The stimulus package signed by President Joe Biden recently provides new options for Americans who need health insurance — and new resources to help lower costs for those who are already insured.
Few of these changes apply to Americans who get insurance at work or through Medicare. But if you buy your own insurance, have been uninsured or have recently lost job-based coverage because of a layoff, the bill introduces new programs and new funding to help you get and stay covered. The new programs are temporary — none last longer than two years.
The array of programs can be complicated and tough to navigate, and some will take a little time to update. Here is some guidance.
I need insurance, and I am collecting unemployment insurance benefits.
The stimulus bill provides substantial, short-term subsidies to buy coverage on the Affordable Care Act marketplaces. Regardless of your income, if you collect unemployment insurance at any time this year, you will qualify for a free silver plan with special bonus coverage that will lower your deductible and copayments.
It may take a little time for Healthcare.gov or your state exchange website to update. But if you sign up for a silver plan now, you will be able to get these benefits for the rest of the year. You may need to pay a higher premium at first while the system is adjusting, but you will eventually be eligible for a refund.
If you used to get insurance at work, you may also qualify for up to six months of free COBRA coverage, meaning you have a choice about which kind of free insurance you want.
I just lost my job-based coverage, but I’d really like to keep it.
Under federal law, you can stay enrolled in your workplace coverage for up to 18 months after losing your job-based insurance. Normally, you would need to pay the full price of this insurance, which can be expensive. But under the new stimulus bill, you can qualify for up to six months of free COBRA coverage, if you lost your coverage in the past year. You can also qualify for the free COBRA if you still have your job but your hours have been cut and you lost your insurance as a result.
After Sept. 30, though, you will need to pay to keep the COBRA plan, or you will need to switch to a different option.
I currently buy “Obamacare” insurance.
The legislation introduces additional subsidies meant to lower the amount most people pay for insurance purchased on Affordable Care Act marketplaces. These extra subsidies will be retroactive to Jan. 1. The details of how you will get this new discount are still unclear: Your premium amount may reset automatically to a lower price, or you may need to go back to Healthcare.gov or your state marketplace to request the discount once the new system is set up. In the District of Columbia, one of the first places to announce a policy, prices will adjust automatically in April. Regardless, once those policies are completed, there will be a way to get a refund for any overpayments you make.
To know your new premium, try the Kaiser Family Foundation’s online calculator, available here. New prices will be updated on Healthcare.gov on April 1.
The stimulus package funds these extra subsidies for two years. Any extension after 2022 will require new legislation.
If you already have Obamacare coverage but have received unemployment insurance any time this year, you now qualify for additional assistance. You should go back to the marketplace to make sure you are signed up for that extra benefit once it is set up.
I didn’t buy health insurance this year, but I want coverage now.
Normally, you can buy insurance only during a six-week period each fall. But the Biden administration established a special enrollment period that runs through mid-May, and most state marketplaces have done the same. This means you can go to Healthcare.gov and sign up for insurance now.
Because of the stimulus bill, the tax credits that help you buy insurance will be higher than ever before — enough to pay for a free silver plan for someone with an annual income of around $19,000, or to lower premiums by as much as $1,000 a month for someone earning around $60,000 in an expensive market. If you go to Healthcare.gov today, you will not see those new prices, but you will still qualify. If you want coverage right away, you will eventually qualify for a refund if you pay too much at first.
The changes in premiums affect nearly everyone, but are particularly valuable for two groups. If you have a low income, subsidies will cover enough to give you a free silver plan with extra benefits that lower your copayments and deductibles. And if you earn more than 400% of the federal poverty level — about $51,000 for a single person or $105,000 for a family of four — for the first time you will qualify for help buying insurance.
These changes were devised to make insurance more affordable for people who have found premiums out of reach. To get a sense of what you will need to pay, the Kaiser calculator may be helpful while the government sites update.
I need insurance, but my income is very low.
In most — but not all — states, simply having a low income can qualify you for Medicaid coverage. Medicaid generally charges no premiums and has very low copayments for doctor visits or prescriptions. In some states, you can qualify by having an income that is lower than around $1,400 monthly for a single person or $2,950 for a family of four.
Missouri and Oklahoma are in the process of expanding Medicaid, so people there may also become eligible later this year. The stimulus bill provides a financial incentive for other states to expand their programs, too. So far, it is unclear whether any of them will take advantage of the offer.
In the states that have not expanded, you may also qualify for Medicaid if you are poor and fall into some other category, such as being the parent of a young child. If you think you could qualify for Medicaid, it is worth applying to find out.
Eligibility for Medicaid will endure even after stimulus provisions expire.
I bought a short-term plan, a health-sharing ministry plan or my own insurance outside of Healthcare.gov.
The changes under the stimulus bill make it worth considering a switch in insurance type.
Many Americans with higher incomes bought their insurance outside the state marketplaces because they did not qualify for subsidies. The new legislation changes that: Higher-income people can now get financial help buying insurance, but only if they sign up for a marketplace plan.
Obamacare plans cover a broader array of benefits than short-term plans or health-sharing ministries do, and they cannot deny your claims based on a preexisting condition.
Whether switching is a good decision for you depends on how much you will save in premiums and how much you have already paid in deductibles. But switching will pay off for enough people that “they should absolutely come in and just see what the prices are,” said Sabrina Corlette, a co-director at the Center on Health Insurance Reforms at Georgetown University. Corlette notes that this is especially true for older people; new subsidies could cut their cost of insurance by more than half.