- The three-month extension provides more time for people to take advantage of expanded marketplace subsidies authorized in the latest stimulus legislation.
- The new savings will become available on April 1 to individuals initially signing up for coverage as well as those already in a marketplace plan who may qualify for additional financial help.
A special enrollment period for securing private health insurance through the nation's public exchanges has been extended by three months, the Biden administration announced Tuesday.
Originally set to close on May 15, the enrollment period now will end on Aug. 15, the Centers for Medicare & Medicaid Services said. The idea is to give consumers more time to take advantage of new savings authorized in the recently enacted American Rescue Plan.
Changes in that $1.9 trillion stimulus package include expanding the premium subsidies (technically tax credits) that are available through the federal marketplace and state exchanges and expanding who qualifies for the financial help.
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Typically, eligibility for premium tax credits through the federal and state exchanges is limited to households whose income is from 100% to 400% of the poverty level. The stimulus package removes that cap for 2021 and 2022, as well as limits the amount anyone pays in premiums to 8.5% of their income as calculated by the exchange.
The tax credit is based on criteria that include income, age and the benchmark "silver" plan in your geographic area. The amount you qualify for is basically advanced to you over the course of the year via reduced premiums.
For illustration, as outlined in a report from the Congressional Budget Office: Say a 64-year-old with $58,000 in income — about 450% of the 2021 poverty level of $12,880 — currently pays $12,900 in annual premiums for a plan through the exchange because they don't qualify for subsidies. Under the proposed change, that person would pay no more than $4,950 (8.5% of their income) — meaning the tax credits would amount to $7,950.
The majority of the 11.5 million people already enrolled in exchange-based health plans receive premium tax credits.
The CBO report estimates that the expanded eligibility would result in 1.7 million more people getting insurance through the marketplace, with 40% of them being individuals who are currently ineligible for premium tax credits under current law because their income is above the 400% cap.
On April 1, the additional savings will be available through the exchanges for individuals who want to sign up for coverage as well as those who already have a plan through the marketplace and may qualify for additional financial help.
More than 200,000 individuals enrolled in marketplace health plans in the first two weeks of the current special enrollment period, which started Feb. 15, according to government data.
If you're new to the marketplace, the best place to start is healthcare.gov. Additionally, the Kaiser Family Foundation has a marketplace calculator to help you estimate whether you would qualify for subsidies under the changed rules.
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