The “open enrollment” window to purchase federally subsidized healthcare opened Nov. 1 and will run through Jan. 15. cheaper insurance – but I don’t know.
“We’re concerned that if people had checked out this program in the past years, they (might not have qualified) and now they won’t be coming back to check again,” said Jeremy Smith, program manager for First Choice. Services, one of two federally funded programs that help Granite Staters navigate options and register. “So we’re trying to let people know it’s a special year and they have to come watch it.”
The solution to the family problem is one of three major changes to federally funded health care plans. The Inflation Reduction Act extends two others enacted under the American Rescue Plan Act: more generous grants and no income limits to apply, meaning that people who lost grants when their incomes increased, even slightly, will instead see subsidies decrease but not disappear.
This year’s open enrollment period is particularly important because it coincides with the expected end of the federal public health emergency when a projected that 90,800 Granite Staters will no longer be eligible for Medicaid. Deputy Insurance Commissioner David Bettencourt urges Granite Staters to check their current eligibility and apply for federal health insurance if they lose Medicaid.
“Every time there’s a rush for the door, it makes it more difficult,” he said.
Granite State Numbers
Affordable Care Act health care plans are divided into four levels: bronze, silver, gold and platinum. All plans must include basic benefits such as emergency services, hospital coverage, maternity, neonatal and pediatric care, mental health and addictions coverage, and prescription drugs.
But these plans differ in cost and coverage: smaller premiums come with higher copays, out-of-pocket expenses, and potentially little choice of provider. For example, the silver plan, considered the “benchmark” or intermediate plan, pays 70% of medical costs compared to 90% in the platinum plan.
To qualify for a 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 on Medicare are not eligible. People with Medicaid or 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 on the federal market. Most have a silver or gold planaccording to the New Hampshire Department of Insurance website.
No more family glitch
For the first time this year, family members of an employee who has insurance with an employer may be able to choose a federally funded Affordable Care Act market plan instead. . To qualify, the cost of an employer’s family plan must exceed 9.1% of the family’s household income.
Prior to the rule change, eligibility was based on the cost of an employer’s individual plan, which is often less expensive than a family plan.
“What would happen is that business owners want to do great things for their employees,” said Keith Ballingall, president of Health Market Connect, the other federally funded navigation program. “So they’ll put a plan in place and say, ‘Look, we’ll, as an employer, cover 100% or a large part of the cost of insurance. But the challenge is that it’s hard for a small business to say yes, we’ll cover it for your whole family, because that expense becomes so big.
In some cases, the employee can remain on the employer’s plan while family members are on an ACA plan, Ballingall said.
The Urban Institute estimated that eligible family members who switch from an employer-sponsored plan to ACA coverage could save $400 per person. The estimated number of people who may be eligible under the rule varies widely, but it is agreed that most would be children. The White House has set the number to 1 million people in October, but the Kaiser Family Foundation said the old rule excluded 5.1 million people from ACA coverage. Bettencourt said the state insurance department doesn’t know how many granite staters would benefit from this change, but estimated it would be a small percentage of the Kaiser Family Foundation’s prediction given the population of the city. State.
Revenue cap lifted
Historically, individuals and families were only eligible for ACA coverage if their household income fell below 400% of the federal poverty level, $54,360 per year for a single person and $111,000 for a family of four people.
This rule created a grant cliff where individuals and families who earned even $1 over the limit were disqualified from any assistance. The income cap has been set aside 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% of the federal poverty level will decline as income rises, but the subsidies will not be eliminated. “So no more cliff,” Ballingall said.
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, people earning up to 150% 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. grant calculator. Before the change, a New Hampshire person at that income level would pay $343 per month for a Silver plan.
And under this rule change, someone with twice that income level would receive a monthly subsidy of $160 and pay $200 per month for this Silver plan.
Individuals can enroll in a market plan through the federal government’s website, health.govbut the two browsers, First Choice Services and Connection to the health marketmay be a better starting point.
Both have staff available to answer questions, check eligibility, explain the benefits of each plan, and complete registration by phone, email, and in person. Staff can also help people determine if they are also eligible for other government health coverage.
Because the companies are federally funded, the assistance is free.
Health Market Connect has 10 browsers located in all regions of the state. They offer support in eight languages, including American Sign Language, and can answer questions via Zoom, chat, text, Facebook messaging and email, Ballingall said. They also book appointments through their website, hmcnh.com.
“We have a team that wants to help everyone and everyone who needs it,” Ballingall said. “If you don’t get health insurance coverage from an employer, there is a program.”
First Choice Services, based in West Virginia, has six browsers dedicated to taking calls from people in New Hampshire. They speak English and Spanish but can arrange translation for other languages.
The company also has three groups in the state that provide telephone and in-person support: Harbor Care, Lamprey Health and the Foundation for Healthy Communities. Its website is firstchoiceservices.org.
Smith cautioned against seeking help via an internet search, saying companies outside the federally funded navigation program could try to sell other plans that don’t offer subsidies and include exclusions. .
“If they’re working with a browser, they’ll get the right information,” he said. “But if they do the Google search, there are a lot of different avenues they could end up on.”
Bettencourt said the State Insurance Department, nh.gov/insurance, can also help. “There is no wrong door,” he said.
Public health emergency
Medicaid enrollment has increased during the pandemic as health problems, job losses and childcare shortages have left more people unemployed and in need of financial assistance. New Hampshire saw its standard Medicaid enrollment increase by 20.1% and expanded Medicaid enrollment increase by 73.5%.
Under the federal public health emergency, in place since January 2020, states are prohibited from ending this coverage, even for those no longer eligible for financial assistance because they have returned to work. or have become old enough for Medicare.
That will change when the federal public health emergency ends and states are once again allowed to “redetermine” whether Medicaid beneficiaries are still eligible for coverage. State Medicaid Director Henry Lipman estimated that 90,800 Granite Staters will not make it and will lose their Medicaid benefits as a result.
State Medicaid and Insurance Department officials have launched a massive campaign to begin these re-enrollments before the public health emergency lifts to avoid an insurance gap. Bettencourt said those who have not yet found alternative coverage in the federal market should do so now and not wait to be declared ineligible for Medicaid.
Federal navigators can help determine whether Medicaid beneficiaries will continue to qualify and, if they don’t, help them find an insurance plan before open enrollment ends Jan. 15. Individuals can also use the State portal, nheasy.nh.gov, to determine eligibility and options for new health insurance. There are many issues to consider, from cost to provider network options, Bettencourt said.
“We can help people think about that,” he said. “Obviously we’re not going to tell them what to do. In a way, we can help them think about their particular situation so that they can make the best choice for themselves.
This story was originally posted by New Hampshire Bulletin.