Looking for affordable health insurance? You'll want to read this.

By Claire Gillespie
February 11, 2021
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President Joe Biden has signed a number of executive orders during his first weeks in office, including a health care package. One of the initiatives reopens HealthCare.gov, the official site of the Affordable Care Act, for a special, three-month enrollment period from February 15 to mid-May.

The first step toward Biden's promise to make health care more affordable and available, it gives Americans a chance to get health insurance through the Affordable Care Act (aka Obamacare), outside the six-week period (November 1 through December 15) that was set by the Trump administration.

For the many people who've dealt with unemployment and financial hardship during the COVID-19 crisis, it could be a lifeline. As of June 2020, about 7.7 million workers lost their employer-sponsored health insurance due to the pandemic, according to the Commonwealth Fund, a foundation focused on health care access.

"There's nothing new that we're doing here other than restoring the Affordable Care Act and restoring Medicaid to the way it was before Trump became president," Biden said as he signed the order in the Oval Office.

Health marketplace: Who is eligible?

Anybody who lives in the US and is a US citizen or national, or is lawfully present. (Basically, if you're considered a US "resident" for tax purposes, you're eligible.) However, the order only applies to people in the 36 states that use HealthCare.gov—the remaining 14 states and the District of Columbia have their own health insurance marketplaces and enrollment rules, so are excluded from the special enrollment period.

Plans come in four "metal" categories: bronze, silver, gold, and platinum. The bronze plan is the least subsidized—60% is paid by the insurance company, while the platinum plan has the lowest costs when you need care. FYI, the categories are based on how you and your plan split the costs of your health care; they have nothing to do with quality of care you receive.

To qualify for one of the plans offered, your household income must be between 100% and 400% of the federal poverty level (FPL). If you qualify for a subsidy, the amount is calculated on a sliding scale based on your income. But you won't qualify if you have access to Medicaid or qualified employer-based health coverage.

The easiest way to find out if you qualify for a subsidy—and how much that will be—is to visit Healthcare.gov. When you enter your expected adjusted gross income (the exact amount, not a ballpark), you'll find out how much of a discount you'll get. If you don't know exactly how much you'll make in a year and end up making more, you'll have to pay back some of the subsidy,

According to an analysis by the Kaiser Family Foundation, around 15 million uninsured people could benefit from the new initiative. Around 8.9 million (60%) of those would get financial help if they signed up, and about 4 million people could get coverage for free.

What subsidies are available?

There are two types of subsidies available: a premium tax credit and cost-sharing subsidies. The tax credit is available to those who buy a marketplace plan and earn a household income between 100% and 400% of the FPL. According to the Congressional Budget Office, the FPL was $12,760 for an individual last year in most states. If you qualify for the tax credit, you pay to just under 10% of your income toward a silver plan, and the federal government covers the rest—either on a monthly basis or as a lump sum tax credit.

Some people may also qualify for cost-sharing subsidies. These are only available to people who make between 100% and 250% of the poverty level and sign up for a silver level plan.

What about Medicaid?

Depending on your situation and where you live, you may qualify for Medicaid, which provides health coverage for low-income families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid is available for all adults under a certain income threshold. To find out if you qualify, HealthCare.gov has a calculator where you provide your home state, family size, and income level. Generally, if you have zero or very low income, you won't qualify for subsidies because you'll be put on Medicaid.

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