Millions of Americans across the country can now save hundreds, if not thousands of dollars, on health insurance premiums over the course of 2021 and 2022. On March 11, 2021, the American Rescue Plan was passed, which included temporary provisions that increase the dollar amount of premium subsidies available to consumers. For 2021 and 2022, the law extends Affordable Care Act (ACA) subsidies to higher-income people who previously did not qualify and increases ACA subsidies for lower-income people who already qualify. For 2021, the highest possible ACA subsidies will be available to individuals who receive unemployment benefits. GetInsured recently released a calculator that lets consumer compare their current premiums with the new tax credit amount.   

Implementing these eligibility changes on the back end is not as easy as flipping a switch and entails significant configuration of the technology platform so that the user experience is seamless, and consumers get access to all the subsidies for which they are eligible under the new law. Below we compare the healthcare.gov roll out of these changes to the approaches used by state-based exchanges operated by GetInsured.  

HealthCare.gov 

  • Consumers who actively log in to HealthCare.gov can take advantage of increased premium subsidies after April 1.  
  • Consumers who wish to take advantage of the maximal premium tax credit that comes with claiming unemployment insurance will need to wait until July.  
  • There currently are no plans to automatically update premium tax credits for consumers who are currently enrolled; those who don’t act proactively on HeathCare.gov will have to wait to receive the additional benefit when the file tax returns in 2022.

State-Based Exchanges 

GetInsured has been busy working with our state clients to implement the ARPA’s enhanced subsidies and other changes such as open enrollment extensions and special enrollment categories.  

  • In Idaho, the increased subsidies are already available for consumers. In an example of state policy flexibility when running a state exchange, the increased subsidies have automatically been applied for all consumers who are currently enrolled.
     
  • Consumers in New Jersey and Pennsylvania can access new subsidies online starting April 15, and in Nevada starting April 19. Special enrollment periods are available in these states for consumers who wish to report changes or enroll for the first time. This SEP and, new functionality to support it, will enable self-service for the following populations: 
    • People enrolled and currently receiving subsidies who now qualify for more APTC 
    • People who applied or enrolled previously and did not qualify for subsidies, but who are now eligible 
    • People who were on unemployment insurance at some point during the year, and therefore qualify for very generous subsidies (this feature is being launched in NV, NJ and PA months ahead of HealthCare.gov) 

In an April 14 press release, New Jersey Governor Phil Murphy announced that, “as a result of the new state and federal savings, nine out of 10 residents enrolling at Get Covered New Jersey will be eligible for financial help.”

In addition to enhanced federal tax credits, the New Jersey state subsidies – called New Jersey Health Plan Savings – will also now be available for residents with incomes up to 600 percent of the Federal Poverty Level (up to $76,560 for an individual and $157,200 for a family of four), up from the previous 400 percent FPL threshold.

PennieTM, Pennsylvania’s health insurance exchange, announced on April 16:
The system enhancements to pennie.com for shopping customers were part of Pennie’s Phase 1 of implementation of the American Rescue Plan provisions. Current customers will also be able to access the enhanced subsidies during this phase, as long as they actively resubmit their Pennie application. The second phase in Pennie’s implementation plan relates to re-running eligibility for current Pennie customers. Pennie will be automatically updating their plans with the enhanced subsidies and will implement these savings by no later than June. Pennie will be notifying their customers when these changes will be available in their accounts, and what steps they need to take to receive them, if necessary.  

In their April 16 press release, the Silver State Health Insurance Exchange (aka Nevada Health Link) noted, “For the first time, since the Affordable Care Act, there are bigger savings for individuals and families who may not have been eligible for savings prior to the passage of this legislation,” said Janel Davis, Communications Officer for the Exchange. “Nevadans who are facing the deep economic ramifications of the pandemic can breathe a sigh of relief knowing they may be eligible for increased or expanded subsidies.”

  • MNsure customers will have their increased subsidies processed in the upcoming weeks and automatically applied to existing enrollments as GetInsured continues to work with separate Minnesota’s METS – Medicaid eligibility system.
     
  • California carriers may be able to encourage customer loyalty thanks to a process GetInsured proposed which would allow carriers to help their current off-exchange customers move to an on-exchange plan with access to subsidies and carry over deductibles and out-of-pocket expenses if they stay with the same carrier. This limits consumer spending losses and carrier business losses and has the potential to help almost 300,000 Californians. 

In an April 12 press release from Covered California, the exchange states:
Nearly 270,000 Californians are insured directly through a health insurance company in what is referred to as “off-exchange coverage.” They currently do not receive any financial help. The new law ensures that everyone eligible will pay no more than 8.5 percent of their household income on their health care premiums if they are enrolled through an Affordable Care Act marketplace like Covered California (unless they select a plan in a higher metal tier). The new and expanded subsidies mean that many consumers will be able save hundreds of dollars per month — or thousands of dollars between May and the end of 2022 — if they switch and get their insurance through Covered California.

  • Effective June 1, consumers in Nevada, New Jersey, and Pennsylvania who are currently enrolled but have not yet revisited their state exchange to take advantage of increased subsidies, will automatically have the new subsidies applied to their premiums. 

“We are pleased to have been able to implement the American Rescue Act Plan changes so quickly,” said Shankar Srinivasan, COO, GetInsured. “Millions can now breathe a bit easier knowing that health insurance coverage is within their reach.”