UPDATED for the #ARP Era: There's FREE Gold in Them Thar Hills! $0-Premium Gold plans in over 600 counties!
NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.
Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.
I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.
If you have a fairly healthy year, you really could go the entire year without paying a dime in healthcare costs while still taking advantage of many of these free services, and also having the peace of mind that in a worst-case scenario, at least you wouldn't go bankrupt. Not perfect, but a lot better than going bare especially since you wouldn't pay a dime in premiums.
However, far less has been written about the zero-premium GOLD plans which are also available to some ACA enrollees around the country. Most of that which has been written about them has been (to my knowledge) written by my friend David Anderson of Balloon Juice.
How is it possible for a Gold plan (which covers around 80% of the average person's healthcare expenses in aggregate and which typically has higher premiums than Bronze or Silver plans while having deductibles averaging less than 1/3 as much as Silver, to cost nothing per month?
Well, that's thanks to the magic of something called Silver Loading, a policy pricing strategy which was adopted by health insurance carriers & given its blessing by state regulators in response to Donald Trump's failed attempt to destroy the ACA markets by cutting off Cost Sharing Reduction (CSR) reimbursement payments.
It's a long, stupid story, but the bottom line is that as a result of the confusing mess above, millions of people who qualify for ACA subsidies are eligible for enough financial assistance to reduce their net, post-subsidy Bronze premiums to nothing...and a much smaller subset of the population even qualifies for enough APTC (Advance Premium Tax Credits) to bring net Gold premiums down to $0/month as well.
The Assistant Secretary for Planning & Evaluation (ASPE) at the U.S. Health & Human Services Department (HHS) recently posted a state-level analysis estimating that a whopping 6.8 million uninsured Americans are eligible for $0-premium Bronze plans across just 36 states (which could extrapolate out to as many as 10.9 million nationally).
The same report estimates around 2.8 million fo those folks are eligible for $0-premium Silver plans* (up to 4.4 million nationally), and 1.2 million could get $0-premium GOLD plans (up to 2.0 million nationally).
*REGARDING SILVER PLANS: It's important to keep in mind that anyone earning less than 150% FPL (roughly $19,000/year if you're single or $39,000/year for a famly of four) is effectively eligible for a $0-premium PLATINUM plan thanks to Cost Sharing Reductions, and anyone earning 150 - 200% FPL is eligible for a low-cost "Platinum" plan...but if you live in the counties below, are over 200% FPL and are looking to pay nothing per month, you should strongly consider going for the Gold.
Dave Anderson has once again come through with a database mapping out the counties where a single 40-yr old (no kids) is eligible for a $0-Premium GOLD plan if they earn up to...
- 175% FPL ($22,300/yr): 616 counties across 15 states
- 200% FPL ($25,500/yr): 344 counties across 9 states
- 250% FPL ($31,900/yr): 145 counties across 4 states
- 300% FPL ($38,200/yr): 21 counties in NE & OK
- 325% FPL ($41,400/yr): 10 counties in OK
It's important to note that this does NOT inlcude the 15 states which operate their own ACA exchanges, which actually hold 37% of the U.S. population. There are likely hundreds of thousand more people eligible for $0-premium Gold plans in those states as well, and several million more eligible for very low-cost Gold plans (under $50/month).
Since just about everyone under 200% FPL is better off with the "Secret Platinum" plan, here's the 145 counties where those earning up to 250% FPL ($31,900) are still eligible for a $0-Premium GOLD plan under the American Rescue Plan:
- IOWA: Adair, Adams, Allamakee, Appanoose, Audubon, Buena Vista, Calhoun, Carroll, Cherokee, Clarke, Clay, Clinton, Crawford, Davis, Decatur, Des Moines, Dickinson, Emmet, Fremont, Guthrie, Hamilton, Hardin, Henry, Howard, Humboldt, Ida, Jefferson, Keokuk, Kossuth, Lee, Louisa, Lucas, Lyon, Mahaska, Monona, Monroe, Obrien, Osceola, Page, Palo Alto, Pocahontas, Poweshiek, Ringgold, Sac, Sioux, Story, Taylor, Union, Van Buren, Wapello, Washington, Wayne, Webster, Winnebago, Winneshiek, Wright
- NEBRASKA: Buffalo, Butler, Cass, Colfax, Cuming, Fillmore, Hall, Hamilton, Johnson, Kearney, Lancaster, Nance, Nemaha, Nuckolls, Otoe, Pawnee, Saline, Seward, Thayer
- OKLAHOMA: Alfalfa, Beaver, Blaine, Bryan, Caddo, Carter, Choctaw, Cimarron, Coal, Custer, Dewey, Ellis, Garvin, Grant, Harmon, Harper, Haskell, Hughes, Johnston, Kay, Kingfisher, Kiowa, Latimer, Le Flore, Lincoln, Love, Major, Marshall, Mayes, Mccurtain, Mcintosh, Murray, Noble, Okfuskee, Pawnee, Payne, Pontotoc, Pushmataha, Roger Mills, Seminole, Sequoyah, Stephens, Texas, Tillman, Washita, Woods, Woodward
- WYOMING: All 23 counties (the entire state)
In fact, it turns out that if you're a single 64-year old and live in one of the following 10 OK counties, you qualify for that same free Gold BCBSOK plan if you earn as much as 675% FPL ($86,500/year): Alfalfa, Bryan, Caddo, Grant, Kay, Marshall, Okfuskee, Seminole, Washita and Woodward Counties
Remember, even if you don't qualify for a FREE Gold plan, a lot more uninsured folks will qualify for one costing less than $10-$20/month.
UPDATE: As I noted above, all enrollees under 150% FPL are now eligible for a $0-Premium "Secret Platinum" plan, and those under 200% FPL can get "Secret Platinum" for less than 2% of their income (just $42/month if you earn exactly 200% FPL).
HOWEVER, if you're still wondering about the additional counties where a single 40-yr old/no kids earning < 200% FPL can get a $0-Premium GOLD plan instead, here's all 344 counties: