5 Reasons Why Enrolling in a Marketplace Plan is Probably Cheaper Than You Think

5 days until the federal Special Enrollment Period (SEP) Deadline on August 15th

In case you’ve missed the news lately, we’re still in the middle of a global pandemic. While this pandemic continues to drag on, one of the most critical things that we have learned is just how important having health coverage is.  

A recent study from Families USA found that states with lower rates of uninsured people also had fewer COVID-19 related deaths. In fact, because Presumptive Eligibility (PE) Medicaid flexibility was opened up to cover more Kentuckians throughout the last year, the Commonwealth saw a demonstrably lower number of deaths than all of our neighboring states. What was the major difference from our neighbors? Kentucky acted quickly to ensure that people had access to health coverage during a hard and ongoing fight against COVID-19. 

In the same vein, the Biden administration initiated a Special Enrollment Period (SEP) in response to the COVID-19 pandemic to allow folks nationwide to enroll in a Marketplace health insurance plan. This SEP began on February 15th and is finally coming to an end this Sunday, August 15th. Over two million people have enrolled in health insurance through the Marketplace during this SEP so far! There has never been a better time to shop for insurance through the  Marketplace because this extended SEP coincided with the passage of the American Rescue Plan Act (ARPA), which provided a number of cost-saving provisions and increased subsidies to help make health insurance more affordable for an estimated 122,600 Kentuckians. For more details on who may be eligible for these potential savings, check out our blog breaking down the new Marketplace savings created by ARPA.

Some people have shopped in the Marketplace in the past and decided that the monthly premium was too expensive or that the deductible or other out-of-pocket costs were just too high to be able to use the insurance. However, the Marketplace has changed and there are many reasons – ARPA included – that enrolling in a Marketplace plan may be much more affordable than you think. Let’s dig into 5 reasons why this is true. 

Kentuckians who receive unemployment insurance for at least one week in 2021 are eligible to receive the maximum amount of premium subsidies, regardless of any income changes later in the year. These Marketplace plans cost $0 monthly.

  1. $0 Monthly Premium Plans

Yes –  seriously! There are Marketplace plans that cost $0 monthly. Kentuckians who receive unemployment insurance for at least one week in 2021 are eligible to receive the maximum amount of premium subsidies and cost-sharing reductions for the entire 2021 year, regardless of any income changes later in the year. This makes the benchmark silver plan $0 monthly for people receiving unemployment benefits in 2021. Even if you think you don’t need health insurance, what do you have to lose when it could cost you literally nothing a month just to be insured?

  1. Free Preventive Care

All Marketplace plans are required to cover the 10 essential health benefits (EHB) as established in the ACA. These benefits include: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. While plans do have to cover all of these benefits, preventive care has a special provision that requires insurers to cover these services for free. . Shots and screenings are required to be provided at no cost to you. Here is a full list of what these preventive services include.

  1. Discounts and Copays

Did you know that just by having health insurance, you already receive a discount on any services you may need? One of the major perks of having a health insurance policy is that insurance companies have contracted rates with providers in their networks setting a limit on how much they can charge you for different services. 

For example, let’s say you have XYZ insurance company and need to see a doctor. Without insurance, if you go see Dr. John Doe, he can charge his full rate of $120 for your visit. Now with insurance, if Dr. Doe is in the insurance’s network, they put a cap on how much he can charge for your same visit. XYZ insurance tells Dr. Doe that he is only allowed to charge you $60 instead. And depending on the type of plan you choose, you may still only have to pay a smaller portion of that through a copayment or coinsurance. But even if you have to pay that full $60, you’ve still saved money just by being insured.  

  1. Out-of-pocket Maximum Prevents Bankruptcy

We often hear that people don’t enroll in low-cost premium plans because high deductibles or other out-of-pocket costs can still make getting needed care costly, but there’s another benefit. Having coverage protects you from bankruptcy. Did you know that ALL Marketplace plans have an out-of-pocket maximum? This cap is in place to limit the amount you pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

The out-of-pocket limit for Marketplace plans do vary, but they still can’t go over a set amount each year. For the 2021 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,550 for an individual and $17,100 for a family.

While that number may seem high, remember – if you’re uninsured or covered by a plan that is not ACA-compliant, there is no such limit in place to protect you. 

  1. Life Happens

One thing we’ve all been reminded of in the last year is that life happens. Regardless of how well you may plan and strategize for things to go a certain way, life and accidents can come along and throw you off course: an angry appendix, catching COVID-19, or even a random trip and fall that leads to a busted knee. All of these events are things that you can try your best to safeguard yourself against, but are mostly unpredictable…and expensive. 

Without insurance, the average cost of an appendectomy in 2020 was $33,000. The average cost of a 5-day COVID-19 hospitalization was $73,000. The average cost of knee surgery was $19,000. Without insurance, life’s unpredictable accidents and unexpected health issues can be devastating. Staying uninsured because you “never get sick” or you “never go to the doctor” may seem cheaper and more affordable to you now, but one unpredictable accident or surprise diagnosis could change all of your financial plans. 

4 out of 5 enrollees can find a plan for $10 or less per month after premium tax credits.

Don’t Miss Your Chance to Shop for Savings

The deadline to enroll in a Marketplace plan is this Sunday, August 15th. Enrolling in Marketplace insurance is more affordable than ever before for average Americans thanks to the American Rescue Plan. So if you’re uninsured, please don’t miss the last few days to check out what the Marketplace has to offer. And if you already have a Marketplace plan, be sure to shop for new savings. 

Four out of five Kentuckians can find a Marketplace plan for less than $10 and returning enrollees can save an average of 40% on their monthly premiums thanks to the increased subsidies from ARPA. If you do the math, I bet enrolling in a Marketplace plan is even cheaper than you think. 

For more information about accessing these benefits, check out healthcare.gov, call the call center 24/7 at 1-800-318-2596, or use the find a kynector tool to get local help before the August 15th deadline.

To learn more about the author, visit: https://kyvoicesforhealth.org/our-team/.