preparing for severe weather starts well before the first raindrop,” Superintendent Andrés Chait said in a statement. “We can’t control the weather, but we can take steps now to protect our students and employees and help our schools stay ready.”

The district will monitor weather patterns using information from the National Weather Service and local emergency officials, it said.

LAUSD encouraged families to update their contact information to ensure they receive district calls, texts and emails. Families should also monitor weather alerts, follow emergency officials’ instructions, avoid flooded roads and review safe routes to and from school, according to the release.

“Preparing for a storm is a shared effort — from the crews maintaining school buildings to the principals reviewing emergency plans and the families making sure they can receive critical updates,” LAUSD said in the release. “By taking these steps before the rain begins, Los Angeles Unified is working to help students and employees stay safe and keep school communities as prepared as possible for the winter ahead.”

Southern California is likely in for a solid dose of rain this week, just days after heat and Santa Ana winds helped fuel several wildfires across the region.

Forecasters expect the bulk of the rain to roll into the Los Angeles basin Wednesday night and continue into Thursday morning, with a small chance of thunderstorms and hail.

The San Fernando Valley, San Gabriel Valley and coastal areas across L.A. and Orange counties could get around an inch over the next few days. Hills and mountains could get up to 3 inches.

“We could see some pretty high rain rates,” said National Weather Service meteorologist Mike Wofford. “It's a good storm for this time of year — it's a little stronger than what we would see normally.”

The possibility of significant rain in the mountains raises concerns about flooding in areas recently burned in wildfires, particularly around the Bryson Fire burn scar near Malibu, which is only a few days old. Burn scars can’t absorb heavy rainfall and are susceptible to landslides.

The National Weather Service has issued a flood watch for the Santa Monica Mountains and surrounding communities from Wednesday afternoon through Thursday. That means heavy rain there could flood streets, creeks and rivers. The flood watch area includes both the Bryson Fire and Palisades Fire burn scars.

This will also be the first nontropical storm of the season, meaning it’s moving into the region from the north. Most storms that hit Southern California follow a similar path, especially during the winter, unlike the tropical storms that formed off the coast of Mexico and brought muggy weather to the region this summer.

Nontropical storms also bring cold air to the region. On Wednesday and Thursday, forecasters expect highs in the 60s and 70s. High elevations will be even cooler.