ARP

 

All 50 states + DC have re-opened enrollment on their respective ACA exchanges in response to both the ongoing COVID-19 pandemic and the American Rescue Plan (ARP), which substantially expands and enhances premium subsidies to millions of people!

If you've never enrolled in an ACA healthcare policy before, or if you looked into it years ago but weren't impressed, please give it another shot now. Thanks to the ARP (and some other reasons), it's a whole different ballgame this spring & summer.

Here's 10 important things to understand when you #GetCovered:

The Urban Institute has come out with a brand-new analysis which projects the impact of making the ACA subsidies which have been expanded & enhanced temporarily under the American Rescue Plan permanent. In other words, this is what they expect the real-world impact would be if Congress were to finally #KillTheCliff and #UpTheSubs permanently (as opposed to for just 2021 - 2022), as I and other healthcare activists been pushing for for years now.

A couple of weeks ago, I used the COVID Special Enrollment Period (SEP) data I had for HealthCare.Gov through the end of March, combined with limited SEP data from some state-based ACA exchanges, to extrapolate out a rough estimate of how many new Qualified Health Plan (QHP) selections may have happened since the new "Spring 2021 Special Enrollment Period" was launched on February 15th, 2021.

At the time, I estimated that perhaps 15,800 people per day on average had newly enrolled in ACA exchange policies as of the end of March, or roughly 710,000 nationally. This included the 528,000 confirmed enrollees via HealthCare.Gov, plus another 183,000 or so via the 15 state-based exchanges.

via Pennie:

Savings to the Rescue – Pennie is Now Open with Increased Savings

  • Pennie Customers Can Now See Savings When Shopping for Health Coverage
  • Uninsured Pennsylvanians will be able to receive significant savings in health coverage as a result of the American Rescue Plan

Harrisburg, PA – April 16 – As a result of the recent American Rescue Plan, also known as the COVID-19 relief package, provisions specific to the Affordable Care Act have impacted the way health insurance is available in Pennsylvania. These provisions include significant impacts, including an increase in savings, for Pennsylvanians seeking individual market coverage and those already enrolled through Pennie, as well as those who may lose their employment and rely on COBRA to maintain their employer coverage. Pennie is excited to announce that these savings are now available at pennie.com for those looking to enroll in quality, affordable coverage.

OK, this is a first...while most other states have been simply extending their existing COVID Special Enrollment Periods out through August to allow for the newly-expanded ACA subsidies, Connecticut is shutting theirs down at midnight tonight (April 15th)...but relaunching it again on May 1st:

Just posted by Access Health CT:

American Rescue Plan Act of 2021: Savings Coming for Connecticut Residents

  • You Can Start to Take Action & See Savings After May 1, 2021

A new federal law was passed in March 2021, the American Rescue Plan Act, and it changed the way we calculate financial help for customers for this year and 2022. Many more customers will now qualify for financial help to make plans more affordable. Whether you’re a first-time shopper, or an existing customer, there could be big changes ahead for your household, and we want to make sure you know how to take advantage of the new financial help available.

As a result of this new federal law:

A few weeks ago, I noted that one of the numerous ACA-related provisions of the American Rescue Plan was this one:

Put simply, subsidized enrollees last year received around $6.3 billion in "excess subsidies"...they underestimated their income for the year 2020 and would normally be required to pay them back, but the ARP is waiving that "clawback" of overpayments for one year only in response to the pandemic.

Again, these are subsidies which were already paid out in 2020. The money is already in the hands of the enrollees (well, technically it's in the hands of the insurance carriers, but that in turn freed up an equal amount in the bank accounts of the enrollees, anyway). This provision simply says that the enrollees don't have to pay it back.

A couple of weeks ago, I used the limited COVID Special Enrollment Period (SEP) data I had for HealthCare.Gov from the last two weeks of February, plus some limited SEP data from a handful of state-based ACA exchanges, to extrapolate out a rough estimate of how many new Qualified Health Plan (QHP) selections may have happened nationally.

