Nearly 14 million people have signed up for private insurance through the Affordable Care Act’s marketplaces, the U.S. Centers for Medicare and Medicaid Services reported on Monday. There are two reasons you might want to pay attention to that.
One is the implications for policy and politics. The new enrollment figure is the highest in the program’s history, and a big reason why, experts agree, is the extra financial assistance that became available last year when President Joe Biden and the Democrats enacted their COVID-19 relief program, the American Rescue Plan.
That assistance effectively reduced premiums, out-of-pocket costs or both for millions of Americans who buy coverage on their own rather than through employers ― in other words, the people who can shop for subsidized insurance at HealthCare.gov or one of the online marketplaces that 18 states operate independently.
Like so many other elements of the COVID-19 relief legislation, the extra insurance subsidies are temporary. Specifically, they are set to expire at the end of 2022. The Build Back Better legislation that Biden and Democratic leaders are trying to pass would extend the new subsidies for at least a few years. But they can’t pass the legislation unless and until they win over Sen. Joe Manchin (D-W.Va.), who has said he objects to other parts of the bill, and at this point it’s anybody’s guess whether they’ll succeed.
The other reason to pay attention to the enrollment figure is that it might get you thinking about your own insurance options and whether you, too, stand to save some money on health insurance. You might find coverage for a lot less than it has cost in the past. You might even find a policy that’s free.
But you’re also running out of time. The last day of open enrollment is Saturday. After that, the only way to get marketplace coverage for 2022 will be if you have a life-changing event, like a layoff or a divorce. Otherwise you’d have to wait until 2023.
Building A Better Obamacare
The private insurance options available through the Affordable Care Act right now are significantly better than what was on offer in the early years of the program’s existence. That’s mainly because of compromises the original legislation’s champions made to get the bill through Congress and onto the desk of former President Barack Obama.
Among the most important compromises was a decision to hold new federal expenditures during the first decade to under $1 trillion ― a level of funding that, the legislation’s champions knew, would force them to scale back the financial assistance available to insurance buyers.
Even with that concession, the program was still pretty generous for low-income people, who not only got larger subsidies for their premiums but also were eligible for special policies with lower out-of-pocket costs. They signed up by the millions, and it’s one reason the number of uninsured Americans fell after the law took full effect.
But people at even modestly higher incomes couldn’t get those special policies: The premium subsidies tapered off with income and cut off altogether at four times the poverty line ― which, in today’s dollars, is about $106,000 in annual income for a family of four. That left some families facing insurance premiums equal to more than one-fifth of their household income ― enough, in some cases, to dissuade them from getting coverage altogether.
Obama, who frequently described the initial Affordable Care Act legislation as a “starter home,” later proposed offering more assistance. But by that time, Republicans controlled Congress and were hellbent on repealing “Obamacare,” not improving it.
Repeal was also the position Donald Trump took as president. When that effort failed, his administration addressed the high cost problem in a very different way than Obama and the Democrats had proposed. Instead of upping the financial assistance, Trump and his deputies made it easier for people to enroll in cheaper but less comprehensive insurance options, such as “short term-limited duration” policies that leave out key benefits.
As a candidate, Biden promised to resume the work of reinforcing the Affordable Care Act. As president, he did just that. The new subsidies he and Democratic leaders enacted have increased the financial assistance available to people who were already eligible while also making assistance available to people who couldn’t get it before. The basic idea is to make sure no family has to pay more than 8.5% of its household income on health insurance premiums.
The extra assistance isn’t the only reason enrollment is up this year. The Biden administration is promoting HealthCare.gov more aggressively and funding more “navigators,” which are the organizations and counselors that advise individual purchasers. The economic dislocations of the coronavirus pandemic have likely played a role as well, since more people are going without job-based coverage.
But experts are in wide agreement that the new assistance has made a difference by simply making insurance cheaper for people.
Maybe A Better Deal For You
How much cheaper? As was the case before, the actual policies and prices available depend on a series of variables ― where you live, what insurers in your area are charging, the size of your household and, of course, your income.
In some states, you are still subject to a financial penalty if you don’t have coverage. In some states, you are eligible for even more assistance, above and beyond what the American Rescue Plan added. And in some states, you both face a penalty and can get extra assistance.
The only way to be sure what’s available to you and how your options compare is to check for yourself, which you can do at HealthCare.gov. If you live in California, Maryland or one of the other 16 states that runs its own marketplace, HealthCare.gov will automatically direct you to that website.
You can also try officially authorized ACA partner websites, like HealthSherpa and W3LL.com, or consult HealthInsurance.org, an independent website with a subsidy calculator and how-to guides from broker and writer Louise Norris. The widely read and cited ACAsignups website, operated by Michigan-based analyst Charles Gaba, has its own open enrollment guide.
The options you find may not be exactly what you want. These are still American private insurance policies, after all. They feature limited networks of providers, require prior authorization for many treatments and include all the other bureaucratic hassles that you wouldn’t find in other countries with more seamless universal coverage systems.
Still, chances are good the options are better than you think. Nearly 11 million uninsured Americans were eligible for subsidized private coverage after the new assistance became available this past spring, according to an analysis by the Henry J. Kaiser Family Foundation, and more than half of them could get coverage with no premiums at all.
And you don’t have to be uninsured to take advantage of the new assistance. If you currently buy private insurance on your own but directly from an insurer, you might be able to save money ― and get essentially the same coverage ― by going through HealthCare.gov or one of the state-based marketplaces.
And price isn’t the only thing to consider. If you’re one of those people who opted to buy a policy that doesn’t comply with the Affordable Care Act’s standards, whether it’s one of those Trump-era short-term policies or maybe a faith-based “health sharing plan” from a ministry, you might find that you can now buy a more comprehensive plan ― one without big gaps in benefits or exclusions for preexisting conditions ― for the same money or even less.
Even if you already have coverage through the marketplace, there’s one very important reason to recheck your options. The formula for financial assistance depends, in part, on what prices insurers in your area are offering. And after several years in which insurers were leaving the marketplaces, lately they’ve been returning ― and that can change the formula dramatically.
If you didn’t select a new policy for this year, chances are good the marketplace automatically reenrolled you in your old plan. The price of that plan may have increased because the subsidy formula changed, so it’s worth evaluating your alternatives when it comes to cost, convenience, covered services and network size.
But the only way to find out is to check. And there are only a few days left to do that.