Thousands in Ariz. may qualify for subsidized ACA insurance
Broker says rates for 2021 plans appear ‘pretty flat’
If Phoenix insurance broker Michael Malasnik has any message about 2021 Affordable Care Act insurance, it’s that thousands of Arizonans could be getting federal help to pay for it but aren’t.
Arizona rates for the 2021 Affordable Care Act insurance appear “pretty flat” compared with 2020, he said, and there are six insurers offering plans in Maricopa County for 2021, so there’s ample choice, with some zero premium plans available.
All of Arizona’s 15 counties have at least one insurer offering plans, and most counties have more than one insurer.
With so much job loss and economic instability due to the COVID-19 pandemic, Malasnik and other health insurance experts are urging Arizonans to explore the Affordable Care Act marketplace plans if they are looking for coverage. The plans are often referred to as “Obamacare.”
“I would imagine a lot of people are going to qualify for subsidies next year and I would strongly recommend they look into it even if they didn’t get them in previous years,” Malasnik said. “From what I can tell, the market’s pretty stable. The big change is going to be people’s incomes.”
Open enrollment for marketplace coverage under the Affordable Care Act began Sunday and goes through December 15. The plans are for coverage that begins Jan. 1, 2021.
Anyone under the age of 65 who earns less than 400% of the federal poverty level — $51,040 per year or less for a single person — and does not get their health coverage through a government or employer plan may qualify for a subsidy.
Compare ACA plans without filling out an application
The individual marketplace created by the Affordable Care Act sells private insurance with federal subsidies avail
able to people with qualifying incomes. Most of the 153,020 Arizonans who purchased plans on the marketplace for 2020 qualified for a federal subsidy to help pay for it.
To be eligible Arizonans must be a citizen of the U.S. or be lawfully present in the U.S., and must not be incarcerated.
Open enrollment for Affordable Care Act coverage should not be confused with open enrollment for Medicare. Medicare is a government insurance program that primarily covers people over the age of 65.
Medicare open enrollment this year began Oct. 15 and goes through Dec. 7. It’s is a chance for people with Medicare to change their Medicare Advantage and prescription drug coverage for the following year. People enrolled in Medicare don’t need ACA coverage and vice versa.
While some states have their own Affordable Care Act marketplaces or exchanges, Arizona uses the federal healthcare.gov marketplace.
While it’s not easy to find on the healthcare.gov website, it’s possible to compare plans and prices without filling out an application.
The “window shopping” option is a good way to both see what’s available and for individuals and families to figure out whether they may qualify for a federal subsidy without investing in the time it takes to apply. There’s even a way to calculate total estimated yearly costs based on how often individuals and families expect to use the health care system
The direct link to window shop for plans: https://www.healthcare.gov/ see-plans/#/
Cover Arizona has bilingual information about how to get help from an enrollment assister, either in person or on the phone. The website — https://coveraz.org/ — also has information about options. Cover Arizona’s enrollment help line is 800-377-3536.
Most premium changes are mild
A Kaiser Family Foundation analysis found that most premium changes on the ACA marketplaces will be modest heading into 2021, even with the uncertainty surrounding the pandemic.
Most individual market insurers that specify the impact of the pandemic on their 2021 premiums are loading an extra couple percentage points onto the premium,with the median COVID-19 factor being 1.9%, the analysis found.
The non-profit foundation has a calculator that provides estimates of health insurance premiums and subsidies for people purchasing insurance: https://www.kff.org/interactive/subsidy-calculator/
Research by Allen Gjersvig, director of outreach and enrollment for the Arizona Alliance for Community Health Centers, shows six Arizona counties had an increase in the benchmark silver plan for a single, 40-year-old person over 2020 prices and seven counties had a decrease for the same plan.
Coconino County saw the largest decrease, $98 a month —15% — in the Benchmark Silver plan for a single person age 40, he found, while Pima and Santa Cruz counties saw the largest increase of $24 a month or 7% for the same plan.
A 40-year-old single person who is a nonsmoker who earns too much for Medicaid (the Arizona Health Care Cost Containment System), and less than 151% of the federal poverty level, which is up to $19,140 per year, can qualify for a no premium bronze plan in all counties.
Court case likely won’t alter plans
The U.S. Census estimates for 2019 show that 822,527 Arizonans are uninsured. Gjersvig said thousands of those people could qualify for subsidized ACA insurance but aren’t taking advantage of it.
While premiums and deductibles may seem costly, it’s going to be cheaper than facing a catastrophic event without health coverage.
Without health insurance, there’s always the risk of an unexpected illness or accident that people won’t be able to afford.
Others will delay care, which accrues cost for the entire health system because it leads to preventable surgeries and hospitalizations. Untreated bronchitis can turn into severe pneumonia. Unaddressed diabetes can turn into an amputation. Hospitals’ uncompensated care money is depleted, and more people go into medical bankruptcy.
The one group that still is facing high premiums for 2021 are individuals and families who earn more than 400% of the federal poverty level. It’s a problem that Democrat Presidential candidate Joe Biden, who was vice president when the Affordable Care Act became law, has said needs fixing.
A 45-year-old single woman living in Maricopa County and earning $55,000 per year would have an income that’s too high to qualify for a premium, for example. That woman would have a choice of 65 plans with monthly premiums ranging from $364.77 per month to $707.30 per month and a range of deductibles, according to healthcare.gov.
In Yavapai County, there would be seven plan choices for a woman of the same age and income level and the premium range would be higher — from $524.97 to $892.04 per month, health care.gov says.
One cheaper option for that group is short-term plans, but those plans do not have the same protections as an Affordable Care Act/Obamacare plan. They could exclude maternity coverage, preventive care and prescription drugs. Short-term plans are also allowed to exclude people based on pre-existing conditions.
“You have to qualify medically,” Malasnik said. “I’ve sold them since the ‘90s. I tell people they are the last holdover from the old world.”
Some states have restricted the sale of short-term health insurance plans, and they cannot be sold on healthcare.gov or state health exchanges. Also, consumers eligible for marketplace subsidies cannot use them to buy shortterm policies.
Gjersvig and other experts stress that price variations on the marketplace depend on a number of factors, including whether or not the person seeking insurance qualifies for federal subsidies. It’s important to look at not only premiums, but deductibles, and estimated yearly costs — all tools available on the healthcare.gov website.
The U.S. Supreme Court on Nov. 10 will hear oral arguments in a lawsuit to overturn the Affordable Care Act, and a decision is expected next year.
It’s unclear what the immediate effect would be if the court overturns the federal law but many health policy experts say the plans should remain in effect for the year, regardless of the lawsuit’s outcome.
For now, at least, the ACA is still the law of the land and that means people get coverage for 2021.
“Have you ever seen the government move on a dime?” Malasnik said. “I think people should buy for next year with absolutely zero concerns.”