At the time, I estimated that perhaps 18,500 people were enrolling per day nationally the final two weeks of February, and that IF that pace remained the same throughout the entire month of March, it would amount to upwards of 832,000 new people enrolling by the end of March (666,000 via HealthCare.Gov, plus another 166,000 via the 15 state-based exchanges).

It's important to note that this wasn't a hard estimate--I was pretty sure that the actual enrollment pace would slow down somewhat after the inital surge, at least until expanded subsidies via the American Rescue Plan (ARP) were officially available in most states, which didn't happen until April 1st.

Note: A few weeks ago, I ran a rough back-of-the-envelope extrapolation of partial data from the first 2 weeks of the ongoing COVID Special Enrollment Period and concluded that IF enrollment via the 36 HealthCare.Gov states was representative nationally, and IF the pace of the last 2 weeks of February held perfectly steady, it would mean around 666,000 new enrollees via HC.gov and 832,000 nationally by the end of March. Those were two pretty big caveats, of course, and as you'll see below, the reality wasn't quite as eyebrow-raising, though it's still pretty impressive.

This just in via the Centers for Medicare & Medicaid Services (CMS):

2021 Marketplace Special Enrollment Period Report

February 15 – March 31, 2021

via MNsure:

Minnesotans will see expanded tax credits through MNsure beginning today

  • Savings will be applied this spring and summer; MNsure extends special enrollment period through July 16

ST. PAUL, Minn.—Recent changes to the Affordable Care Act made through the American Rescue Plan mean more Minnesotans will be able to access tax credits through MNsure. The changes lower premiums for most people who are currently enrolled through MNsure and expand access to tax credits to many Minnesotans who previously made too much money to qualify for financial help. Minnesotans who are not currently enrolled in a plan through MNsure, including those who are uninsured, have until July 16 to enroll in coverage.

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.

Breaking via the Washington Healthplanfinder:

Washington Healthplanfinder is extending special enrollment period for Washingtonians seeking health coverage through August 15, 2021

  • More Savings Coming to Washington Healthplanfinder Customers

Due to recent federal action bringing new savings opportunities to current and new individual health insurance market customers, Washington Healthplanfinder is extending the current special enrollment period from May 15 through August 15. This aligns with the recent federal announcement extending the special enrollment period for those using the federal marketplace. This special enrollment period allows currently uninsured individuals, and people both on and off the Exchange, the opportunity to benefit from these new savings.

This morning, Vox reporter Dylan Scott posted a story touting exclusive access to a new ASPE analysis which estimates nearly 7 million uninsured Americans who now qualify for a FREE ($0 premium) ACA health insurance policy, in large part thanks to the American Rescue Plan's expanded subsidies:

Roughly 29 million people currently living in the US lack health insurance. According to the new HHS estimates, about 6.8 million of them could now purchase an ACA plan with no monthly premium, and another 1.3 million could sign up for a health plan that costs less than $50 a month. Many of those people already qualified for free or low-cost coverage prior to the ARP, but based on the federal projections, the new law’s expansion of the ACA made an additional 2 million Americans eligible for free or cheap coverage.

Here's the formal kick-off announcement from HHS Sec. Becerra:

  • An average of three out of five eligible uninsured Americans can access $0 plans after advance payments of tax credits and an average of four out of five current HealthCare.gov consumers will be able to find a plan for $10 or less per month after advance payments of tax credits
  • Department also announces $50 Million Boost to Special Enrollment Period Outreach Campaign

Today, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that additional savings and lower health care costs are available for consumers on HealthCare.gov. The American Rescue Plan (ARP) has increased tax credits available to consumers, helping to reduce premiums and giving consumers access to affordable health care coverage.

The Department also announced an additional $50 million in advertising to bolster the Special Enrollment Period outreach campaign. The campaign will run through August 15, 2021.

