Updated Information Regarding New COVID-19 Emergency Special Enrollment Period Impacts from the American Rescue Plan Starting April 1st
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MARCH 31, 2021
The recently passed AMERICAN RESCUE PLAN, the Biden Administration’s comprehensive effort to counter the economic and health impacts of the Covid-19 pandemic includes an extension of the Emergency Special Open Enrollment Period (SEP) for individuals and families to enroll in Health Insurance Marketplace coverage. The previously announced emergency SEP began on February 1st and was expected to expire on May 15th, however, that deadline has now been extended until August 15th. This SEP will allow individuals and families in states like Florida with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage for most of the year.
Additionally, there are major financial impacts to the Marketplace costs and available subsidies contained in the new American Rescue Plan that are going into effect this week, starting April 1. The $1.9 trillion covid relief law will make coverage significantly more affordable for millions of people who either have marketplace coverage, are uninsured or have lost their employer coverage. In addition, it will eliminate repayment requirements for 2020 premium tax credits. Consumers can begin to see those improvements next month but will need to go to healthcare.gov and update their application for the changes to take effect then. Our certified Covering Florida Navigators are ready and able to assist with the new process.
What’s new: (portions courtesy of Kaiser Health News)
Enhanced Premium Subsidies for Marketplace Plans
When: 2021 and 2022
Who benefits: Just about everyone who has coverage through the Affordable Care Act’s marketplaces. Premium costs for people eligible for subsidies will shrink by $50 per month on average, according to the federal government, but some people will see much larger savings.
Under the ACA, people with incomes between 100% and 400% of the federal poverty level (from $12,760 to $51,040 for one person or $26,200 to $104,800 for a family of four) were eligible for premium tax credits to reduce their premiums for marketplace coverage. Under the changes passed in the new law, how much people owe is reduced at every income level and capped at 8.5% overall.
For example, a single person who makes $30,000 annually will pay $85 per month in premiums on average under the new law for a silver-level plan instead of $195, according to an analysis by the Center on Budget and Policy Priorities. A family of four making $75,000 will pay $340 rather than $588 per month for similar coverage.
For example, prior to the new law, an older customer not yet in Medicare with an income just over 400% of the federal poverty level in some states would be paying 20% to 30% of their income toward their health care premium. That will now be capped at 8.5%.”
At the other end of the income spectrum, people with incomes up to 150% of the poverty level ($19,140) will owe nothing in premiums. Under the ACA, they had been required to pay up to 4.14% of their income as their share of the premium cost.
Steps to take now:
- People who have marketplace coverage in Florida should go back to www.Healthcare.gov to update their applications and reselect their current plan if desired to get new details about their subsidies starting April 1.
- The enhanced tax credit is in effect for all of 2021 and 2022. For premiums paid for January through April, consumers can claim those premium tax credits when they file their taxes next year.
- People who don’t update their applications now will still be able to claim the additional tax credit amount when their file their taxes in 2022.
The more generous premium tax credits may mean people can switch to better coverage with lower cost sharing for the same contribution. Whether switching is a good decision for you depends on how much you’ll save in premiums and how much you’ve already paid in deductibles. But switching will pay off for enough people that they should consider checking to see what the prices are. This is especially true for older people; new subsidies could cut their cost of insurance by half. A Covering Florida Navigator can help you consider the available choices.
- People who bought a 2021 plan off the marketplace, perhaps because their income is too high to qualify for premium tax credits, will have to enroll in coverage on the marketplace now in order to get the new premium tax credits, said Straw.
- People who are uninsured can sign up now during the covid special enrollment period that runs through Aug. 15 on the federal exchange. People who sign up before April 1 should go back in after April 1 to update their applications.
- Consumers can reach out to us now for appointments through the Covering Florida website www.CoveringFlorida.org or by calling 877-813-9115, or by contacting any of our statewide partners listed below.
There are additional new provisions that are important to share with anyone who currently or has received or has been determined eligible to receive Unemployment Insurance in 2021. Under the American Rescue Plan, anyone who has received unemployment benefits this year will be considered to have income at 133% of the federal poverty level (about $17,000) for the purposes of calculating how much they owe in premium contributions for a marketplace plan. Since people with incomes up to 150% of the poverty level don’t owe anything in premiums under the new law, these unemployed workers can get a zero-premium plan. If they buy a silver-level plan, they can also be eligible for cost-sharing reductions that shrink their deductible and other out-of-pocket costs.
