It would be hard to imagine a worse time then during a global pandemic to be without health insurance, yet enrollment in the Affordable Care Act (ACA) health insurance marketplaces via Healthcare.gov is down nearly 6% from last year.

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But physicians have an opportunity to help spread the word and ensure that patients and their families have the health coverage they need in the new year—especially important as millions of Americans have lost their employer-sponsored health insurance and may be unaware of the options available to them.

There is still time to select a plan before the Dec. 15 deadline, and it is critical that physicians get the word out. The AMA is taking part in Get Covered 2021, a coalition of states, medical societies, patient and consumer advocacy groups and others working to lower the nation’s ranks of the uninsured, and encouraging people to wear a mask to prevent the spread of COVID-19.

Of the 28 million Americans without health insurance, 16 million are eligible for financial assistance to help pay their costs of coverage. This includes 6.7 million who are eligible for free or low-cost coverage through their state’s Medicaid program and 9.2 million who are eligible for subsidies through a state or federal insurance marketplace.

Across all marketplaces, 86% of enrollees receive financial help covering up to 85% of their monthly premium costs, according to the coalition. Additionally, of those 16 million uninsured who are eligible for financial help, the coalition estimates that this includes:

  • 1.7 million people with diabetes.
  • 525,000 people with COVID-19.
  • 88,000 people with cancer.

AMA President and Susan R. Bailey, MD, and Peter V. Lee, executive director of Covered California, appeared on the “AMA COVID-19 Update” to discuss the importance of health care coverage for all Americans and how to get covered before the Dec. 15 deadline. The appearance was timed to “Get Covered Day,” observed Dec. 10.

Here are three messages to relay to patients.

Uninsured Americans and people interested in exploring their coverage options for 2020 have until Dec. 15 to enroll on the HealthCare.gov website, applicable to 36 states. Fourteen states and the District of Columbia run their own ACA marketplaces, and therefore may have extended deadlines for open enrollment as follows:

  • Nevada—Jan. 15.
  • Massachusetts, Rhode Island—Jan. 23.
  • California, New York, Washington, D.C.—Jan. 31.

In these states and DC, patients will be redirected from HealthCare.gov to shop for an ACA marketplace plan via a state-run website.

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Automatic reenrollment does keep patients covered, but better plans with more coverage and/or a more affordable price may be available.

Nationally, the average benchmark silver plan premium has declined by more than 2% for 2021, according to the Kaiser Family Foundation (KFF).  

The KFF reports that the average monthly benchmark silver plan premium price for a 40-year-old—before any applicable premium tax credits are applied—will be $452 in 2020, compared with $462 in 2020. Price varies widely by geography, however, and the millions of Americans eligible for premium tax credits can enjoy substantial premium savings, with some even having health plan options available at no cost to them.

Patients should follow this checklist of the 10 things needed to complete enrollment in the individual marketplace. These include Social Security numbers, birthdates and mailing addresses for everyone applying for coverage.

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Subsidies are still available to help consumers purchase marketplace plans, but qualifying income levels change year to year. In addition, in California, state law provides qualifying individuals with state subsidies that may be in addition to federal subsidies, and extend to income levels too high to currently qualify for federal subsidies.

So, even though a patient was not eligible for subsidies years ago when they last checked, he or she may be eligible in 2021. Also, patients eligible for subsidies may be eligible for a different amount of assistance for 2021 coverage.

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