A couple of weeks ago I noted that all 11 California health insurance carriers participating on the state's ACA exchange, CoveredCA.com, have agreed not to reset deductibles for current off-exchange enrollees who shift to an on-exchange plan during the ongoing COVID Enrollment Period.

This is a HUGE deal, especially in California, where an estimated 430,000 residents are enrolled in off-exchange ACA policies which are virtually identical to their on-exchange equivalent, with the sole distinction of those enrolled in them not being eligible for ACA subsidies.

With subsidies being beefed up and the 400% FPL subsidy cliff having been killed (for the next 2 years, at least), this means that hundreds of thousands of Californians have just become eligible for thousands of dollars in savings...as long as they transition to the same plan on-exchange.

Your Health Idaho, which had been scheduled to end their COVID-19 Enrollment Period on March 31st, has understandably extended the deadline out by another month in light of the American Rescue Plan's expanded/enhanced subsidies. Via email:

Enhanced Subsidies Go into Effect at Your Health Idaho April 1

Your Health Idaho Continues to Enroll Idahoans through April 30, 2021

BOISE, Idaho –Your Health Idaho, the state insurance exchange, will remain open throughout the month of April so Idahoans can take advantage of enhanced financial assistance, which lowers consumer’s monthly premiums. 

For the first time ever, tax credits, which act like an instant discount, may be available for those who were not previously eligible and will be increased for Idahoans who already receive them. For some Idahoans, these savings can be significant. For example, a Treasure Valley married couple in their 20s making $50,000 a year could pay less than $10 a month and a family of four making $105,000 could pay as little as $200 a month.

In the United States, major medical insurance policies for those who don't have healthcare coverage through their employer, Medicare, Medicaid, CHIP, the Veteran's Administration or some other source are available via the ACA's individual market exchanges. The individual market for residents of 36 states is HealthCare.Gov; the remaining 14 states + DC each have their own ACA exchange, such as Covered California, NY State of Health and so forth.

There are usually dozens of ACA policies available via the ACA exchanges, but they fall into five major categories: Catastrophic, Bronze, Silver, Gold and Platinum plans (other major distinctions include HMOs vs. PPOs and other variables,but those are for another day).

With rare exceptions, Catastrophic plans are only available to enrollees under 30 years old. ACA premium subsidies can't be used to help pay for Catastrophic plans either, so enrollment is rare; during the 2020 Open Enrollment Period, only 89,000 ACA exchange enrollees selected Catastrophic plans out of over 11.4 million total, or just 0.8%.

HealthSource RI becomes the latest state-based exchange to jump onboard the August 15th train...

Governor McKee and HealthSource RI Announce New Enrollment Period Extended Through August 15

  • Historic level of financial assistance is now available through HealthSource RI.
  • New Enrollment Period has been extended through August 15, 2021, adding three months to the previous May 15, 2021 deadline.
  • Starting April 1, most HSRI customers will have a lower monthly bill.
  • Beginning in summer 2021, HSRI will make more financial assistance available to people who previously did not qualify to receive it based on their income.
  • Individuals and families who have received unemployment payments in 2021 will be newly eligible for additional financial help for this year or may qualify for health coverage at no cost.
  • Rhode Islanders should enroll in coverage as soon as possible to take full advantage of these new benefits. 
  • The deadline to enroll is August 15, 2021.

A few weeks ago, Pennie (Pennsylvania's ACA exchange), like several other state-based exchanges, put out a simple statement celebrating the passage of the American Rescue Plan (ARP) and the dramatic improvement in ACA affordability that it brings for the next two years. Like most of the other exchanges, Pennie's initial press release was pretty bare-bones, as the bill had just been signed into law and there were a ton of logistical details to be worked out.

