Here’s how you can benefit from the Affordable Care Act market this year (and how it works)

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This story was originally published by PublicSource, an information partner of NEXTpittsburgh. PublicSource is a non-profit media organization that offers local journalism at publicsource.org. You can subscribe to their newsletters at publicsource.org/newsletters.

One of the most common critiques of the Affordable Care Act [ACA] is that it hasn’t really made health insurance affordable for consumers as it had promised.

However, due to the American Rescue Plan Act [ARPA], many more people purchasing health insurance in the market are eligible for new subsidies which significantly reduce costs.

Bill Tuthill, senior vice president of federal markets at Highmark, has focused almost exclusively on the insurance company’s ACA market since the law’s origins in 2009, and he finds ARPA exciting.


“For the average consumer, the way a consumer experiences the Affordable Care Act, I would feel very confident in saying that the American Rescue Plan Act is the biggest step in fulfilling this promise since the initial passage of the law, ”Tuthill said.

Highmark and UPMC, Western Pennsylvania’s largest health insurance providers, say customers can expect more affordable health insurance options during the current open enrollment phase. And it seems that so far a lot of people are opting for plans with better benefits now that the prices are more affordable.

As a result of the ACA, the purchase of private insurance plans is done in an online marketplace that is regulated and subsidized by the government. Enrollment for 2022 health insurance plans in the ACA market began on November 1 and ends on January 15. To get a plan that starts before January 1, the deadline is December 15.

What grants are available?

ARPA, a $ 1.9 trillion pandemic bill enacted by President Joe Biden in March, adds a series of grants for people who buy their own private insurance, as opposed to a plan to employer, Medicaid or Medicare.

A substantial change: people whose incomes reach 150% of the federal poverty line [FPL] can take advantage of tax credits to subscribe to a Silver plan for free. For example, people earning $ 19,320 or a family of four earning $ 39,750 are at 150% FPL. A Silver plan pays around 70% of healthcare costs, compared to 60% for Bronze plans, 80% for Gold, and 90% for Platinum.

And, unlike before, even for individuals who make more than 400% of the FPL, there may be tax credit grants available. For example, singles earning $ 51,520 and families of four with a total income of $ 106,000 are 400% of the FPL.


These tax credits can be used month to month to reduce health care premiums. Any amount of your tax credit that you don’t use will get your taxes back at the end of the year. Experts recommend that individuals update their income and household information online every year, which can be done here. If a plan automatically renews without updated information, a person may have to repay sums to which they are no longer eligible at the end of the year on their federal taxes.

How does it all work?

Pennsylvania created its own online marketplace, called Pennie, in 2019. States can choose to create their own marketplace if they decide it can be done more effectively in-house. Representatives from UPMC and Highmark said Pennie had helped control health insurance costs in western Pennsylvania.

The Kaiser Family Foundation [KFF] estimates that these new grants will save individuals an average of $ 70 per month, ranging from $ 33 to $ 213 depending on income. However, these figures relate to the federal market; Since Pennsylvania has its own system, these numbers may look different locally.

Grants will expire after 2022, unless Congress passes additional legislation. The highly controversial and ever-evolving Build Back Better Act, if passed in its current form, would extend ARPA grants for another three years, until the end of 2025. Republicans in Congress oppose generally to ACA as they argue that it is unconstitutional and increases government involvement in the health sector. While Democrats, the only ones voting in favor of ARPA, are broadly in favor of adding subsidies and regulations to strengthen the law.

KFF Senior Fellow Karen Pollitz said it can be years before many of the people they are designed for can take advantage of the new health care benefits. If someone is eligible for further grants on their current plan, they will automatically receive the reduced costs even if they do not visit the market again, but they may miss out on a better plan.

According to a KFF study, about 75% of people enrolled in market insurance plans do not check whether they are eligible for new grants when a new enrollment period arrives, Pollitz said. Many uninsured people also don’t check out because they think they will never be able to afford health insurance.

“Just because you’re building it, they won’t necessarily mean they’re coming, or at least not right away,” Pollitz.

What do UPMC and Highmark offer?

For an open enrollment this time around, ACA experts and insurance companies recommend exploring market options, even for those who were not eligible for grants in the past.

“Don’t count it,” said Joseph Bayura, UPMC’s director of product development for individual and small group sales.

Due to the increase in grants, UPMC and Highmark said people are switching to better plans rather than receiving similar plans for new, lower costs.


“You see a big change in the gold level plans,” Bayura said. “People say, ‘If you provide higher level grants, I will consider a more comprehensive coverage option for my family. “

Tuthill explained that consumers basically have two options regarding which tier insurance plan to choose this time around:

“They can either say, ‘I can stay in my existing plan and save $ 100, $ 150. “Or,” I used to spend everything I spent before, maybe I can take that money – it’s in my budget, I’m already spending it – maybe I can take that money and put it into a more generous plan. “”

UPMC and Highmark have also changed their open enrollment offers, with the exception of ARPA. For example, UPMC is offering a plan that will offer free virtual appointments, aimed at younger, healthier people who might otherwise choose not to purchase health insurance. Highmark offers a gold level plan for people 60 and older who want to retire before they are eligible for Medicare, according to Tuthill. This plan offers hearing aid benefits as well as up to three hours per month of help with physical tasks like going to the grocery store.

What does the future look like?

If these grants are not renewed or made permanent, individuals would likely see their premiums rise to levels similar to the status quo before ARPA grants. People enrolled in the new free Silver plans, in particular, could see their costs increase dramatically if the grants expire and they do not enter the market to change their plans, according to Coleman Drake, an assistant professor at the University of the Department. of Pittsburgh Health Policy and Management.

“They’re going to have to actively log into their accounts and tie their credit cards to their accounts in order to start making payments,” Drake said. “And I would be very worried if that would cause a huge unsubscribe. I hope we don’t have to have this conversation around this time next year, but it is a possibility until this bill is passed.

Matt Petras is a freelance writer and educator based in the Pittsburgh area. He can be contacted at [email protected] or on Twitter @mattApetras.

This story has been verified by Elizabeth Prall.


ACAAaffordable Care ActAmerican Rescue Plan ActARPAhighmarkhighmarkPublicSourceupmc

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