Daily Sitka Sentinel

ACA Subsidies Giving Sitkans Healthy Boost

By SHANNON HAUGLAND
Sentinel Staff Writer

The federal American Rescue Plan includes provisions for making health care coverage more affordable under the Affordable Care Act, and it’s resulting in a higher number qualifying for subsidies, the SEARHC patient health benefits department says.

“You always get excited because it makes a big difference for people,” said SEARHC’s Susan Briles, patient health benefits supervisor. “This makes a gigantic difference.”

Susan Briles,  SEARHC outreach and enrollment specialist, talks about  insurance at her office today. (Sentinel Photo by James Poulson)

The American Rescue Plan is part of the new round of relief packages for the pandemic. Part of this is related to health care benefits, and includes both SEARHC beneficiaries and non-beneficiaries who qualify.

President Biden signed the American Rescue Plan on March 11. He announced on March 23 that the special enrollment period to allow people to sign up for health care through the Health Insurance Marketplace is extended to August 15, from the previous deadline of May 15. 

The changes to the health insurance marketplace went into effect April 1, and since then Briles and her team have been able to give some good news to some dozen Sitkans: either that they now qualify for a subsidy under the ACA;  that they qualified for a higher subsidy, or a better plan; or all the above.

“The increase in subsidies has been amazing,” Briles said. “I had for instance a woman who for the last few years has not been able to get a subsidy because their income was over 400 percent of the federal poverty level and since she was having to pay full price, it was around $1,400. She came in, we redid hers, and now it’s $400, literally saved her a thousand dollars a month. Hers was very dramatic, of course.”

Another example of someone who already qualified for a subsidy for the premium (Gold) insurance plan saw the monthly premium cut from $300 a month to $178, after the increased subsidy. 

Not all will qualify under the new subsidy, which caps premiums at 8.5 percent of household income “based on the cost of the benchmark (Silver) plan.” 

“If you didn’t qualify for a subsidy before it’s well-worth your while to sign in and see if you qualify,” Briles said.

The limit for those eligible for a subsidy previously was 400 percent of the federal poverty level: $62,400 for a single household income, $84,520 for two, $106,640 for three, $128,760 for four, $150,880 for five and $173,000 for a six-person household. That has gone up, and the legislation will cap premiums for enrollees at 8.5 percent of household income, based on a Silver plan, the mid-range health insurance plan.

Many who qualified for a subsidy under ACA in the past who have gone to Briles or other patient benefits specialists are seeing a higher subsidy. And some have become newly eligible.

“Now they can get reasonably priced insurance,” Briles said. “There’s a lot of people out there – if they realized this was there – they could get reasonably priced insurance. A good plan for a reasonable price.”

Members of federally recognized tribes also can be newly eligible for more benefits under the Tribally Sponsored Health Insurance program. While the Indian Health Service provides health care to beneficiaries, TSHIP “can help make more services available to ... all Alaska Native and American Indian People, and help you receive medical care when you are traveling or away from tribal health facilities.”

Similar to ACA, TSHIP provides a premium subsidy to eligible beneficiaries who are Alaska residents and not covered by certain other programs. Briles said the plan is useful for those with complex health issues, and who need services and medications outside the IHS formulary.

The deadline to apply for insurance under the Special Enrollment Period, with financial assistance through the American Rescue Plan, has been moved from May to August 15. But Briles noted that Sitkans could be saving money every month if they apply now.

Briles and five other specialists are available for in-person or phone appointments and there is no charge, but residents also can enter information into the healthcare.gov website if they already have an account or want to apply.

Briles said she’s been looking forward to this legislation going through for a few months and started getting an increasing number of emails in recent weeks from the Department of Health and Human Services and Centers for Medicare and Medicaid Services.

A handout from the two departments described the American Rescue Plan the Marketplace component:

ARP makes major improvements in “access to and affordability of health coverage through the marketplace and by increasing eligibility for financial assistance to help pay for marketplace coverage.”

The handout says premiums under the expanded program will decrease on average by $50 per person per month or by $85 per policy per month.

“Four out of five enrollees will be able to find a plan for $10 or less per month after premium tax credits (bronze plan), and over 50 percent will be able to find a Silver plan for $10 or less,” the handout says. (The marketplace in this state has Gold, Silver and Bronze plans. Platinum isn’t available in Alaska, and the only company available in Sitka is Premera.)

The handout also provides information on how the tax credits work.

The marketplace is open to those who are self-employed or whose employer does not offer insurance. A news release from healthcare.gov said more than 500,000 had enrolled during the special signup period under the American Rescue Plan, as of today.

Briles said the calls are starting to come in, but her phone is not yet ringing off the hook. 

Her department can be contacted at 966-8662.

A link to the fact sheet for “American Rescue Plan and the Marketplace” is at:

cms.gov/newsroom/fact-sheets/american-rescue-plan-and-marketplace