Today, at their monthly board meeting, Pennie provided some further info on how they plan to proceed:

Pennie’s American Rescue Plan Policy Goals

  • Implement ARP provisions as soon as possible, and as broadly as possible, to maximize savings for Pennie customers
  • Automate these provisions, to the extent possible, to ensure that the benefits under the new law reach Pennie customers without requiring customer action
  • Ensure that customers who need to take an action are given specific instructions on what they need to do to maximize their benefits
  • Use this unique opportunity to connect more Pennsylvanians to comprehensive coverage and reduce the number of uninsured throughout the Commonwealth

The Kaiser Family Foundation has updated their ACA Exchange Subsidy Calculator tool, which lets you plug in your household information and calculate how much you're eligible for in subsidies, as well as telling you things like:

  • Your percent of the Federal Poverty Level (FPL)
  • The full-price benchmark Silver plan
  • Your net price for the benchmark Silver plan
  • The net price of theleast-expensive Bronze plan
  • The maximum you'd have to pay in out-of-pocket costs

It's been updated to reflect the newly-expanded & enhanced subsidies available under the American Rescue Plan for 2021 & 2022. The official ACA exchange websites will have this data available over the next few weeks depending on which state you live in (HealthCare.Gov is supposed to go live on April 1st; Covered California on April 12th; other states will vary):

via Connect for Health Colorado:

Connect for Health Colorado Extends Enrollment Period through at least August 15

DENVER — Yesterday afternoon, President Biden announced that the federal health insurance marketplace, HealthCare.gov, will extend the current enrollment period through August 15, 2021, to help as many people as possible get covered following the passage of the American Rescue Plan Act of 2021.

Connect for Heath Colorado® Chief Executive Officer, Kevin Patterson, released the following statement in response:

“We will follow the federal decision so that we can help as many Coloradans as possible get covered this year. Keeping our doors open through at least mid-August maximizes the number of people who can apply for financial help and enroll through our Marketplace, especially as our state recovers from the pandemic. We will share more details soon about how Coloradans who are newly eligible for benefits under the American Rescue Plan can get those additional savings.”

A lot has happened since I last ran some back-of-the-envelope math to get a feel for how many Americans are enrolling in ACA exchange policies durign the 2021 COVID Enrollment Period, which started in most states on February 15th.

At the time, HealthCare.Gov had reported 206,000 Qualified Health Plan (QHP) selections as of February 28th. I also had some partial COVID SEP data from a handful of the state-based ACA exchanges, as of various dates. I had 225,000 QHPs confirmed nationally.

At the time, I concluded that based on the enrollment pace of the first few weeks...

As noted above, Medicaid expansion states have only increased average SEP enrollment by around 2/3 as much as Non-expansion states. Since all 15 state-based exchanges have expanded Medicaid, this suggests that the 206K via HC.gov probably represents more like 80% of the total, meaning perhaps 258,000 nationally (~168,000 more than average).

June 16, 2020:

On March 20th, the Vermont Health Connect ACA exchange joined other state-based exchanges in launching a formal COVID-19 Special Enrollment Period.

On April 15th, just ahead of the original SEP deadline, they bumped it out by a month.

Then, with the May deadline approaching, I took a look and sure enough, they've bumped it out another month.

And now, with the June deadline having come and gone...

Due to the COVID-19 emergency, Vermont Health Connect has opened a Special Enrollment Period until August 14, 2020.

I admit that this is starting to get a bit silly. At a certain point I'm guessing at least one of the state exchanges will just say "screw it" and open 2020 enrollment up for the full year.

This is from a couple of weeks ago; I'm reposting it standalone for clarity. Via the Washington Health Benefit Exchange:

Washington Health Benefit Exchange Issues Statement on the Signing of the American Rescue Plan Act of 2021

Pam MacEwan, CEO Washington Health Benefit Exchange (Exchange), issued the following statement today following the signing of the American Rescue Plan Act of 2021:

“The new stimulus plan is great news for both our current Exchange customers as well as the uninsured who have not been able to afford health insurance. Enhanced premium assistance will help people afford and keep health coverage during the current pandemic.

