Enrollment for subsidized health insurance begins Nov. 1 on Kynect; 'family glitch' fix makes plans available to many more

Kynect illustration

By Melissa Patrick
Kentucky Health News

Open enrollment for federally subsidized health insurance plans starts Nov. 1 and runs through Jan. 15, for coverage that begins Jan. 1. 

Kentuckians can sign up for a qualified health plan on the state-based marketplace, Kynect, at Kynect.ky.gov. On the site, Kentuckians can compare options, apply for coverage and complete all enrollment on one platform. 

"Kynectors," who help Kentuckians sign up for coverage on Kynect, are available at no charge in every county to answer questions and help people sign up for coverage.

Federal subsidies for the plans were expanded during the pandemic, and some of them have been  extended through 2025, including the removal of the "subsidy cliff," allowing people with incomes above 400% of the poverty line to qualify for a subsidy if the full price of the benchmark plan is more than 8.5% of their income.

A Centers for Medicare and Medicaid Services fact sheet says the extension of benefits will continue to be money-savers for people who purchase marketplace plans, noting that "Consumers in these plans saved an average of $800 on their premiums in 2021 as a result of the American Rescue Plan," the first big spending bill passed by Democrats in Congress. 

The Biden administration has also removed what is called the "family glitch," which prevented some families from buying subsidized plans because their employer-based insurance was deemed affordable even though the affordability was based only on the cost of employee' coverage, not the extra premium required to cover dependents.

"This left millions of people, mostly women and children, stuck between being unable to afford unsubsidized coverage from a family member's existing policy while also being deemed ineligible to receive more affordable coverage through the marketplace," Kentucky Voices for Health said in an e-mail.

The Internal Revenue Service now looks at the affordability of an employer's plan by considering premium costs for the entire family. 

The Kaiser Family Foundation estimates that 5.1 million Americans have fallen into the family glitch. KVH estimates the change could affect as many as 72,000 Kentuckians.

Statewide, Kaiser reports that 73,935 people enrolled in individual or family plans during the open enrollment period for 2022 coverage. That was a little lower than 2021, when nearly 78,000 people enrolled.

Temporary Medicaid ending; special marketplace enrollment period ends Aug. 15; premium-free COBRA ends in September

Families USA graphic; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

Kentuckians have about two more months to buy reduced-cost health insurance on the federal marketplace under the special enrollment period. The deadline to sign up on healthcare.gov is Aug. 15. 

The Biden administration reopened the marketplace in mid-February under the American Rescue Plan Act, for people who needed coverage during the pandemic, and later extended the deadline to Aug. 15. 

The special enrollment is open to both new and existing customers, including the thousands of Kentuckians who qualified for temporary Medicaid coverage during the pandemic through the state's "presumptive eligibility" program. The PE program will end for some of them on June 30.

"Kentuckians who will be losing their PE coverage at the end of this month, should contact a kynector to learn more about regular Medicaid and Marketplace options," Kentucky Voices for Health said June 15. 

KVH said Kentuckians who have been enrolled in PE coverage since January will be disenrolled on June 30. Those who enrolled after January may have a different end of coverage date.  

The special enrollment period includes provisions that make the plans more affordable, including enhanced premium subsidies, also known as tax credits, to help offset the cost of insurance. It also makes more people eligible for the subsidies, limits costs to no more than 8.5% of income, down from nearly 10%, and eliminates repayments that may be required when people reconcile their tax return with the tax credit they received. 

“Four of five enrollees will be able to find a plan for $10 or less per month after premium tax credits, and over half will be able to find a Silver plan with a zero-dollar premium," Carrie Banahan, deputy secretary of the state Cabinet for Health and Family Services, said in a news release. 

Silver plans have the the second-lowest costs and are the benchmarks used to calculate the tax credits. They are the most common choice of marketplace shoppers, said Banahan.

State officials said premiums will decrease on average by $50 per person per month, or by $85 per policy per month, although the savings will vary per individual. 

Through the end of May, just over 10,000 Kentuckians signed up for health insurance during the special enrollment period, according to a federal report. 

That's an increase in enrollment from the same period in 2020 and 2019, when 5,550 and 5,789 signed up, respectively. Open enrollment is usually in effect only six weeks at the end of a year, except for those who experience a "qualifying life event," like getting married or losing a job.

