The three-month special enrollment period for the health insurance marketplace under the Affordable Care Act is under way in 36 states in accordance with the executive order signed by President Joe Biden in his bid to fight Covid-19 more efficiently. But cost may continue to play spoilsport as an estimated 8.9 million uninsured Americans remain eligible for marketplace subsidies but are not enrolled yet. Health policy think tank Kaiser Family Foundation (KFF) feels that though styled as a “special” enrollment period, it will operate more like an “open” enrollment period as no qualifying life event is required to apply.
- During SEP, people who are currently uninsured can enroll, and people already enrolled in marketplace plans can change to different policies. But despite subsidies that depend on age and income, pricing may keep many of the 8.9 million uninsured Americans away from the special drive.
- According to KFF, nearly 6 million uninsured are eligible to buy unsubsidized coverage through the marketplace today. This includes 3.4 million whose income is too high (over 400% federal poverty level) to qualify for subsidies.
- The out-of-pocket healthcare spending on Affordable Care Act marketplace premium for an individual who is at the poverty level hovers around $22/month, or 2.07% of the household income, for the benchmark silver plan. In contrast, for an individual whose income is at 401% of the poverty level and is nearing the age of Medicare eligibility, even the subsidized premium can top 20% of his income.
- According to KFF, Congress is considering new COVID relief legislation that would, among other things, increase marketplace subsidy amounts and eligibility. A House bill would extend premium tax credits to individuals with income above 400% FPL and substantially increase tax credits for people with lower income. Millions of currently subsidized marketplace enrollees would be eligible for more affordable coverage.