“Our enduring goal is to ensure that every Washingtonian can get affordable health insurance coverage for themselves and their family. Today’s landmark legislation takes the necessary steps to help those who face high insurance costs that have prevented them getting health coverage for 2021 and 2022.

This is from a couple of weeks ago; I'm reposting it standalone for clarity. via HealthSource RI:

New Federal Changes Mean An Increase In Financial Help for Most HealthSource RI Customers; New Customers May Also Enroll Now

EAST PROVIDENCE, Rhode Island (March 11, 2021) — Recent changes at the federal level mean most HealthSource RI (HSRI) customers will soon be paying less for their health coverage. This change will result in the federal government providing an additional $30 million dollars in Advanced Premium Tax Credits (APTCs) that will bring premium costs down for HealthSource RI customers.

This is from a couple of weeks ago; I'm reposting it standalone for clarity. via Pennie: (via a text graphic for some reason):

Joint Statement from The Pennsylvania Insurance Dept. & Pennie regarding the American Rescue Plan Act of 2021:

"The American Rescue Plan Act of 2021 will not only provide financial assistance through the forthcoming stimulus checks, but will also provide an estimated $270 million in additional subsidies to current Pennie customers in 2021 alone. Through this law, marketplace premiums will be capped at 8.5% of a household's income, meaning current Pennie customers will see lower monthly premiums and those without coverae or who were previously ineligible will now have access to financial help if they shop at Pennie.com.

In some cases, lower-income enrollees will have their monthly premiums eliminated entirely. Additionally, anyone who was eligible for unemployment income in 2021 will be eligible for coverage thorugh Pennie with a $0 premium for the remainder of the year.

via MNsure:

MNsure Statement Regarding Federal Changes to the Affordable Care Act

ST. PAUL, Minn.—On Thursday, March 11, President Biden signed the American Rescue Plan, which includes several key health care provisions to the Affordable Care Act that will expand benefits available to Minnesotans through MNsure. This includes an increase in the amount of tax credits MNsure enrollees receive to help them pay for their premiums and an expansion of tax credits to middle-income Minnesotans who previously fell outside income thresholds for financial help. This increase in benefits means Minnesotans who purchase health insurance through MNsure will be able to find a plan with premiums that cost no more than 8.5% of their household income.

This is from a couple of weeks ago, but I'm reposting it standalone for clarity. Via DC Health Link:

Premium Drop for DC Health Link Coverage Thanks to the American Rescue Plan

  • $36 million in yearly insurance premium savings for DC residents with DC Health Link coverage; coverage available for as little as $2/month for laid-off residents; 100% of COBRA premium paid for laid-off workers 

Washington, DC – Today, the DC Health Benefit Exchange Authority announced major savings for residents in the District of Columbia who purchase private health insurance through DC Health Link, the District’s state-based online health insurance marketplace established under the Affordable Care Act (ACA). Now signed into law by President Biden, the American Rescue Plan reduces premiums for health insurance through DC Health Link, provides health insurance for as little as $2/month to people who lost their jobs, and pays for 100% of COBRA for laid-off workers. We estimate that residents will save about $36 million in premiums.

via Access Health CT (via forwarded email):

Dear Brokers,
 
A lot has transpired regarding the American Rescue Plan Act of 2021*. Our team has been meeting with CMS, other state-based marketplaces, our insurance carriers, and other stakeholders, and is in the process of putting together a strategic plan to implement these changes.

We know some of you might be getting questions from customers/stakeholders in the days to come since the federal exchange (Healthcare.gov) will have a robust national campaign supported by President Biden to help spread the word. Here’s what you should know: 

Timelines are/will be different: Healthcare.gov will be implementing the subsidy expansion and a possible Special Enrollment Period at a different time than Access Health CT (AHCT). It may start earlier and may end later than CT (we do not know dates at this time).

Access Health CT:

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