5 answers about the new enrollment for health insurance

For those who have been without health insurance during the pandemic, relief is already in sight.

In January, President Joe Biden signed an executive order to open the federal health insurance marketplace for three months, starting Monday, the 15th, so that uninsured people can buy a plan and / or change coverage if they already have one.

Consumer advocates applauded the initiative. Since 2016, the number of Americans without health insurance has been rising, reaching 30 million in 2019. The economic crisis caused by the coronavirus has worsened what was already a bad situation, depriving millions of people of their health plans.

The move stands in contrast to the Trump administration’s approach. As COVID-19 took hold last spring and the economy imploded, health experts pleaded with the Trump administration to open up the federal market so people could buy insurance during the worst public health emergency in a century.

The administration refused, noting that those who found themselves suddenly without coverage because they lost their jobs could enroll in the market under the ordinary rules. They also cited concerns that sufferers who had resisted buying insurance before would do so now and increase premiums.

The Biden administration has committed to spending $ 50 million on outreach and education to publicize the new enrollment period.

This is essential, according to experts. Although the number of people signing up for Affordable Care Act (ACA) plans has remained at a good level, the number of new consumers signing up to the federal marketplace has decreased every year since 2016, according to the Kaiser Family Foundation, coinciding with funding cuts for marketing and outreach.

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“There are many uninsured people who, even before covid, were eligible for high market subsidies or Medicaid and didn’t know it,” said Sabrina Corlette, a research professor at the Center for Health Insurance Reform at the University of California. Georgetown.

A marketing campaign can reach huge numbers of people and hopefully attract them, regardless of whether or not they lost their insurance because of covid, Corlette added.

Here are the answers to questions about the new enrollment option.

When can consumers enroll and in which states?

The registration window will be open for three months, from February 15 to May 15. Uninsured residents of any of the 36 states using the federal health care.gov platform can search for plans during that time and enroll.

States that operate their own markets, and the District of Columbia, are establishing special enrollment periods similar to the new federal, although they may have somewhat different eligibility deadlines or rules.

In Massachusetts, for example, the enrollment window remains open until May 23, while in Connecticut it closes on March 15. For its part, Colorado has reopened enrollment in its marketplace for residents without insurance, but anyone already enrolled in one of the state’s marketplace plans will not be able to switch plans until the regular open enrollment period in the fall.

Can people who lost their jobs and health insurance many months ago enroll during the new enrollment period?

Yes, the enrollment window is open to anyone who is uninsured and who would normally be eligible to purchase coverage (people serving prison or jail terms and those in the country without papers cannot enroll).

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People with incomes up to 400% of the federal poverty level (about $ 51,500 for an individual or $ 106,000 for a family of four) may qualify for premium tax credits that can substantially lower their costs, even down to $ 0.

Typically, you can buy a plan from the Marketplace only during the annual open enrollment period in the fall or if you experience a life event, such as a birth or move, or loss of severance insurance, in what is called a special period of inscription.

But generally, individuals must register with the market within 60 days of the event.

With the new enrollment period, how long a person has been without insurance is not relevant, nor do they have to provide documentation that they have lost work-based coverage.

“The message is very simple: come and apply,” explained Sarah Lueck, a policy analyst at the Center on Budget and Policy Priorities.

What about people who are already enrolled in a Marketplace plan? Can your coverage change during this new period?

Yes, as long as your coverage is through the federal market. If, for example, someone is enrolled in a gold plan, but wants to switch to a cheaper bronze plan with a higher deductible, they can. However, as mentioned above, some state markets do not offer this option.

Many people have lost significant income during the pandemic. How can they decide if a subsidized Marketplace plan is better for them than Medicaid?

They don’t have to decide. During the application process, the marketplace asks for information about your income. If their annual income is below the Medicaid threshold (for many adults in most states, 138% of the federal poverty level, or about $ 18,000 for an individual), they will be directed to that program for coverage.

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If people are eligible for Medicaid, they cannot get subsidized coverage.

People can enroll in Medicaid at any time of the year; there is no need to wait for an annual or special enrollment period.

Individuals already enrolled in a Marketplace plan whose income changes should return to the Marketplace and update their income information as soon as possible. They may be eligible for higher premium subsidies or, if income has dropped significantly, Medicaid.

Likewise, if your income has increased and is not in line with market estimates, you may face excessive subsidy payments when you file taxes.

What about people who signed up for federal COBRA to continue coverage from their employer after losing their job? Can they give it up and sign up for a Marketplace plan?

Health experts say that those who live in the federal market states can take that step. Under COBRA, individuals can be required to pay the full amount of the premium plus a 2% administrative fee. Market coverage is almost certainly cheaper.

Typically, if people have COBRA coverage and drop it in the middle of the year, they can’t enroll in a Marketplace plan until the annual fall open enrollment period. But this new period will grant that option.

KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth journalism on health issues. Along with Policy Analysis and Surveys, KHN is one of KFF’s top three programs.

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