Fixing ‘Family Mistake’ Requalifies Thousands of Granite Staters for Cheaper Insurance – New Hampshire Bulletin

The open enrollment window to purchase subsidized healthcare from the federal government opened on November 1st and runs through January 15th. Here’s the bigger news: A fix for the so-called “family bug” means thousands more people can now qualify for cheaper insurance – but don’t know.

Jeremy Smith, program director for First Choice Services

“We’re concerned that people who have reviewed this program in previous years (may not have qualified) and now aren’t going to come back and review it again,” said Jeremy Smith, program director of First Choice Services, one of the two state-owned funded programs that help Granite Staters with selection and enrollment. “So we’re trying to make sure people know this is a special year and they need to watch it.”

Addressing family disruptions is one of three major changes to federally-subsidized health plans. The Inflation Reduction Act expands on two others enacted under the American Rescue Plan Act: more generous subsidies and no applicable income cap, meaning people who lost subsidies when their income increased even slightly have subsidies phased out instead, but not disappear.

This year’s open filing period is especially important as it coincides with the expected end of the federal public health emergency, when a an expected 90,800 Granite Staters will no longer qualify for Medicaid. Deputy Insurance Commissioner David Bettencourt is urging Granite Staters to review their current eligibility now and enroll in federal health insurance if they lose Medicaid.

“Every rush towards the door makes the situation more difficult,” he said.

Granite State numbers

Affordable Care Act health care plans are divided into four levels: Bronze, Silver, Gold and Platinum. All plans must include basic benefits such as emergency services, hospital care, maternity, newborn and child care, mental health and addiction insurance, and prescription drug benefits.

However, these plans vary in cost and coverage: Smaller premiums come with higher co-payments, upfront costs, and potentially a narrower choice of providers. For example, the silver plan, considered the “benchmark” or mid-range plan, pays 70 percent of medical expenses versus 90 percent in the platinum plan.

To qualify for a plan, an individual must reside in the United States and be a citizen, national, or otherwise legally resident in the country. Individuals who are incarcerated or on Medicare are not eligible. Individuals insured through Medicaid or the Children’s Health Insurance Program (CHIP) can have a plan but no federal grant to pay for it.

Bettencourt said 48,000 Granite Staters receive subsidies for ACA plans purchased through the federal market. Most have a Silver or Gold planaccording to the New Hampshire Department of Insurance website.

No more family breakdown

For the first time this year, family members of a worker who is insured through an employer may instead choose a state-subsidized Affordable Care Act Marketplace plan. To be eligible, the cost of an employer’s family plan must be more than 9.1 percent of the family’s household income.

Prior to the rule change, eligibility was based on the cost of an employer’s individual plan, which is often cheaper than a family plan.

Keith Ballingall, President of Health Market Connect

“What would happen is that people who own a business want to do great things for their employees,” said Keith Ballingall, president of Health Market Connect, the state’s other federally-funded navigation program. “So they’re going to come up with a plan and they’re going to say, ‘Look, we, as an employer, pay 100 percent or a large portion of the insurance costs.’ But the challenge is that it’s difficult for a small business to say yes, we’ll do it for your whole family because that cost gets so big.”

In some cases, the employee can stay on the employer’s plan while family members receive an ACA plan, Ballingall said.

The Urban Institute has estimated that eligible family members who switch from an employer plan to ACA insurance could save $400 per person. The estimated number of people who fall under the rule varies widely, but the consensus is that most would be children. The White House gave the number 1 million people in October, but the Kaiser Family Foundation said the old rule excluded 5.1 million people from ACA coverage. Bettencourt said the state Department of Insurance didn’t know how many Granite Staters would benefit from this change, but estimated it would be a small percentage of the Kaiser Family Foundation’s prediction given the state’s population.

Income limit lifted

In the past, individuals and families were only eligible for ACA insurance if their household income fell below 400 percent of the federal poverty line, $54,360 annually for a single person and $111,000 for a family of four.

This rule created a subsidy cliff, with individuals and families earning even $1 over the limit being barred from any subsidy. The income ceiling has been postponed until the end of this year in the US bailout plan. The Anti-Inflation Act extends the deadline to 2025.

Subsidies for those earning above 400 percent of the federal poverty level will decrease as income rises, but subsidies will not be eliminated. “Not a cliff anymore, then,” Ballingall said.

Extended Subsidies

The US bailout also increased subsidies, but only until the end of this year. These improvements will continue through 2025 under the Inflation Reduction Act. This will allow some people to get a plan for little to no premium.

For example, individuals earning up to 150 percent of the federal poverty line, $20,385 for a single person and $41,625 for a family of four, would pay nothing on an ACA silver plan, according to the Kaiser Family Foundation subsidy calculator. Before the change, a person in New Hampshire with this income level was paying $343 per month on a Silver plan.

And under that rule change, someone with twice that income would get a $160 monthly grant and pay $200 a month on that silver plan.

Free navigators

Individuals can sign up for a marketplace plan through the federal government’s website. healthcare.govbut the two navigators First Choice Services and Healthcare Market Connect, may be a better place to start.

Both agents are available to answer questions, verify eligibility, explain the benefits of each plan, and complete enrollment via phone, email, and in person. Staff can also help individuals determine if they are eligible for other state health insurance.

Since the companies are funded by the federal government, the help is free.

Health Market Connect has 10 Navigators in all regions of the state. They offer support in eight languages, including American Sign Language, and can answer questions via Zoom, chat, text, Facebook Messenger and email, Ballingall said. They also book appointments through their website, hmcnh.com.

“We have a team that wants to help anyone and everyone who needs it,” Ballingall said. “If you don’t get health insurance coverage from an employer, there’s a program out there.”

Based in West Virginia, First Choice Services has six Navigators dedicated to taking calls from people in New Hampshire. They speak English and Spanish but can arrange translation for other languages.

The company also has three groups in the state that provide telephone and in-person help: Harbor Care, Lamprey Health, and the Foundation for Healthy Communities. His site is firstchoiceservices.org.

Smith cautioned against finding help by searching the internet, saying companies outside of the state-funded Navigator program may try to sell other plans that offer no subsidies and include exclusions.

“If you work with a navigator, you get the right information,” he said. “But if they do the Google search, there are a lot of different ways that they could end up.”

Bettencourt told the state insurance department, nh.gov/insurance, can also help. “There is no wrong door,” he said.

Public health emergency

Medicaid enrollments surged during the pandemic as health concerns, job losses and childcare shortages left more people out of work and in need of financial assistance. New Hampshire saw a 20.1 percent increase in standard Medicaid enrollments and a 73.5 percent increase in expanded Medicaid enrollments.

As part of the state health emergency that has been in effect since January 2020, states are prohibited from ending this coverage, even for those who are no longer eligible for financial assistance because they have returned to work or have become old enough for Medicare.

That will change when the state public health emergency ends and states are allowed to “redetermine” whether Medicaid recipients are still eligible for coverage. State Medicaid Director Henry Lipman has estimated that 90,800 Granite Staters will not receive and lose their Medicaid benefits.

State Medicaid and Department of Insurance officials have launched a massive campaign to start these new enrollments before the public health emergency is lifted to avoid an insurance gap. Bettencourt said those who have not yet found alternative coverage through the federal market should do so now and not wait until they are found ineligible for Medicaid.

The federal navigators can help determine if Medicaid recipients continue to qualify and, if they don’t, help them find an insurance plan before open enrollment ends on January 15. Individuals can also use the government portal. nheasy.nh.govto determine eligibility and options for new health insurance. There are many issues to consider, from cost to the provider’s network options, Bettencourt said.

“We can help people think this through,” he said. “We’re obviously not going to tell them what to do. We can help them think about their specific circumstances so they can make the best choices for them.”

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