By Surabhi Dangi-Garimella, Ph.D.
Following the announcement of a Special Enrollment Period in the health insurance marketplace from February 15 to May 15 for those who may have lost employer-sponsored insurance during the COVID-19 pandemic, the Biden administration has introduced the $1.9 trillion American Rescue Plan. The plan includes strategies to expand the scale of vaccine administration across the nation and open up schools, provide monetary relief to families, support small businesses, and protect the jobs of first responders and essential workers.
A significant focus of the plan is on improving healthcare access in the wake of the pandemic, by making more affordable options available and offering increased premium tax credits on high-quality healthcare plans. Here are the specifics:
- Affordable coverage:
- An estimated $50/person/month and $85/policy/month reduction in many premiums
- With the rollout of the plan,
- 11% more enrollees can find a plan with a monthly premium at or below $10 (after tax credits)
- 36% more enrollees can find a Silver Plan at a monthly premium of $10 or below
- Healthcare.gov will allow 25% of enrollees to upgrade to a plan with lower out-of-pocket (OOP) costs at the same or lower premium compared to their current plan
- Expanded eligibility:
- 3.6 million currently uninsured individuals will now be eligible for healthcare coverage savings
- 1.8 million uninsured whose incomes are below 150% of the federal poverty level (FPL) will now have access to benchmark Marketplace plans with zero-dollar premiums
- 9.5 million uninsured whose income is between 150%-400% of the FPL will be able to get financial support to help cover their premium for Marketplace plans
- Addressing racial disparity: Expansion and affordability are both expected to make a mark on traditionally underserved and uninsured communities, who have also seen significantly greater job loss or loss of health coverage during the pandemic. The Rescue Plan expects to
- Provide new coverage to 69,000 American Indians and Alaska Natives either at a subsidized rate or at zero-dollar premiums
- More than a million uninsured Latinos will be eligible for health coverage at a subsidized rate or at zero-dollar premiums
- Close to 700,000 uninsured Black and African American individuals will be eligible for health coverage at a subsidized rate or at zero-dollar premiums
- Close to 250,000 uninsured Asian, Native-Hawaiian, and Pacific Islanders will be eligible for health coverage at a subsidized rate or at zero-dollar premiums
The expanded eligibility will last for 2 years and will expire in January 2023. According to Kaiser Family Foundation’s estimates, these changes will allow an additional 3.7 million individuals (20% more) to purchase subsidized Marketplace coverage plans. Additionally,
- 63% of those who are currently uninsured will be eligible for financial assistance via Marketplace plans, Medicaid, or Basic Health Plans
- 40% of uninsured will be eligible for an almost free health plan via one of these options
- $70/month average savings are expected for individuals currently enrolled in a Marketplace health plan
- $213/month average savings for those whose income is between 400%-600% of FPL
- $33/month average savings for those whose income is under 150% of FPL ($0 premium for silver plans and much reduce OOP costs)
- Those enrolled in Marketplace plans in 2020 do not have to repay any excess premium tax credits for that year to the Internal Revenue Service
- For up to 6 months in 2021 (between April1, 20201 and September 30, 2021), eligible individuals will get premium subsidies for COBRA coverage
While these numbers are very encouraging, their impact will, obviously, only be visible later in the year. Since this announcement came after many had already enrolled for 2021 coverage, rollout and change implementation by states may take some time. Other rate-limiting steps will be making the target population aware of these newly available options and providing navigator help for enrollment or making changes to existing enrollment.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brought her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.