Nationwide, more than 1.2 million people have signed up. 

New premium-free COBRA options until September

If you had health insurance through your job until you lost hours or lost employment, you and your family may qualify for health coverage through premium-free COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, which instituted the provision). 

The American Rescue Plan also requires the federal government to pay 100% of COBRA insurance premiums for eligible employees who lose their jobs (and for their covered relatives) through September, allowing them to stay on their company-sponsored health plans.

Families USA offers a fact sheet that answers a variety of questions about eligibility, enrollment process and other topics. It also features a list of local, state and national resources. 

Families USA also warns consumers that COBRA is only available through their former employer or health plan, and not through a website. 

President Biden has proposed in his American Families Plan to make some of these pandemic changes permanent, including the premium tax credits, expanded coverage to those who earn 400% and above the federal poverty level, and the 8.5% household income cap on the monthly amount a person would pay for their policy.

Special open enrollment period for government-subsidized health insurance extended to Aug. 15; new rules expand who qualifies

By Melissa Patrick

Kentucky Health News

The special open enrollment period for people to buy government-subsidized  health insurance on the federal marketplace has been extended by three months to Aug. 15. 

Kaiser Family Foundation graphs; for a larger version of any image, click on it.

President Joe Biden announced the extension March 23, the 11th anniversary of the Patient Protection and Affordable Care Act becoming law. The special enrollment period was set to end May 15. 

The special enrollment period includes enhanced premium subsidies, also known as tax credits, to help offset the cost of the marketplace's health insurance plans. It also makes more people eligible for the subsidies and eliminates repayments that may be required when people reconcile their tax return with the tax credit they received.

The enhanced subsidies, along with several other health-related provisions, were authorized under the  $1.9 trillion relief-and-stimulus law and are aimed at making coverage more affordable for people who already have marketplace coverage, who are uninsured or have lost their employer coverage.

Open enrollment is usually open for only six weeks at the end of a year, except for those who experience a "qualifying life event," like getting married or losing a job. 

Under the American Rescue Plan, subsidized premiums will drop an average of $50 per person per month, according to a federal fact sheet. It also says four out of five enrollees will be able to find a plan for $10 or less per month after the tax credit, and most will be able to find a "silver" plan for $10 or less. Silver plans have the the second-lowest costs and are the benchmarks used to calculate the tax credits. 

Under the ACA, only people with incomes between 100% and 400% of the federal poverty level  were eligible for a tax credit to reduce their premiums for marketplace coverage. 

The American Rescue Plan removes that cap for two years and allow people with incomes above 400% of the poverty level ($51,040 for an individual) to be eligible for the enhanced subsides. 

It also limits the amount a person would pay for a plan to 8.5% of household income, down from 9.83%. The federal government picks up the slack.

For example, Kaiser Health News reports that a typical single person who makes $30,000 a year will pay $85 per month for a silver plan instead of $195, according to an analysis by the Center on Budget and Policy Priorities. A family of four making $75,000 will pay $340 rather than $588 per month for similar coverage, the analysis found.

The Kentucky Center for Economic Policy reports that the American Rescue Plan's provisions mean that many who earn between 139% of the poverty level ($17,900 for an individual) and 150% of the federal poverty level ($19,320 for an individual) can find plans with zero premiums.

In Kentucky, anyone earning up to 138% of the federal poverty line qualifies for Medicaid, which is free of charge. 

The savings are available to both new and existing enrollees and will start on April 1. They will be available for two years. They will help the 77,800 Kentuckians who are already covered by marketplace plans, and open enrollment to more Kentuckians.

Kaiser Health News has a list of things to do to determine whether you qualify for an enhanced subsidy:

• People with marketplace coverage through healthcare.gov should update their applications and reselect their current plan to get details about their subsidies that will start on April 1. 
• The more generous premium tax credits may mean that a person can switch to better coverage with lower cost sharing for the same contribution, although Kaiser Health News cautions that switching plans may mean any money paid toward a deductible under the current plan could be lost -- so check with your insurer before making a switch. 
• People who have already bought a 2021 plan on the marketplace that didn't qualify for a premium tax credit under the ACA will need to enroll again to get the new premium tax credit.
• Recipients of unemployment insurance benefits in 2021 are urged to enroll in a marketplace plan now. Under the new law, unemployed workers can get a zero-premium plans in 2021. 

