No health insurance? There's still time to sign up for subsidized private coverage during special enrollment window

If you don’t have health insurance, you have a few weeks left to sign up for for low- or no-cost private coverage through the public marketplace.

A special enrollment period that opened Feb. 15 and closes Aug. 15 allows individuals to use healthcare.gov (or their state’s exchange) to sign up for a plan, which might come with significant subsidies to reduce what you pay for coverage. Unless you have a qualifying life event — i.e., getting married, having a child, etc. — after the current window closes, you’d generally have to wait until open enrollment this fall to sign up.

About 1.5 million Americans have secured coverage during the current enrollment period, according to government data through June 30. Another 2.5 million people who already were enrolled through the marketplace have been able to lower the cost of their premiums. Roughly 12 million in all are enrolled through the marketplace, which was authorized by the Affordable Care Act of 2010.

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Most enrollees get financial help. And due to the American Rescue Plan Act, which was signed into law in March by President Joe Biden, the subsidies (technically tax credits) are larger for 2021 and 2022, and will reach a greater number of people.

Before that expansion, the aid was generally available to households with income from 100% to 400% of the poverty level. The cap is eliminated through next year, and the amount that anyone pays in premiums will be limited to 8.5% of their income as calculated by the exchange.

Additionally, as of July 1, zero-premium health plans that come with minimal or no cost-sharing — i.e., deductibles and copays — are available through the marketplace to individuals collecting unemployment at any point this year.

“People who have been unemployed at any point this year essentially can get very generous or free health coverage,” said Cynthia Cox, a vice president at the Kaiser Family Foundation and director of its Affordable Care Act program. 

Overall, about 3 out of 5 eligible uninsured Americans should be able to access zero-premium plans, according to the Centers for Medicare & Medicaid Services. That includes those who would qualify under the unemployment provision.

“Even if you were unemployed earlier this year but have gained employment, if you still have no coverage, you can get it now,” Cox said. “You’d just have to demonstrate you were deemed eligible for unemployment benefits.”

There is no income test to take advantage of this benefit, she said. Be aware, however, that you generally cannot qualify for any subsidies through the ACA marketplace if you can get health coverage through your employer.

“Generally speaking, [enrollees] are people who can’t get insurance any other way — not through their work or their spouse’s work or through Medicare or Medicaid,” Cox said.

If you’re new to the marketplace and think you would qualify for the unemployment subsidies, the best place to start is healthcare.gov. Once you plug in your information and the subsidies are applied, you generally should see at least a couple free “silver” plans, Cox said.

“That’s where you get the premium help, and also additional help with [cost-sharing],” Cox said. “And the deductible is so low that it’s more like a ‘platinum plan,’ which is the best you can get.”

Separately, anyone who’s getting coverage under the Consolidated Omnibus Budget Reconciliation Act  — the law that lets you stay on your employer’s plan when you leave your company — may want to see if switching to coverage through the marketplace would make sense.

COBRA coverage typically is expensive because you are responsible for the full premium instead of your employer chipping in. However, the federal government is picking up the tab for COBRA payments through September, per the American Rescue Plan Act.

When that runs out, you would need to either pay the full monthly premium or find alternative coverage.

“They might want to see if it makes sense to switch to the exchange before then,” Cox said.

The low-cost silver plans cover about 94% of a person’s costs, Cox said, compared with 85% in employer plans.

If you qualify for Medicaid, healthcare.gov should also indicate that. Roughly 81 million people were enrolled in Medicaid or the Children’s Health Insurance Program as of February, according to government data. That’s about 11 million more than pre-pandemic.

The Biden administration has also proposed extending the annual open enrollment for the ACA marketplace. Instead of running from Nov. 1 to Dec. 15 as it has in recent years, it would remain open until mid-January, under the proposal.

Additionally, the administration has proposed allowing year-round marketplace enrollment for households with up to 150% of the poverty level. (Individuals who qualify for Medicaid can already sign up at any time.)

“For now, though, people should act when there is an enrollment opportunity,” Cox said.