The “open enrollment” window to buy subsidized health care from the federal government opened Nov. 1 and runs through Jan. 15. Here’s the bigger news: A fix of the so-called “family glitch” means thousands more people may now qualify for cheaper insurance – but not know it.
“We’re worried that if people had checked on this program in years past, they (may not have qualified) and now they won’t come back and check again,” said Jeremy Smith, program director for First Choice Services, one of two federally funded programs that help Granite Staters navigate options and enrollment. “So we’re trying to make sure that people know that this is a special year and that they need to come look at it.”
The family glitch fix is one of three significant changes to the federal subsidized health plans. The Inflation Reduction Act extends two others enacted under the American Rescue Plan Act: more generous subsidies and no income limit to apply, meaning people who lost subsidies when their income increased even slightly will instead see subsidies taper off but not disappear.
This year’s open enrollment period is especially important because it coincides with the anticipated end of the federal public health emergency when an expected 90,800 Granite Staters will no longer qualify for Medicaid. Deputy Insurance Commissioner David Bettencourt is urging Granite Staters to check their ongoing eligibility now and sign up for federal health insurance if they will lose Medicaid.
“Anytime there is a rush to the door, it makes for a more difficult situation,” 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, newborn, and pediatric care, mental health and addiction coverage, and prescription drug benefits.
But those plans differ in cost and coverage: smaller premiums come with higher copays, out-of-pocket costs, and potentially few choices of provider. For example, the silver plan, considered the “benchmark” or middle-of-the-road plan, pays 70 percent of medical expenses versus 90 percent in the platinum plan.
To qualify for any plan, a person must live in the United States and be a citizen, national, or otherwise in the country lawfully. People who are incarcerated or on Medicare are not eligible. People insured through Medicaid or the Children’s Health Insurance Program (CHIP) can have a plan but not federal subsidies to pay for it.
Bettencourt said 48,000 Granite Staters receive subsidies for ACA plans purchased through the federal marketplace. Most have a silver or gold plan, according to the New Hampshire Insurance Department website.
No more family glitch
For the first time this year, family members of an employee who has insurance through an employer may be able to choose a federally subsidized Affordable Care Act Marketplace plan instead. To be eligible, the cost of an employer’s family plan must be more than 9.1 percent 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 people who own businesses want to do great things for their employees,” said Keith Ballingall, president of Health Market Connect, the state’s other federally funded navigator program. “So they’ll put in a plan and say, ‘Listen, we’ll cover, as an employer, 100 percent or a big chunk of the cost of insurance.’ But the challenge is it’s hard for a small business to say yes, we’ll cover it for your entire family because that expense gets so large.”
In some cases, the employee may remain on the employer’s plan while family members get an ACA plan, Ballingall said.
The Urban Institute has estimated that eligible family members who move from an employer plan to ACA coverage could save $400 per person. The estimated number of people who may be eligible under the rule varies widely, but there is agreement that most would be children. The White House put the number at 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 does not know how many Granite Staters would benefit from this change but estimated it would be a small percentage of the Kaiser Family Foundation prediction given the state’s population.
Income cap lifted
Historically, individuals and families were eligible for ACA coverage only if their household income fell below 400 percent of the federal poverty level, $54,360 annually for a single person and $111,000 for a family of four.
That rule created a subsidy cliff where individuals and families who earned even $1 above the limit were disqualified from any assistance. The income cap was set aside in the American Rescue Plan until the end of this year. The Inflation Reduction Act extends the deadline to 2025.
Subsidies for those earning over 400 percent of the federal poverty level will decline as income rises, but subsidies will not be eliminated. “So, no more cliff,” Ballingall said.
The American Rescue Plan also enhanced subsidies but only until the end of this year. Those enhancements will continue until 2025 under the Inflation Reduction Act. That will allow some people to get a plan for little to no premium.
For example, individuals earning up to 150 percent of 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 Kaiser Family Foundation’s subsidy calculator. Prior to the change, an individual in New Hampshire at that income level would pay $343 a month for a silver plan.
And under this rule change, someone at twice that income level would receive a $160 monthly subsidy and pay $200 a month for that silver plan.
Individuals can enroll themselves in a marketplace plan through the federal government’s website, healthcare.gov, but the two navigators, First Choice Services and Health Market Connect, may be a better place to start.
Both have staff available to answer questions, check eligibility, explain each plan’s benefits, and complete enrollment via phone, email, and in person. Staff can also help individuals determine whether they are eligible for other government health coverage as well.
Because the companies are federally funded, the assistance is free.
Health Market Connect has 10 navigators located in all regions of the state. They offer assistance in eight languages, including American Sign Language, and can answer questions via Zoom, chat, text, Facebook messenger, and email, Ballingall said. They also book appointments through their website, hmcnh.com.
“We have a team that wants to help everybody and anybody that needs it,” Ballingall said. “If you don’t obtain health insurance coverage from an employer, there is a program out there.”
First Choice Services, based in West Virginia, has six navigators 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 phone and in-person assistance: Harbor Care, Lamprey Health, and the Foundation for Healthy Communities. Its website is firstchoiceservices.org.
Smith cautioned against finding help through an internet search, saying companies outside the federally funded navigator program may try to sell other plans that don’t offer subsidies and include exclusions.
“If they’re working with a navigator, they’re going to be getting the right information,” he said. “But if they do the Google search, there’s a lot of different avenues they could end up down.”
Bettencourt said the state Insurance Department, nh.gov/insurance, can also help. “There is no wrong door,” he said.
Public health emergency
Medicaid enrollments surged during the pandemic as health concerns, job losses, and child care shortages left more people out of work and in need of financial assistance. New Hampshire saw its standard Medicaid enrollments increase 20.1 percent and enrollments in expanded Medicaid rise by 73.5 percent.
Under the federal public health emergency, in place since January 2020, states have been prohibited from ending that coverage even for those who no longer qualify for financial assistance because they’ve 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 recipients still qualify for coverage. State Medicaid Director Henry Lipman has estimated 90,800 Granite Staters won’t and will lose their Medicaid benefits as a result.
State Medicaid and Insurance Department officials have launched a massive campaign to begin those re-enrollments before the public health emergency is lifted to avoid a gap in insurance. Bettencourt said those who have not already found alternative coverage through the federal marketplace should do so now and not wait to be found ineligible for Medicaid.
The federal navigators can help determine whether Medicaid recipients will continue to qualify and, if they won’t, help them find an insurance plan before open enrollment ends Jan. 15. Individuals can also use the state’s portal, nheasy.nh.gov, to determine eligibility and options for new health insurance. There are many questions to consider, from cost to provider network options, Bettencourt said.
“We can help people think through that,” he said. “We’re obviously not going to tell them what to do. We can kind of help them think about their particular set of circumstances so that they can make the best choice for themselves.”