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Navigating The Individual Market During The Special Enrollment Period

posted by AHIP

on April 1, 2021

On March 11, 2021, President Biden enacted the American Rescue Plan Act (ARPA), enhancing premium assistance eligibility for the millions of Americans who buy their own coverage through the Affordable Care Act (ACA) marketplaces. Changes to the ACA’s tax credits are temporary—for 2021 and 2022—but will significantly enhance affordability for millions of Americans.

  • For the first time, Americans with incomes over 400% of the federal poverty level (FPL)—that’s an annual income of $51,040 for an individual or $104,800 for a family of 4—will be eligible for financial assistance to help lower their monthly premiums.
  • People with incomes up to 150% FPL–$19,140 for an individual or $39,300 for a family of 4—are eligible for $0 premium and very low deductible when they enroll in the benchmark silver plan.
  • At every income level, people will be eligible for more generous financial assistance and will be required to contribute no more than 8.5% of their household income toward a benchmark silver plan.
  • For 2020 only, people who received unemployment compensation for at least one week will be eligible for even more generous financial assistance to lower monthly premiums and out-of-pocket costs.

Enhanced eligibility under ARPA means 3.7 million people are newly eligible for financial assistance to purchase marketplace coverage. On average, monthly premiums for coverage through healthcare.gov will be lower by $50 per person. Four out of five people will be able to get a plan for $10 per month or less with financial assistance, and over 50% of enrollees will be able to enroll in a silver plan for $10 or less per month.

Beginning April 1, consumers in the 36 states using healthcare.gov can access enhanced subsidies. The current special enrollment period (SEP), which runs through August 15, allows consumers to newly enroll in Marketplace coverage to access financial assistance and is available for current enrollees to access more generous financial assistance and change plans if they choose.

When consumers return to healthcare.gov or their state Marketplace website there are a few important things to keep in mind:

  • When you newly enroll in coverage or update your financial assistance amount, the change will be effective on the first of the following month. If you enroll or update your coverage on April 1-30, your coverage will begin May 1.
  • If you are currently uninsured:
    • You may be newly eligible for financial assistance even if you weren’t before. Visit healthcare.gov to check your eligibility to find a plan that best meets your health care and financial needs. Be sure to make sure your doctors are in network and any prescription drugs are covered when enrolling in a plan.
  • If you are currently enrolled in coverage off-Exchange:
    • You may be newly eligible for financial assistance even if you weren’t before.
    • You may be able to switch to the same plan with the same health insurance provider on-Exchange.
  • If you are currently enrolled in Marketplace coverage:
    • You may qualify for a much lower deductible to help keep your annual costs down if you switch to a silver level plan.
    • Keep in mind, if you switch plans during the SEP, any amounts you have already paid toward your deductible or out-of-pocket maximum could reset.
  • If you are eligible for enhanced financial assistance because you received unemployment compensation:
    • Extra savings will be available beginning in July. Enroll now to access coverage and receive financial assistance based on your income level. Beginning in July, you should return to healthcare.gov to get even more monthly assistance.

The deadline to enroll in coverage or switch plans is August 15. If you are currently uninsured or want to lower your monthly premiums, enroll or update your financials now to make sure you can access comprehensive coverage and enhanced financial assistance.