Officials are urging people receiving unemployment insurance to enroll in a marketplace plan now to take advantage of the law’s enhanced premium tax credits. The federal government said the additional savings for people who collect unemployment insurance will be available starting in early July.
People who are uninsured or have marketplace coverage can still receive the enhanced premium subsidies described above in the meantime. And because the new law excludes the first $10,200 in unemployment insurance from income for the 2020 tax year, people may be able to qualify for higher premium tax credits based on lower income.
Another provision of the new law allows for consumers to skip paying back excess Marketplace subsidies, benefitting people who earned more money last year than they estimated when they signed up for marketplace coverage. Under the ACA, people estimate their income for the upcoming year, and the marketplace estimates how much in premium tax credits can be advanced to them every month. At tax time, people reconcile their actual income with their projected income, and if they received too much in tax credits, they generally must pay it back to the government. The new covid relief bill eliminates that requirement for 2020. A Covering Florida Navigator can assist you if you are in this category.
Finally, Floridians who lost their employer-sponsored coverage and want to stay on that plan can enjoy subsidies to cover 100% of COBRA premiums through September of 2021. Generally, when people get laid off and lose their employer coverage, they can opt to keep it for 18 months, but they have to pay the entire premium plus a 2% administrative fee. This is done under provisions of a law known as COBRA. Under the new law, the federal government will pay the entire COBRA premium through September of this year.
For people undergoing treatment for a medical condition, it can be important to keep their coverage and existing providers. And switching plans midyear can leave people on the hook for a brand-new deductible. But the newly enacted enhanced premium tax credits and free marketplace coverage for people who collect unemployment insurance make marketplace coverage much more affordable than in the past. That could be important because, after September, the new COBRA subsidies will end and people will be responsible for the entire premium, unless the government puts in place a special enrollment period for that circumstance. Without another special enrollment period, they might not be able to get into a marketplace plan until January.
People who missed the original 60-day enrollment window for keeping their job-based coverage can go back and enroll in COBRA now. They have 60 days to enroll after they’re notified of the new provisions under the covid relief plan. They will not owe premiums back to their original eligibility date, but any medical claims they incurred before their enrollment won’t be covered. Consumers should review coverage to determine whether COBRA or marketplace coverage is the best, most affordable option.
Covering Florida is the statewide consortium of certified Navigator groups partner organizations, with multiple partner organizations located throughout the state. These include:
- Big Bend Area Health Education Centers (AHEC) – Serving Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Liberty, Leon, Madison, Taylor, Wakulla and Washington counties.
- Covering Central Florida (Primary Care Access Network) – Serving Lake, Orange, Osceola and Seminole counties.
- Epilepsy Florida (ACA Navigation South Florida) – Serving Broward, Miami-Dade, Monroe, and Palm Beach counties.
- Family Healthcare Foundation – Serving Hillsborough, Pinellas, Pasco and Polk counties
- Health Planning Council of Northeast Florida – Serving Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties.
- Health Planning Council of Southwest Florida – Serving Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Highlands, Lee, Manatee and Sarasota counties.
- Suwannee River Area Health Education Centers (AHEC) – Serving Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Marion, Putnam, Suwannee and Union counties.
- University of South Florida Navigators – Serving the entire State of Florida, to include Brevard, Citrus, Escambia, Hernando, Indian River, Martin, Okaloosa, Okeechobee, St. Lucie, Santa Rosa, Sumter and Walton counties.
Consumers enrolling in a plan on HealthCare.gov are guaranteed to receive comprehensive coverage, with no pre-existing condition exclusions or markups. All plans cover essential benefits, including doctor and hospital visits, prescription drugs, mental health treatment, and maternity care. In addition, consumers receive free preventive care services, such as immunizations and health screenings. Testing and treatment of COVID-19 are considered essential health benefits and are covered by all HealthCare.gov Marketplace plans.
As always, you can find someone to help you navigate the enrollment process by visiting www.CoveringFlorida.org or calling 877-813-9115. Consumers are encouraged to make an appointment now to get the comprehensive health coverage they need.
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The project described was supported by Funding Opportunity Number NAVCA190357-02-00 from the U.S. Department of
Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of
the authors and do not necessarily represent the official views of HHS or any of its agencies.