The Kaiser Family Foundation offers a Health Insurance Marketplace Calculator to help people estimate how much their marketplace coverage would cost with the relief bill's changes.  

The ARP also requires the federal government to pay 100% of COBRA insurance premiums for eligible employees who lose their jobs (and for their covered relatives) through September, allowing them to stay on their company-sponsored health plans. This provision is especially important for people with medical conditions because it allows them to keep their coverage and existing providers.

Dec. 15 is the deadline to sign up for federally subsidized health insurance; Kentucky enrollment is running behind last year's

By Melissa Patrick

Kentucky Health News

The deadline to enroll in federally subsidized health insurance for 2021 is fast approaching, with the last day Tuesday, Dec. 15 to sign up for coverage that starts Jan. 1.  

And while anyone already enrolled will automatically be re-enrolled in a 2021 marketplace plan, it is highly recommended that you check out other options to make sure your current plan still meets your needs. 

“It’s very important for individuals to update their applications, even if they were covered last year, so they can review the most current information on what savings are available and to find a plan that best meets their needs,” Kentucky Health Benefit Exchange Director Edith Slone said in a news release.  

Some things to consider when choosing coverage are whether the number of people in your household has changed, whether your income or medical needs have changed -- which is especially important this year because of the pandemic -- and whether the plan includes your providers or their formularies include your prescriptions.

Consumers are also encouraged to not only look at premium costs, but to also look at annual deductibles, which must be met before much of the coverage will kick in. 

And don't assume you can't afford coverage. The Cabinet for Health and Family Services says about 80 percent of Kentuckians who sign up on healthcare.gov will qualify for a tax credit or subsidy to reduce their monthly payments. 

Under the 2010 Patient Protection and Affordable Care Act, subsidies to offset premium costs are available on a sliding scale for people who earn between 100% and 400% of the federal poverty level. That range next year is $12,760 to $51,040 for an individual and $26,200 to $104,800 for a family of four, says Kaiser Health News, in an article that addresses how to choose a plan if you've had covid-19 and are worried about possible long-term complications.

Map shows Anthem marketplace plan availability by county.

In addition, many Kentuckians will have more choices this year, probably at a slightly higher cost, since Anthem Health Plans and CareSource both expanded their coverage areas, giving 94 of the state's 120 counties more than one company to choose from. This year, only 56 counties had two insurers on the healthcare.gov marketplace. 

Anthem is offering at least one of its 13 plans in all 120 counties in 2021, up from 93 in 2020. CareSource is offering all 12 of its plans in 94 counties, up from 83 in 2020.

Through the end of November, 2,939 fewer Kentuckians had enrolled on the federal exchange than at the same time last year. That was 12.2% less than at this time last year, but because of calendar procession, this year's tally had two fewer days, or 6.7% fewer. Nationally, more people had signed up compared to last November. 

Map shows CareSource plan counties in blue.

As of Nov. 28, Kentucky's enrollment on the federal exchange was 24,043, compared to 26,982 last year, according to the Centers for Medicaid and Medicare Services. None of these numbers reflect any automatic re-enrollments.

"We expected numbers would be less this year due to the pandemic," Susan Dunlap, spokeswoman for the health cabinet, said in an e-mail. " More are qualifying for presumptive-eligibility Medicaid coverage and traditional Medicaid coverage due to loss of income" in the coronavirus pandemic.

Another challenge may be a lack of awareness about the Affordable Care Act coverage on the marketplace, which is most widely known as Obamacare. The Kaiser Family Foundation reports that its polling found public awareness about the 10-year-old law is falling, compared to a decade ago.

"For example, 59% of the public knows the ACA offers subsidies for marketplace health plans, compared to 75% ten years ago," the foundation reports. "Among uninsured consumers today, understanding of ACA options and enrollment rules is more limited. Less than half (43%) know open enrollment is the time to sign up for marketplace plans; and 14% of uninsured individuals living in states that have expanded Medicaid eligibility under the ACA know about this expansion. KFF also finds many consumers are unsure about the current status of the ACA; as of this spring, just 22% of the uninsured know the law remains in effect. Uncertainty may result in part due to public debate and news coverage about a pending Supreme Court case to overturn the law." 

The health cabinet said it is reaching out to current and potential enrollees via direct mail, emails, phone calls, and community outreach events held by local Kynectors, who help people enroll.  

