What does the American Rescue Plan (third stimulus package) mean for the Affordable Care Act?

What you need to know about the Special Open Enrollment Period: 

1. Anyone can sign up for a plan now.  

It’s easy to sign up for health insurance if you recently lost your job or are self-employed. Even if you haven’t had insurance in a long time, this Special Open Enrollment Period may be for you!  

This is just like the annual Open Enrollment Period that happens in November and December. This Open Enrollment Period is open through August 15. If you enroll, your plan will start the first day of the following month. For more or to make an appointment with a Health Insurance Navigator, visit charlottelegaladvocacy.org/getcovered

2. You can change your plan if you want, but you will probably have to re-start your deductible. 

Through August 15, current enrollees can change to a new plan that will last for the rest of the year. But you should consider how much you’ve already paid toward your deductible and/or other out of pocket expenses when deciding whether or not to change your plan.  When you change plans, the amount you’ve paid already towards meeting your prior plan’s deductible and/or out pocket expenses may be reset to zero, and you would need to start over paying out of pocket expenses to reach the deductible on your new plan.  If you have made significant payments toward your deductible, check with your insurance company to see how it might impact you and what options are available to keep credit toward what you have already paid. 

What people need to know about the relief bill and its changes to the ACA: 

1. Lower monthly premiums: federal government subsidies will reduce the amount you have to pay for health insurance each month. 

The plan significantly increases premium tax credits for 2021 and 2022. These increased subsidies will substantially reduce or even eliminate monthly premiums for millions of people with Marketplace plans.  

On average, premiums will decrease by $50 per month. No one will have to spend more than 8.5% of their income on premiums. People with income below 150% of the poverty line (about $19,000 for a single person, $25,800 for a couple, and $39,000 for a family of four) will pay no premiums for some plans, including Silver plans with cost sharing reductions. 

Current enrollees, including those who recently enrolled through the 2021 Special Enrollment Period, will need to update their Healthcare.gov applications to get the new subsidies. These subsidies will be visible on Healthcare.gov starting April 1, and you will start receiving them on May 1. You will need to reselect your current plan for the changes to take effect to reduce your premiums for the remainder of the year. If you do nothing, you do not lose access to the tax credits, but you’ll get them as a refund when you file your taxes next year. When you file your taxes in 2022, you will get a reimbursement of the additional tax credits you would have qualified for from January through April 2021.  

Due to the SOEP, you may be able to change plans until August 15. If you qualify for these additional benefits, the new tax credits will be applied to your policy starting on May 1.  

If you purchase a plan now, you will get a refund if you go back into your Healthcare.gov application after April 1. 

2. Increase Subsidies for Those Who Have Lost Their Jobs 

The plan expands premium tax credits for people who receive unemployment benefits in 2021. This means that individuals currently unemployed are guaranteed to get the most generous subsidies on Healthcare.gov. It doesn’t matter what their actual year-end income is.  

These additional tax credits will be available starting this summer. 

3Protect Families from Having to Pay Back Subsidies 

In 2020 some people lost their jobs early in the year but later got new ones with higher earnings than they had expected. Others worked additional hours or received bonus pay as essential workers. The American Rescue Plan exempts low- and moderate-income families from having to repay the premium tax credit they received in 2020.  

4. Government will pay the cost of COBRA coverage 

If you lost your job and your job’s health insurance, you can use COBRA to keep your same health insurance plan. But instead of losing your employer’s contribution for your premiums, the government will pick up the bill. The government will pay the entire COBRA premium from April 1 through September 30, 2021. 

If you get a new job that offers health insurance before Sept. 30, you will lose eligibility for this no-cost COBRA coverage. And someone who left a job voluntarily would not be eligible, either. 

We encourage you to review your options with the Marketplace before signing up for COBRA, since plan options may be more attractive to you, depending on your particular situation.  

NAVIGATING OPEN ENROLLMENT: Healthcare.gov Income Questions

The Open Enrollment Period is often the only opportunity for individuals and families to sign up for a health insurance plan for the following year. Until August 15, 2021, you can sign up for a 2021 plan.

Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During this Open Enrollment Period, navigators have received calls and questions from Cabarrus, Mecklenburg and Union County residents about the household income section of the Healthcare.gov application. With this year’s pandemic and economic uncertainty, many have lost or changed employment and are struggling to estimate their income.

Listed below are some helpful tips and general guidelines. More of what to (and not to) include is available at charlottelegaladvocacy.org/getcovered.

