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Health Insurance Coverage Set to Expand With Changes to ACA Subsidy Provisions

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ACP will provide members with guidance to understand the changes and help patients obtain coverage

April 2, 2021 (ACP) – The newly approved COVID-19 relief bill will dramatically expand access to health insurance through the Affordable Care Act, and the American College of Physicians is helping members understand the changes, so they can help patients get coverage.

“Health insurance is becoming much more affordable. Many people will be saving thousands of dollars a year,” said Bob Doherty, ACP senior vice president for governmental affairs and public policy. “These are eye-popping numbers. They reveal how this is an extraordinarily positive development that will transform lives for the better.”

Under the new law, almost all Americans who get coverage through the federal and state marketplaces will see health insurance rates go down in 2021 and 2022 due to increased subsidies. Some people with higher incomes will get subsidies for the first time, while others will see their subsidies rise. Those who are receiving unemployment benefits this year will receive the maximum subsidies.

ACP will release a primer to educate physicians, and it's working on a one-page information sheet for patients.

Here's a closer look at the effects of some of the major changes:

  • The increases in subsidies will allow 80 percent of enrollees to purchase a plan for $10 or less per month, and more than half will be able to enroll in a Silver plan for $10 or less per month. Those with incomes at 100 to 150 percent of the federal poverty level could enroll in a benchmark Silver plan at no cost.
  • Many premiums will decrease, on average, by $50 per person per month and $85 per policy per month.
  • For the first time, middle-income individuals and families with incomes at and above 400 percent of the federal poverty level – $52,040 for a single adult and $104,800 for a family of four – will be eligible for premium subsidies. Their premiums for benchmark Silver plans will be limited to no more than 8.5 percent of their annual household income.
  • These changes will allow 3.6 million uninsured people to become newly eligible for premium tax credits, including 360,000 uninsured African-Americans and 730,000 Latinos.
  • Individuals receiving unemployment benefits in 2021 are eligible for temporary enhanced health insurance subsidies. This will allow them to enroll in benchmark Silver plans with zero-dollar premiums and low cost-sharing.
  • The federal government will pay for COBRA insurance continuation benefits – for workers who were laid off or had their hours reduced – for the period from April 1 to Sept. 30, 2021. This will make a major difference because COBRA premiums can be expensive.

Americans will have extra time to take advantage of these changes. The Biden administration has created a special enrollment period through Aug. 15, 2021 for healthcare.gov, the federal health insurance marketplace. Deadlines for state marketplaces may be even later.

It's important for patients to understand that they may have to take steps to get the subsidies, Doherty said. ACP is working to make sure this is clear in the communications that it's designing for patients.

“We're going to make it as easy as possible for our members and their patients to understand what's going on,” he said. “We'll provide members with concise information in understandable language that they can share with patients. Look for an ACP template that physicians will be able to adapt for their clinic websites.”

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Back to the April 2, 2021 issue of ACP Advocate