The foundation says the importance of health coverage is greater than ever because of the surge of new coronavirus infections, which can cost upwards of $10,000 for a mild-infection and tens of thousands of dollars for more severe cases. 

"At the very least, people with ACA-compliant private insurance are protected by out-of-pocket maximums, limiting how much enrollees must pay for a hospitalization. There is currently no guarantee that hospitals waive covid-19 treatment costs for uninsured patients, meaning those without coverage could be on the hook for large medical bills," the foundation reports.

It's important to not miss the Dec. 15 deadline because unless you qualify for a special enrollment period, you won't get another chance until next year. 

Where can I find help?

The state-based call center is available at 855-459-6328 to assist Kentuckians with questions about  where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week, excluding holidays.

Click here to find a Kynector, who can provide in-person help with applying for health coverage at no cost. Click here for information on how to assign an authorized representative to apply for or manage your benefits, Kynectors, and insurance agents, who can also help you sign up for benefits. 

Healthcare.gov provides a shopping tool to allow you to preview 2021 plans and estimated prices before you log in.

Healthinsurance.org also offers an Open Enrollment 2021 Guide.

The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

More counties will have two insurers to choose from when open enrollment for federally subsidized health plans starts Nov. 1

Kentucky Health News map, based on CareSource information. It will offer all of its 12 health-insurance plans in other counties; Anthem will offer at least one of its 13 plans in every county.

By Melissa Patrick
Kentucky Health News

Many Kentuckians will have more choices, probably at slightly higher cost, when enrolling for federally subsidized health insurance Nov. 1 through Dec. 15.

Anthem Health Plans and CareSource both expanded their coverage areas, giving 94 of the state's 120 counties more than one company to choose from. This year, only 56 have two insurers on the healthcare.gov marketplace.

State Department of Insurance table; for a larger version, click on it.

Anthem will offer at least one of its 13 plans in all 120 counties in 2021, up from 93 in 2020.

CareSource said it will offer all 12 of its plans in 94 counties, up from 83 in 2020.

The cost of Anthem policies will average 5.7 percent higher than this year's plans. That's about a third of the 16.6% overall hike the company requested.

CareSource plans will average 4% more than this year, which is about a fourth less than the 5.3% increase the insurer requested.

Anthem's filing summary said its request was driven by increases in the cost of care and an increase in member use, plus an expected increase in cost due to the pandemic, including an expected resurgence of elective procedures that were deferred in 2020. Anthem said it expects the pandemic's impact on the individual market to increase in 2021 due to uncertain economic conditions and loss of income and group coverage.

CareSource's filing summary was less certain about the pandemic's impact, saying it saw "substantial uncertainty" about "whether the pandemic will increase or decrease costs in 2021."

The state allowed Anthem and other insurers offering plans for small groups under the Patient Protection and Affordable Care Act to raise premiums an average of 9.68%. Individual premiums will vary, depending on whether individuals smoke, how old they are and where they live.

Detailed rate filings are at http://insurance.ky.gov/PPC/Ratefil/default.aspx.

Kentuckians will need to sign up for the upcoming open enrollment period on healthcare.gov. Click here for a list of what is needed to apply.

Next year, Kentuckians will apply for their federally subsidized plans on Kynect, a state portal that Gov. Andy Beshear relaunched Oct. 5 as a one-stop shop for health coverage and other benefits. Kynect will replace a state site called Benefind.

Kynect was created by Beshear's father, then-Gov. Steve Beshear, in 2013 under the Affordable Care Act. It was dismantled in 2017 by Republican Gov. Matt Bevin, who served between the Democrats and said the site was too expensive to maintain and was redundant. However, Beshear said the return to the state-based exchange is expected to save Kentuckians about $15 million a year.

For now, the kynect.ky.gov portal offers access to the federal exchange, where subsidized plans are available, and state enrollment for Medicaid, the Kentucky Children’s Health Insurance program and the Kentucky Integrated Health Insurance Premium Payment program.

Qualified families can also access Supplemental Nutrition Assistance Program benefits (formerly food stamps) and family and child-care assistance programs through the Kynect portal. It will also provide additional resources including support for job training, foster care, elder care and addiction, as well as support for veterans with disabilities, immigrants and refugees, and homeless Kentuckians. It can also connect people with services in their communities.