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While current issuers are immersed in navigating the PY2025 Qualified Health Plan Application Process, it is equally critical to begin strategizing for PY2026. This year the Affordable Care Act (ACA) Marketplaces saw record-breaking enrollment levels. Over 21 million people turned to the Marketplace for coverage in 2024, with 15 states doubling their 2020 enrollment. The number of uninsured people has dramatically declined from 45.2 million in 2013 to 26.4 million in 2022.
What’s driving these record numbers? Two significant factors: Medicaid redeterminations and member subsidies. For the first time since the COVID “pause”, millions of Medicaid members had their eligibility redetermined, prompting many to seek new coverage through the Marketplace. Additionally, subsidies funded by the Inflation Reduction Act (IRA) have made ACA Plans more affordable than ever for qualifying consumers.
However, with redetermination volumes slowing and IRA subsidies set to expire in 2025, issuers must start strategizing for PY2026 now. How will they attract new members? How will rates be impacted? What operational processes must be adapted to meet a changing regulatory landscape?
Let ProspHire help plan your roadmap for success. Our expertise in healthcare consulting can guide you through these transitions, ensuring you remain competitive and compliant in the evolving marketplace.
