The Centers for Medicare & Medicaid Services (CMS) is extending access to the Special Enrollment Period (SEP) until August 15th.
New and current enrollees will have more time to enroll or re-evaluate their coverage needs with increased tax credits available to reduce premiums.
♦ As a result of the American Rescue Plan Act (ARPA), additional savings will be available for consumers through HealthCare.gov starting April 1st.
• More people than ever before will qualify for help paying for health coverage, even those who weren’t eligible in the past.
• The ARPA also provides relief from 2020 premium tax credit repayment. But not for 2021 plan year.
• Most people currently enrolled in a Marketplace plan may qualify for more tax credits.
These savings will decrease premiums for many, on average, by $50 per person per month and $85 per policy per month.
On average, one out of four enrollees on HealthCare.gov will be able to upgrade to a higher plan category that offers better out-of-pocket costs at the same or lower premium compared to what they're paying today.
If you are eligible and enroll under the SEP you will be able to select a plan with coverage that could start as soon as the first month after plan selection.
People living in states that did not expand Medicaid (who are in the "coverage gap") will be newly eligible for premium tax credits and cost-sharing reductions if one member is approved for or receives unemployment compensation at any point in 2021. The household will be deemed as having income above the poverty line.
• Coverage gap hits families whose income is above their state's eligibility for Medicaid but below the minimum level to be eligible for tax credits through the ACA marketplace. The ARPA temporarily helps these people.
Current enrollees should submit an application update on or after April 1st to receive an updated eligibility determination.
To do so, you should use the “report a life change” pathway to update your application, and then click the option for “change to my household’s income,” even if all the information on the application remains the same.
After submitting the application update and receiving a new eligibility determination, you should enter the “plan compare” section of the site and confirm your current plan selection, so that your insurance company receives your new tax credit information.
The Biden administration announced that starting on September 1st, HealthCare.gov will automatically apply the enhanced premium tax credits for some enrollees, even if they have not updated their application.
This is being done to ensure as many consumers as possible can receive enhanced benefits during the coverage year.
However, the information used for that automatic update will be based on information previously submitted by the enrollee.
♦ Updating your application would be the best way to be sure you are receiving all the assistance you are entitled to.
♦ You can also wait until you file and “reconcile” your 2021 taxes next year (in 2022) to get the additional premium tax credit amount.
If you think you might want to claim additional premium tax credits when you file taxes, it is recommended that you update your application and review your plan options during the SEP ending August 15th.
You may be able to choose a plan with lower out-of-pocket costs for the same price or less than what you’re currently paying.
Deductible may start over
If desired, you may choose to make a new plan selection, but it’s important to consider the new plan’s deductible — it’ll likely start over.
♦ If you change plans or add a new household member, any out-of-pocket costs you already paid on your current 2021 Marketplace plan probably won’t count towards your new deductible, even if you stay with the same insurance company.
If you have already paid a lot in out-of-pocket costs toward your deductible, check with your insurance company to see how it might impact you and what options are available to receive credit for what you’ve already paid.
Once you update or submit a new application, your will receive an eligibility determination notice that you can download.
This notice will include your financial assistance amount and instructions for what you may need to do next, such as select a plan or submit documentation to confirm your income or immigration status if necessary.
How soon will my bill change?
Updates to advance payments of the premium tax credit (APTC) generally take effect with the next month’s premium bill.
As an example, updated plan selections made on or after April 1st and on or before April 30th will result in APTC increases effective May 1st, and thus will be reflected on May's bill.
Will APTC increases be retroactive?
Increases are effective January 1, 2021 according to the American Rescue Plan Act.
However, due to the significant complexity required for implementation of this retroactively, you will need to claim this benefit in the form of a premium tax credit at the time you complete your Federal Income taxes next year. The tax filing will reconcile your premium tax credits for the entire year.
If your state doesn’t use HealthCare.gov
The Special Enrollment Period (SEP) is currently available to consumers in the 36 states that use the HealthCare.gov platform.
Consumers served by State-based Marketplaces that use their own platform can check their state's website to find out more information on SEPs in their state.
If you get unemployment compensation
You may be able to get another increase in premium tax credits.
Beginning in early July on HealthCare.gov, anyone who has received or has been determined eligible to receive unemployment compensation for any week during 2021 may be able to get another increase in savings when enrolling in new Marketplace coverage or updating their existing Marketplace application.
♦ These savings are to be made available starting in early July.
At that time, you should return to HealthCare.gov to update your application and current plan with more tax credits to lower your premiums for the rest of the year.
If you are eligible for COBRA
If you’re eligible for COBRA because of a reduction in the hours you work or you involuntarily lost your job, you may qualify for help paying for your COBRA premiums (called “premium assistance”) from April 1, 2021 through September 30, 2021 under the American Rescue Plan Act of 2021.
♦ Generally, premium assistance means that you’ll have a $0 monthly premium.
If you qualify, you should get a written notice of your eligibility for COBRA premium assistance from your former employer.
If you didn’t get a letter and think you may qualify, check with your former employer or health insurance company.
Note: You can’t have both a Marketplace plan with premium tax credits and COBRA with premium assistance. If you’re eligible for both, you’ll have to choose one.