Early in the new year of 2021, the Biden Administration implemented The American Rescue Plan (ARP) with the intent of reducing health care costs and expanding access to health insurance plans.
There are currently over 9 million Americans accessing health care through the Affordable Care Act Marketplace, which provides subsidized plans with lower premiums based on household income. Their goal is for there to be at least a few plan options available to every consumer at a monthly premium no more than 8.5% of their household income.
- Uninsured couples earning over $70,000 annually could save more than $1,000 per month on their premium
- A family of four making $90,000 annually will see their premiums decrease by $200 per month
- A single individual making $19,000 annually will be able to find health insurance coverage with no monthly premium at all, saving roughly $66 per month on average
This plan also introduced an extended Open Enrollment Period that in past years ended on December 15th for the coverage to be effective the following year. For 2021, that new period was from January 15th-May 15th but has now been extended even further to August 15th and coverage can be effective on the 1st of the following month.
The ARP is reevaluating the level of subsidy that Americans qualify for based on their income. Those with new or existing Marketplace plans can visit www.healthcare.gov or call the Marketplace directly to confirm whether or not their tax credit will be increased, resulting in lower out of pocket monthly premium responsibility for the insured. You can also wait until you file your 2021 taxes next year to get the additional premium tax credit amount. However, it is recommended that you update your application and review your plan options during the allotted period up until August 15th.
There is something to keep in mind regarding coverage if you change plans during this time. It is important to consider the new plan’s deductible as it’ll likely start over. If you change plans or add a new household member, any out-of-pocket costs you already paid on your current 2021 Marketplace plan probably won’t count towards your new deductible, even if you stay with the same insurance company.
These are variables that a licensed agent or Marketplace representative can discuss as they pertain to specific situations. The website again for resources regarding the Affordable Care Act is www.healthcare.gov.
The cost of Medicare can seem confusing but it’s really quite simple. Because it is very case-by-case for each individual’s situation, this is a very brief guide to reference Medicare premiums in 2021. Part A, which is for hospital coverage, has $0 premium regardless of who is qualifying or what their income and employment status is. Part B, however, is determined by income level and how taxes are filed. This chart shows the different brackets for each and the current premiums for 2021.
|File Individual Tax Return||File Joint Tax Return||File Married & Separate Returns||2021 Monthly Premium|
|$88k or less||$176k or less||$88k or less||$148.50|
|$88k – $111k||$176k – $222k||N/A||$207.90|
|$111k – $138k||$222k – $276k||N/A||$297.00|
|$138k – $165k||$276k – $330k||N/A||$386.10|
|$165k – $500k||$330k – $750k||$88k – $412k||$475.20|
|$500k or above||$750k or above||$412k or above||$504.90|
This chart is specific to Florida Blue’s current Advantage Plan and Plan G supplement but may also be helpful to show the estimated cost of both routes you can go if purchasing additional coverage to Parts A and B.
|Medical Coverage||Medical Coverage|
|Monthly Premium: $47.90||Monthly Premium: $180.60 (Plan G at age 65)|
|Part A: $0||Part A: $0|
|Part B: contingent on income (see above)||Part B: contingent on income (see above)|
|Prescription Drug Coverage||Standalone Part D|
|Monthly Premium: included in plan||Monthly Premium: $73.70|
|Deductible: $250||Deductible: $405|
$47.90 (+ Part B)
$254.30 (+ Part B)
|Includes copays & coinsurance.|
Out of pocket max: $6,500 in network/$10,000 out of network
|Part B deductible ($203) must be met.|
No copays or coinsurance.
On January 28, 2021, President Biden signed an Executive Order directing the Department of Health and Human Services (HHS) to open healthcare.gov for a three month special enrollment period (SEP).
Usually, the Open Enrollment Period for new health insurance or changes to a current plan is from November 15-December 15 of every year for the following year’s coverage. In the past, if you needed new coverage or changes made outside of that time frame, you would have to qualify by having a life event such as marriage, divorce, birth, adoption, loss of employer-provided coverage, etc.
This Period for 2021 is from February 15-May 15 to provide an additional opportunity for uninsured and underinsured Americans to enroll in coverage in the face of the COVID-19 pandemic. Coverage would be available as soon as the 1st of the following month. This applies to both subsidized plans (with premium assistance based on income qualifications) in the Marketplace and non-subsidized plans that are considered Off-Marketplace.
According to Florida Blue, here are a few tips if you are in the market for new health insurance or to make changes to what you currently have:
- Starting February 15, consumers seeking to take advantage of this SEP can find out if they are eligible by visiting healthcare.gov or speak with an agent. The application process and plan selection can either be done online or through an agent as well.
- Consumers who are eligible and enroll under this SEP will be able to select a plan with coverage that starts prospectively the first of the month after plan selection. Consumers will have 30 days after they submit their application to choose a plan.
- Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan. In order to use this SEP, current enrollees will need to go through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment.
- Consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.
HHS has published a fact sheet here: https://www.hhs.gov/about/news/2021/01/28/hhs-announces-marketplace-special-enrollment-period-for-covid-19-public-health-emergency.html providing additional details on implementing the healthcare.gov SEP as well as an CMS fact sheet here: https://www.cms.gov/newsroom/fact-sheets/2021-special-enrollment-period-response-covid-19-emergency with more technical details.
Health care is a hot topic of conversation lately in politics since the Affordable Care Act and now numerous methods of reform are being discussed. But also with regard to the economy since the cost of care seems astronomical lately. Many argue that one of the drivers behind a lot of that cost increase is prescription drugs.
According to data analyzed by 3 Axis Advisors (a health care research firm), retail prices for 460 prescription drugs are increasing by an average of 5.2% in 2020 – more than double the projected rate of inflation for the year. Many manufacturers are raising the prices on existing drugs as well, so it isn’t just new therapies being introduced.
While patients typically don’t have a say in the diagnosis or treatment plans they receive from medical professionals, they do have a choice (and a right) to look into where they get prescription medications from. You, as the patient, owe it to yourself to do a little bit of research and get your drugs at the lowest cost possible to you.
Here are a few ideas to explore so you can be sure you’re doing all that you can as an advocate for yourself:
• Sourcing for lower cost – A common misconception is that one drug will cost the same regardless of where you have the prescription filled… Publix, CVS, Walgreens, Winn Dixie, etc. There are tools such as GoodRx that allow you to search specific drug names and find the cost at different retailers in your area.
• Coupons – There are websites online, the manufacturer itself, and retailer coupons that can provide significant savings. Some pharmacists will check for coupons on your behalf but not always.
• Websites such as Drug Store Unlimited that get drugs from other countries can also save money.
• Patient assistance programs – Ask your doctor about programs available in your area that may offer advice and guidance, more so with Medicare but also for individual health plans.
Just a few minutes of your time before you fill your next prescription could be very beneficial to you.