Full Citation

Title: Access to Marketplace Plans with Low Premiums on the Federal Platform Part I: Availability Among Uninsured Non-Elderly Adults and HealthCare.gov Enrollees Prior to the American Rescue Plan

Citation Type: Miscellaneous

Publication Year: 2021

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Abstract: Approximately 30 million Americans remain uninsured, meaning that they do not have financial protection from the costs of obtaining health services and treatment, and many are eligible for Medicaid or Marketplace coverage. Black, Latino, and Native American persons are more likely to be uninsured, and communities of color have been especially hard hit by both the COVID-19 pandemic and the economic downturn. The Centers for Medicare & Medicaid Services (CMS) determined that the COVID-19 emergency presents exceptional circumstances for consumers in accessing health insurance and provided access to a Special Enrollment Period (SEP) for individuals and families to apply and enroll in the coverage they need. This SEP will be available to consumers in the 36 states served by the federal Marketplace on the HealthCare.gov platform. Consumer access to the 2021 COVID-19 SEP on HealthCare.gov began on February 15, 2021 and will run through August 15, 2021. This SEP is an opportunity for uninsured and underinsured individuals living in the 36 states using Healthcare.gov to enroll in affordable coverage. Some of these individuals may have lost health insurance coverage or income during the COVID-19 pandemic. The SEP also allows individuals currently enrolled in a plan through HealthCare.gov to switch plans. Most of the fifteen states (including the District of Columbia) that run a State-Based Marketplace (SBM) have also made available a COVID-19 SEP with a similar timeframe. Marketplace financial assistance, including advanced premium tax credit (APTC) payments, is essential to making health insurance available to individuals with no alternative for affordable coverage.9 APTCs are generally available to eligible individuals and families with household incomes between 100 and 400 percent of the federal poverty level (FPL) in states that have not expanded Medicaid under the ACA and between 138 and 400 percent FPL in states that have expanded Medicaid. 10 For many individuals, particularly low-income individuals, APTCs on HealthCare.gov are large enough to substantially reduce premiums for consumers, in some cases to zero dollars. These credits are based on the premium of the benchmark plan (the second-lowest cost silver (SLCS) plan) available through HealthCare.gov in a person’s area of residence. These zero-dollar and low-premium plans are more affordable so more people can enroll in health insurance. These plans can provide access to health care coverage and financial protection for millions of Americans who otherwise may be left uninsured and potentially liable for the full costs of their health care utilization. Previous literature has identified affordability and unawareness of subsidy eligibility as common reasons individuals remain uninsured. Zero- and low-premium plans help to directly address this challenge, but many uninsured individuals may not realize they may be eligible to enroll in zero- or low-premium HealthCare.gov plans. Lower costs may also attract more younger and healthier individuals to enroll in Marketplace plans, which in turn can improve the risk pool and lower overall average costs for the broader Marketplace population. This Issue Brief examines the availability of zero- and low-premium plans in states served by the federal Marketplace, Healthcare.gov, based on the premium subsidies available as of March 1, 2021, which does not yet include the enhanced subsidies created by the American Rescue Plan. Those subsidies will become available on Healthcare.gov on April 1, 2021, taking effect for covered enrollees as early as May 1, and are discussed in more detail later in this Issue Brief. Tables in the brief show zero- and low-premium plan availability for HealthCare.gov states overall, subset by demographic and other characteristics, and by state. The purpose of this Issue Brief is to expand understanding and awareness of the availability of low premium health plans, where they may be available, and to whom.

Url: https://aspe.hhs.gov/sites/default/files/private/pdf/265291/low-premium-plans-issue-brief.pdf

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Authors: Branham, D Keith; Conmy, Ann B; Deleire, Thomas; Musen, Josie; Xiao, Xiao; Chu, Rose C; Peters, Christie; Sommers, Benjamin D

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Data Collections: IPUMS USA

Topics: Aging and Retirement, Health, Population Health and Health Systems

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