The American Rescue Plan includes a number of provisions that helps to make health coverage more affordable. Below are some questions we are asked frequently.
Q1: Who qualifies to shop through the Marketplace?
A1: If you do not have coverage through the Oregon Health Plan or Medicare, and you are not offered coverage through a job, you likely can shop through the Marketplace and may qualify for financial help.
Q2: Who qualifies for financial help?
A2: People who can shop through the Marketplace may qualify for financial help if they do not have access to other coverage that is considered affordable and meets the minimum value standard. There is no longer an income cap to qualify.
Q3: What kind of financial help is available?
A3: There are two types of financial help available through the Marketplace: premium tax credits to reduce your monthly premium cost and cost-sharing reductions that lower your out-of-pocket costs when visiting the doctor, seeking other services, or getting a prescription filled.
Q4: Can anyone get financial help now?
A4: Yes, it is possible. The American Rescue Plan reduced the amount of expected contribution towards the monthly premium for all people enrolled through the Marketplace. This means that you are expected to pay less towards your monthly premium, so you may qualify for even more savings. The most people will need to contribute towards a benchmark plan is 8.5 percent of their income.
Q5: Did anything else change under the American Rescue Plan?
A5: Yes. People who are eligible for or have received at least one week of unemployment insurance benefits in 2021 are eligible for the maximum amount of premium tax credits and cost-sharing reductions. This means you may be able to get a plan for as low as $1 per month.
Q6: If I am currently enrolled in a Marketplace plan, how do I receive the additional tax credits/lower premiums?
A6: If you are currently enrolled, including if you recently enrolled through the 2021 special enrollment period, you can update your application and enrollment in order to get new eligibility results. You will need to reselect your current plan in order for the changes to take effect to reduce your premiums for the remainder of the year.
Q7: Can I change my health plan right now?
A7: While the 2021 special enrollment period opportunity is available through Aug. 15, you can decide during this period if you want to change to a new plan for the rest of the year. Consider how much you have already paid toward your deductible when deciding whether or not a change in plan makes sense for you. When you change plans, the amount you have already paid towards meeting your prior plan's deductible may be reset to zero, and you would need to start over paying out-of-pocket expenses to reach the deductible on your new plan. If you have made significant payments toward your deductible, check with your insurance company to see how it might affect you and what options are available to keep credit toward what you have already paid.
Q8: If I am currently enrolled through the Marketplace, what will happen if I do not log back in to HealthCare.gov?
A8: If you enrolled in a Marketplace plan before April 1 and have not taken action yet, the Marketplace plans to redetermine your premium tax credit eligibility using information on your current application in September 2021. However, we recommend all enrollees log in, update their application, and review their plan options during the 2021 special enrollment period through Aug. 15 because they may be able to choose a plan with lower out-of-pocket costs for the same price or less than what they are currently paying. This will also ensure they receive the most accurate amount of financial help.
Q9: If I do not have coverage, when should I apply?
A9: If you need coverage, you can apply and enroll before Aug.15 for a 2021 health plan. The sooner you apply, the better. If you enroll by July 31, your plan will start Aug. 1.
Q10: If I am already paying a low premium, or no premium, should I take any action?
A10: If you are already paying low or no premiums, you may find plans with more generous cost-sharing and lower out-of-pocket costs, and may benefit from changing plans. Premiums after tax credits will decrease, on average, by $50 per person per month. Four out of five enrollees will be able to find a plan for $10 or less per month with premium tax credits, and more than 50 percent will be able to find a Silver plan for $10 or less with tax credits. This means you may be able to find plans with lower out-of-pocket expenses and lower deductibles for a similar premium to what you are currently paying.
Q11: This is all kind of confusing. Where do I start?
A11: We get it; health coverage can be confusing. We have a quick tool that will give you a snapshot of how much financial help you can get and what plans are available to you. Find this tool at OregonHealthCare.gov/WindowShop.
In addition, we partner with health coverage experts throughout the state to provide free one-on-one help with applying and enrolling in health coverage. Find a local expert at OregonHealthCare.gov/GetHelp.
Have more questions?
The Oregon Health Insurance Marketplace is hosting a live Health Insurance Town Hall event on Thursday, July 15, from 12:30 to 1 p.m. You can watch the event on Zoom at bit.ly/OHIMtownhall. The recording of the town hall will be available on the OHIM Facebook page after the event.