ACA Health Insurance Changes Lower Costs for Consumers

What kinds of services are covered by ACA health insurance plans?

The COVID Enrollment Period for the Affordable Care Act (ACA) marketplace, which allows consumers to enroll without a qualifying life event, has been extended through August 15, 2021. And new financial help available through the spring 2021 pandemic relief bill (called the American Rescue Plan) empowers even more individuals and families to choose a high-quality, affordable health insurance plan tailored to meet their particular health needs. 

If you don’t have health coverage through your employer or another government program, the ACA marketplace has a plan that’s just right for you. Bill Tuthill, vice president of federal markets for Highmark, is here to help you take advantage of new ACA subsidies that lower premiums and other out-of-pocket costs. 

What kinds of services are covered by ACA health insurance plans?

ACA plans offer comprehensive health coverage. All plans must cover certain “essential health benefits,” which include important items such as doctor’s visits, inpatient and outpatient hospital care, prescription drug coverage, mental health services, and pregnancy and childbirth.  And, ACA plans cover a variety of preventive services – like vaccinations and annual wellness visits – for $0.

The American Rescue Plan made some important changes to the ACA marketplace. What should consumers know, and what kind of financial help is available to individuals and families?

The ACA marketplace provides a range of affordable coverage options for individuals and families, and the American Rescue Plan made ACA plans affordable for even more consumers. Under the American Rescue Plan, consumers who make more than 400 percent of the federal poverty level–which is about $51,000 for an individual and $105,000 for a family of four–are now eligible for subsidies or tax credits through the ACA marketplace that lower premiums. Previously, these consumers who made more than 400 percent of the federal poverty level were not eligible for premium subsidies. 

As an example, a 64-year old married couple making $75,000 (435% FPL) previously had a silver premium of $1,600 per month since they were not eligible for premium subsides. With the passage of the American Rescue Plan, this same plan will now costs them $530 per month. This represents a monthly savings of over $1,100 ($13,000 annually) and a drop in the percent of their income spent on premium from 26.3% to 8.5%.  So, ACA plans are now a great option for more middle-class individuals and families. 

On top of that, the American Rescue Plan qualifies those who currently have health insurance coverage through the ACA for enhanced subsidies and tax credits and expands the availability of plans with $0 premiums after subsidy. The bill also provides maximum financial assistance available for ACA health insurance for those who filed for unemployment at some point in 2021, and caps the amount of money any consumer can contribute toward the premium of the benchmark plan (second lowest cost silver plan) at no more than 8.5 percent of their income. 

Early results indicate that with the passage of American Rescue Plan, nearly 90% of Highmark’s ACA members qualify for subsidies or tax credits to make their coverage more affordable, this is up from 75% before passage. Furthermore, we expect the new legislation to add to the nearly 8,000 Highmark members in Pennsylvania who already receive a tax credit that reduces their premium to less than $5 per month.

Highmark also offers ACA plans in Western Pennsylvania with some of the lowest deductibles in the state, including options with $0 deductibles. 

What kinds of health plans does Highmark offer to ACA shoppers? 

We realize that our ACA customers aren’t all looking for the same thing in a health plan, so we make a broad range of options available and help our customers make the right decision for them. 

Highmark’s most affordable ACA plan in the Pittsburgh and Erie markets is Together Blue, which offers consumers access to high-quality, convenient primary and specialty care through Allegheny Health Network (AHN). With Highmark and AHN together, we can connect your coverage and care to create a remarkable health experience–one that offers lower costs, higher quality and convenience. The value offered by Together Blue continues to increase as AHN introduces new and expanded access points across Western Pennsylvania, bringing care closer to where people work and live.

In Western PA, we also offer a range of ACA plans that provide consumers with a network built around AHN and select community hospitals (called my Direct Blue) and broad-network access plans (called my Blue Access). In 2021, both my Direct Blue and my Blue Access ACA products will offer in-network access to 95 percent of doctors and hospitals around the country through the national BlueCard® program.

To give consumers flexibility and convenient access to care, all of Highmark’s individual and family products also cover video visits. And, in response to positive feedback, we have expanded our number of ACA plans that offer bundled adult dental and vision coverage. Highmark is the only insurer in the region offering ACA plans that include adult dental and vision coverage.

What advice do you have for ACA shoppers?

Current ACA marketplace enrollees should update their application online or call a trusted Highmark advisor or their health insurance broker, in order to see the new savings available through the American Rescue Plan this year. Consumers who are new to the ACA market should either visit Pennie.com or call a Highmark advisor or broker to shop for plans on the marketplace. The new savings from the American Rescue Plan has made high-quality, ACA coverage affordable for even more consumers. 

Where can people go to learn more?

To learn more about our ACA plans, you can visit https://www.discoverhighmark.com/plans/aca-plans.html or call 877-959-2550. We have an expert team available to help new and current shoppers update their applications, as well as sort through their options, and pick the right plan for them.