Healthcare.gov/Screenshot by NPR
Signing up for health insurance can be a confusing headache. At the same time, the need for a financial safety net if someone in your family gets sick is incredibly important. With the ongoing pandemic and economic crunch, the stakes are even higher.
Now, during a special enrollment period, the Biden administration is trying to make getting health insurance irresistible — and simpler, too.
You can sign up on all Affordable Care Act marketplaces, including the federal insurance exchange, Healthcare.gov, until August. And in the nearly $2 trillion pandemic relief bill passed earlier this year, the government included $35 billion to make premiums and other health insurance costs more affordable.
In fact, for several groups of people, it’s possible to enroll in health coverage for zero dollars in monthly premiums. Many more — the federal government estimates four out of every five enrollees — qualify for plans with premiums of $10 or less per month.
If you need health coverage or want to see if you can lower your costs, here are six tips for taking advantage of these new prices and options.
1 – Know your deadlines and be prepared
In most states, you have until Aug. 15 to choose a plan on Healthcare.gov, and nearly all adults are eligible to sign up.
If you live in the District of Columbia or one of the 14 states that has its own insurance website, check this list to find out where to enroll. Be sure to double-check enrollment rules and deadlines, since they may be different than the ones for Healthcare.gov.
And to make things easier on yourself, pull together all the documents you’ll need, such as Social Security cards, immigration documentation and tax returns, before you start your search.
2 – Who can get those zero dollar plans?
First of all, zero dollar premium ACA plans aren’t new. The Kaiser Family Foundation estimates that there are already about 4.5 million uninsured people who qualify for zero premium “bronze” plans, the most basic tier of insurance options.
What’s different now is that people also can get better, more comprehensive “silver” plans with no monthly premiums.
“Anyone earning less than 150% of the poverty line — which is around $19,000 a year if you’re single, or around $39,000 a year for a family of four — anyone below that cutoff point pays nothing for the benchmark silver plan,” explains Charles Gaba, who analyzes health care data and policy at ACASignups.net. Silver plans cover about 70% of your health care costs — compared to 60% for bronze plans.
Another group that can get zero dollar plans is people who lost a job in the last year and couldn’t afford COBRA premiums — the program for continuing an employer-based insurance plan after a layoff.
“Thanks to these subsidies, they can now get 100% of their COBRA premium paid for at least through September,” says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. She says your employers should contact you with details about how to receive this benefit if you qualify. This Department of Labor FAQ provides more details.
There’s one more group that can get zero dollar plans. “If you’ve gotten any unemployment benefits this year, you get a very rich plan — what’s called a platinum level plan, that essentially covers all but a very small amount of a patient cost sharing,” says Corlette. That provision of the law hasn’t gone into effect yet — the government expects those savings will be available starting in early July.
3 – Not free, but cheap
While you may be eligible for zero dollar plans, they aren’t always the best option, says Jeremy Smith, a health insurance navigator at the nonprofit First Choice Services in West Virginia. Navigators give free advice to people who want to enroll in ACA plans.
“The catch with a lot of the zero dollar plans is they still have pretty high deductibles in a lot of cases,” Smith explains. (The deductible is the amount you have to pay out-of-pocket for covered services before your insurance starts picking up the tab.)
Younger people who don’t use their insurance very often might go for the zero dollar plans, but Smith is seeing a lot of people opt for plans that cost something every month, but have lower overall costs.
“It’s still saving them some money and it’s a better deductible and out-of-pocket maximum, so they’ve really been able to use this opportunity to get what’s even better coverage for them and their family,” Smith says.
A few weeks ago, Maria Graciela Lopez in Tampa Bay, Fla., decided to keep her bronze plan, but with the new discount. She had been paying $364 a month to cover herself and her husband. Starting May 1, Lopez says they will pay $209.
“That’s like $160 less than we used to pay every month — that is a big deal,” she says. Lopez even convinced her son to leave his employer-based insurance and sign up for an ACA plan that covers his allergy shots.
Bottom line: Don’t let past experience — or what you may have heard about affordability — stop you from checking out what’s available right now, says Gaba of ACASignups.net.
“Even if you checked last year — you went to the site, you checked, ‘Oh, I don’t qualify’ or ‘Oh, it’s still too expensive’ — check again, because the subsidies have been beefed up dramatically,” he says.
3 – New flexibility, with a catch
If you’re already enrolled in a marketplace plan that you’re happy with, all you have to do to get these new rates is to log in, click to apply for coverage, and re-select your current plan. You’ll get the new rates on your premiums and other costs for the rest of the year, starting the month after you complete your application.
You don’t have to pick the same plan — if you find one that gives you better coverage or lower rates, you can select that instead. But be warned: Because this special enrollment period is in the middle of the year, your deductible might reset if you switch plans. If you’ve already paid a lot toward your deductible this year, it might be costly to start over.
Theoretically, you could even change plans more than once before Aug. 15, if your new plan turns out not to be a good fit. But again, make sure to consider that you might have to start from scratch on your deductible.
4 – The usual reminders
If you’re not ready to commit just yet, you can browse your options using “window shopping” tools on Healthcare.gov or your state marketplace. You can see full priced plans, or enter information about income and dependents to get an idea of how much of a subsidy you could get to lower those costs.
Also, remember not to focus just on your monthly premium; it’s important to look at other costs, too. When you’re browsing plans, HealthCare.gov and some state marketplaces will show your “estimated total yearly costs” for each plan. This takes into account the plan’s deductible and copays, plus how much health care you expect to use.
Though it’s hard to predict if you’re going to get injured or pregnant or sick in the coming year, leverage what you do know about your health needs. If you have a doctor you like, or if you know you need a certain prescription drug, look for a plan that covers them. HealthCare.gov allows you to search for and select specific doctors and drugs to easily see if they’re covered.
5 – Beware of too-good-to-be-true plans
If you see a good deal online, make sure you’re looking at an ACA plan. When you search for health insurance on the internet, you may stumble on short-term plans that advertise much lower monthly premiums, but don’t cover the ACA’s famous 10 essential benefits, including hospitalization and maternity coverage.
You can also quality-check ACA plans. Healthcare.gov introduced a star rating feature a few years ago, similar to what consumers use on Yelp or Amazon. The ratings are based on information insurers submit regarding cost, combined with enrollee feedback, and can help you identify plans people are happy with.
6 – Get free help from the pros
If you’re still overwhelmed, help is available — and free of charge. Navigators across the country are trained and ready to help people enroll in ACA plans. The Trump administration slashed federal funding for navigators, but they’re still out there, and the Biden administration is beginning to reinvest in the program.
In the COVID-19 era, many navigators meet with you virtually, by phone or video chat. Smith, the navigator in West Virginia, says it takes people about an hour and a half to sign up.
Katie Roders Turner is a navigator with the Family Health Care Foundation in the Tampa Bay, Fla., area. She’s busy calling previous clients, letting them know that there are new subsidies and that it’s worthwhile to see if they can get a better deal.
Since there’s a longer window of time during this special enrollment period — a total of six months versus six weeks during the standard, annual open enrollment in the fall — Roders Turner says the process is “no longer a sprint,” but “a marathon.”
But she points out that the quicker you reenroll or sign up, the quicker you can take advantage of these rates. “If you want your coverage to start May 1, let’s get that appointment in now and do our selection so that your coverage can begin sooner — in addition to the savings, of course.”