Important points:

  • You must estimate your projected income for 2021.
    • If you are unemployed, it may be difficult to do this. Estimate how much you would make if you returned to your previous job.
    • If you don’t have a set salary or wages (for example, if you are a freelance worker, seasonal worker, or run your own business), it will be easier to estimate your income if you have a copy of your tax return from last year on hand.
    • If you are self-employed, you should input your net income. Click here for more help estimating your self-employment income.
    • If your income is very low or if you are unemployed, and you or a family member falls into one of the following groups, you may qualify to receive Medicaid: children under 21, pregnant women, women with breast or cervical cancer, individuals age 65 or older, blind or disabled individuals, people in need of long-term care, or people receiving Medicare.
  • You must report changes in income.
    • During the year, you must go back into your application to report if your income goes up or down. This will keep your monthly premium at a manageable price and help to reduce the amount of financial assistance you may have to pay back, if any at all.
  • You can receive financial assistance.
    • Estimating your income as accurately as possible allows the Marketplace to determine your eligibility for financial assistance.

Be sure to include:

  • Anticipated changes in income
    • Consider these questions: How might your income change in the coming year? Are you expecting business to improve or worsen? Will you be getting a raise? Work more hours? Get a seasonal job? Will another household member get a job? Will you gain or lose a dependent?
  • The anticipated income of all household members
    • If another person in your tax household has health coverage through a different plan or program, you still need to include their income on your application. Marketplace financial assistance is based on the income of all tax household members. You will be able to clarify on the application which household members do not need health coverage. Tax household members not applying for coverage are not required to provide any other information except income information (e.g. They do not have to provide a Social Security Number).
  • Some disability-related income
    • Only include Social Security disability payments when estimating your income for next year. Do not include Supplemental Security Income, only Social Security retirement or disability payments.
  • Income from investments
    • Things like stocks and bonds.
  • Alimony
    • Include only if your divorce or separation was finalized before January 1, 2019.

Do NOT include:

  • Self-employment expenses
    • Subtract any self-employment expenses from your estimated income.
  • Some disability-related income
    • Do not include Veterans’ disability income payments, Supplemental Security Income (SSI) payments, and workers’ compensation payments when estimating your income for next year.
  • Social Security payments for applications that have not yet be approved
    • You can update your Marketplace application later next year if your application is approved.
  • Alimony
    • Do not include if your divorce or separation was finalized on or after January 1, 2019.
  • Child support

Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711, or online at www.ncnavigator.net. Appointments are filling quickly! Open Enrollment to sign up for a health insurance policy for 2021 will end August 15, 2021!

More Resources:

More information on how to report your income: https://www.healthcare.gov/income-and-household-information/how-to-report/

And on what to include: https://www.healthcare.gov/income-and-household-information/income/

NAVIGATING OPEN ENROLLMENT: Top Four Mistakes To Avoid

Woman holds child while talking on the phone and taking notes

Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During the Open Enrollment Period, navigators take appointments free of charge with residents of Cabarrus, Mecklenburg and Union County who are concerned about making common errors that could jeopardize their ability to maximize coverage and minimize cost. 

Find FAQs and how to make an appointment and keep reading to learn the top four mistakes navigators see people make on the Health Insurance Marketplace.

1. Missing the Deadline 

The Open Enrollment Period is going on now through August 15, 2021. It is very difficult to qualify to sign up for health insurance on the Marketplace beyond the designated timeframe. Usually, adjustments or new enrollments are allowed only as a result of a major life event, such as marriage, divorce, job loss or a new child. 

2. Misunderstanding Costs 

During Open Enrollment, some people only look at the cost of premiums and don’t take into consideration the deductibles, copays, coinsurance and out-of-pocket maximums. These are all important factors that will help determine your overall health care costs in 2021. 

3. Over- or Under-Insuring 

A basic high-deductible plan generally has the lowest monthly premium, but it requires the policy holder to spend more before full coverage kicks in. Some people mistakenly select this option because they think it will be cheapest, but they ultimately pay more out of pocket. Navigators suggest a quick assessment of your health care spending over the last couple of years. If you tend to undershoot your deductible, you might be better off moving to a high-deductible plan. If you usually hit your deductible before it resets, you could come out ahead by paying a higher premium for a heartier plan. Remember: The cost of many preventive measures, such as mammograms, colonoscopies and cholesterol screenings, are covered 100% before you meet your deductible and require no copay.  

4. Opting Out

A few years ago, not buying health insurance meant facing a potentially costly penalty. While that penalty no longer exists, forgoing coverage is a big mistake. A single illness or injury could total thousands of dollars out of pocket.

Still looking for the answer to your question or need additional guidance to get signed up on the Health Insurance Marketplace? Make an appointment with a navigator and sign up for additional information today.