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If you’re among the millions of people across the nation with no health insurance, you may be able to remedy that soon.
A special enrollment period to get a plan through the federal Affordable Care Act health exchange (or your state’s exchange if it has one) opens Monday and runs through May 15. Authorized by an executive order from President Joe Biden last month, the reopening is part of the administration’s effort to expand coverage to more individuals and families in an affordable way.
“If you are uninsured, there is a very good chance you could get free or low-cost coverage,” said Cynthia Cox, a vice president at the Kaiser Family Foundation and director of its ACA program.
“A lot of people can get either Medicaid or a free plan on the exchange,” Cox said.
Pre-pandemic, roughly 30 million individuals already were without coverage, a number that had been trending upward for several years. On top of that, an estimated 2 million to 3 million workers lost employer-based health plans last year between March and September, according to the Kaiser Family Foundation.
Most enrollees in the marketplace receive subsidies (technically tax credits), which reduce what they pay in premiums. Additionally, they may qualify for help with other cost-sharing like deductibles.
An estimated 4 million uninsured individuals could get a plan through the exchange with no premium payment and 4.9 million more could get subsidies to reduce the cost of such a plan, according to Kaiser.
Biden also is pushing to increase the subsidies as part of the next economic relief package that Congress is working on. While the current level of aid can reduce the cost of a plan through the exchange, 45% of people who have looked into it said the cost was higher than they expected, according to a recent survey from personal finance website ValuePenguin.com.
The average national unsubsidized premium for a “silver” plan through the ACA exchange is $462 monthly, according to ehealthinsurance.com. However, that amount varies from place to place, and if you qualify for subsidies, you’d pay less.
Premium subsidies are available to families whose income is 100% to 400% of the federal poverty level, based on household size. That translates into income from $12,760 to $51,040. For a family of four, it would be $26,200 to $104,800.
Meanwhile, in states that expanded Medicaid, you can qualify for coverage through the program if your income is no more than 138% of the federal poverty level. For an individual, that would mean up to $17,609; for a family of four, $36,156. It’s also worth noting that if you qualify for Medicaid, you can sign up at any time.
The best place to start if you’re new to this is healthcare.gov, where you can create an account and explore your plan options. Or, if your state operates its own health-care exchange, the federal site will direct you to it.
If you want to window-shop without creating an account, there is a tool on the federal exchange (or on your state’s site) that lets you enter general information about yourself, including income and number of dependents.
Either way, your eligibility for financial assistance will be calculated, regardless of whether it would be through Medicaid or through premium subsidies. Additionally, your children may qualify under the Children’s Health Insurance Program, or CHIP, even if you qualify for coverage through the marketplace.
“The exchanges are designed to be one-stop shopping,” Cox said. “You put in information and it tells you what you qualify for.”