The “open enrollment” window for purchasing subsidized health care from the federal government opened on November 1st and runs through January 15th. Here’s the bigger news: Fixing the so-called “family problem” means thousands more people could now qualify for cheaper insurance — but I don’t know it.
“We’re concerned that if people checked into this program years ago, they (may not have qualified) and now won’t go back and check again,” said Jeremy Smith, program director for First Choice Services, one of two federal funded programs that help Granite Staters navigate options and enrollment. “So we’re trying to make sure people know it’s a special year and that they should come see it.”
The family adjustment is one of three significant changes to federally subsidized health plans. The Deflation Act expands on two others put in place under the American Rescue Act: more generous subsidies and no income cap to apply, meaning people who lost subsidies when their income rose even slightly, instead they will see subsidies decrease, but not disappear.
This year’s open enrollment period is especially important because it coincides with the expected end of the federal public health emergency, when an estimated 90,800 Granite Staters will no longer qualify for Medicaid. Deputy Insurance Commissioner David Bettencourt is urging Granite Staters to check now if they qualify and sign up for federal health insurance if they lose Medicaid.
“Anytime there’s a rush to the goal, it makes it more difficult,” he said.
Health plans under the Affordable Care Act are divided into four tiers: bronze, silver, gold, and platinum. All plans must include basic benefits such as emergency services, hospital coverage, maternity care, newborn and pediatric care, mental health and addiction coverage, and prescription drug benefits.
But these plans vary in price and coverage: Lower premiums come with higher co-pays, out-of-pocket costs and potentially fewer provider choices. For example, the silver plan, considered the “benchmark” or average plan, pays 70 percent of medical costs versus 90 percent in the platinum plan.
To be eligible for any plan, a person must live in the United States and be a citizen, national or otherwise in the country legally. People who are incarcerated or enrolled in Medicare are not eligible. People insured through Medicaid or the Children’s Health Insurance Program (CHIP) may have a plan, but no federal subsidies to pay for it.
Bettencourt said 48,000 Granite Staters receive subsidies for ACA plans purchased through the federal marketplace. Most have a silver or gold plan, according to the New Hampshire Department of Insurance website.
For the first time this year, family members of an employee who has insurance through an employer may choose a federally subsidized marketplace plan for affordable care instead. To be eligible, the cost of the employer’s family plan must be more than 9.1 percent of the family’s household income.
Before the rule change, eligibility was based on the cost of the employer’s individual plan, which is often less expensive than the family plan.
“What’s going to happen is people who own businesses want to do great things for their employees,” said Keith Ballingall, president of Health Market Connect, the state’s other federally funded navigation program. “So they’ll put a plan in and say, ‘Look, we’ll cover, as an employer, 100 percent or a large portion of the cost of the insurance.’ But the challenge is, it’s hard for a small business to say yes, we’ll cover it for your whole family because that expense is getting so big.’
In some cases, the employee can stay in the employer’s plan while family members get an ACA plan, Ballingall said.
The Urban Institute estimated that eligible family members who switch from an employer plan to ACA coverage could save $400 per person. Estimates of the number of people who may be eligible under the rule vary widely, but there is agreement that most will be children. The White House set the number at 1 million people in October, but the Kaiser Family Foundation said the old rule excluded 5.1 million people from ACA coverage.
Historically, individuals and families were only eligible for ACA coverage if their household income fell below 400 percent of the federal poverty level, $54,360 a year for a single person and $111,000 for a family of four.
This rule created a subsidy crash where individuals and families who earned even $1 over the limit were disqualified from any assistance. The income ceiling was enshrined in the US bailout until the end of this year. The Inflation Reduction Act extends the deadline to 2025.
Subsidies for those earning more than 400 percent of the federal poverty level will decrease as incomes rise, but the subsidies will not be eliminated. “So, no more rock,” said Ballingall.
The US bailout also increased subsidies, but only until the end of this year. These improvements will continue through 2025 under the Inflation Reduction Act. This will allow some people to get a plan for little or no premium.
For example, individuals earning up to 150 percent of the federal poverty level, $20,385 for a single person and $41,625 for a family of four, would pay nothing for an ACA silver plan, according to the Kaiser Family Foundation’s subsidy calculator. Before the change, a person in New Hampshire with that income level paid $343 a month for a silver plan.
And with this rule change, someone with twice the income level would get a $160 monthly subsidy and pay $200 a month for that silver plan.
Individuals can enroll in a marketplace plan through the federal government’s website, healthcare.gov, but the two navigators, First Choice Services and Health Market Connect, may be a better place to start.
Both have staff on hand to answer questions, check your eligibility, explain the benefits of each plan and complete enrollment by phone, email and in person. Staff can also help people determine eligibility for other government health insurance.
Because the companies are federally funded, the help is free.
Health Market Connect has 10 navigators located in all regions of the state. They offer help in eight languages, including American Sign Language, and can answer questions via Zoom, chat, text, Facebook Messenger and email, Ballingall said. They also book appointments through their website, hmcnh.com.
First Choice Services, based in West Virginia, has six dispatchers dedicated to taking calls from people in New Hampshire. The company also has three groups in the state that provide telephone and in-person assistance: Harbor Care, Lamprey Health and the Foundation for Healthy Communities. Its website is firstchoiceservices.org.
Smith cautioned against seeking help by searching the Internet, saying companies outside the federally funded Navigation Program may try to sell other plans that don’t offer subsidies and include exclusions.
Bettencourt said the state Department of Insurance, nh.gov/insurance, can also help.
Medicaid enrollments have increased during the pandemic as health concerns, job losses and childcare shortages have left more people out of work and in need of financial assistance. New Hampshire saw a 20.1 percent increase in standard Medicaid enrollments, and expanded Medicaid enrollments increased by 73.5 percent.
Under the federal public health emergency, effective January 2020, states are prohibited from ending that coverage even for those who no longer qualify for financial assistance because they have returned to work or become old enough to Medicare.
That will change when the federal public health emergency ends and states once again have the power to “redetermine” whether Medicaid recipients are still eligible for coverage. State Medicaid Director Henry Lipman has estimated that 90,800 Granite Staters do not have and will lose their Medicaid benefits.
State Medicaid officials and the Department of Insurance launched a massive campaign to begin these re-enrollments before the public health emergency was lifted to avoid a gap in insurance coverage. Bettencourt said those who have not yet found alternative coverage through the federal marketplace should do so now.
Federal navigators can help determine whether Medicaid recipients will remain eligible and, if they don’t, help them find an insurance plan. Individuals can also use the state portal, nheasy.nh.gov, to determine eligibility and options for new insurance.