Dec. 15 is the deadline to sign up for federally subsidized health insurance; Kentucky enrollment is running behind last year's

By Melissa Patrick

Kentucky Health News

The deadline to enroll in federally subsidized health insurance for 2021 is fast approaching, with the last day Tuesday, Dec. 15 for coverage that starts Jan. 1.  

And while anyone already enrolled will automatically be re-enrolled in a 2021 marketplace plan, it is highly recommended that you check out other options to make sure your current plan still meets your needs. 

“It’s very important for individuals to update their applications, even if they were covered last year, so they can review the most current information on what savings are available and to find a plan that best meets their needs,” Kentucky Health Benefit Exchange Director Edith Slone said in a news release.  

Some things to consider when choosing coverage are whether the number of people in your household has changed, whether your income or medical needs have changed -- which is especially important this year because of the pandemic -- and whether the plan includes your providers or their formularies include your prescriptions.

Consumers are also encouraged to not only look at premium costs, but to also look at annual deductibles, which must be met before much of the coverage will kick in. 

And don't assume you can't afford coverage. The Cabinet for Health and Family Services says about 80 percent of Kentuckians who sign up on healthcare.gov will qualify for a tax credit or subsidy to reduce their monthly payments. 

Under the 2010 Patient Protection and Affordable Care Act, subsidies to offset premium costs are available on a sliding scale for people who earn between 100% and 400% of the federal poverty level. That range next year is $12,760 to $51,040 for an individual and $26,200 to $104,800 for a family of four, says Kaiser Health News, in an article that addresses how to choose a plan if you've had covid-19 and are worried about possible long-term complications.

Map shows Anthem marketplace plan availability by county.

In addition, many Kentuckians will have more choices this year, probably at a slightly higher cost, since Anthem Health Plans and CareSource both expanded their coverage areas, giving 94 of the state's 120 counties more than one company to choose from. This year, only 56 counties had two insurers on the healthcare.gov marketplace. 

Anthem is offering at least one of its 13 plans in all 120 counties in 2021, up from 93 in 2020. CareSource is offering all 12 of its plans in 94 counties, up from 83 in 2020.

Through the end of November, 2,939 fewer Kentuckians had enrolled on the federal exchange than at the same time last year. That was 12.2% less than at this time last year, but because of calendar procession, this year's tally had two fewer days, or 6.7% fewer. Nationally, more people had signed up compared to last November. 

Map shows CareSource plan counties in blue.

As of Nov. 28, Kentucky's enrollment on the federal exchange was 24,043, compared to 26,982 last year, according to the Centers for Medicaid and Medicare Services. None of these numbers reflect any automatic re-enrollments.

"We expected numbers would be less this year due to the pandemic," Susan Dunlap, spokeswoman for the health cabinet, said in an e-mail. " More are qualifying for presumptive-eligibility Medicaid coverage and traditional Medicaid coverage due to loss of income" in the coronavirus pandemic.

Another challenge may be a lack of awareness about the Affordable Care Act coverage on the marketplace, which is most widely known as Obamacare. The Kaiser Family Foundation reports that its polling found public awareness about the 10-year-old law is falling, compared to a decade ago.

"For example, 59% of the public knows the ACA offers subsidies for marketplace health plans, compared to 75% ten years ago," the foundation reports. "Among uninsured consumers today, understanding of ACA options and enrollment rules is more limited. Less than half (43%) know open enrollment is the time to sign up for marketplace plans; and 14% of uninsured individuals living in states that have expanded Medicaid eligibility under the ACA know about this expansion. KFF also finds many consumers are unsure about the current status of the ACA; as of this spring, just 22% of the uninsured know the law remains in effect. Uncertainty may result in part due to public debate and news coverage about a pending Supreme Court case to overturn the law." 

The health cabinet said it is reaching out to current and potential enrollees via direct mail, emails, phone calls, and community outreach events held by local Kynectors, who help people enroll.  

The foundation says the importance of health coverage is greater than ever because of the surge of new coronavirus infections, which can cost upwards of $10,000 for a mild-infection and tens of thousands of dollars for more severe cases. 

"At the very least, people with ACA-compliant private insurance are protected by out-of-pocket maximums, limiting how much enrollees must pay for a hospitalization. There is currently no guarantee that hospitals waive covid-19 treatment costs for uninsured patients, meaning those without coverage could be on the hook for large medical bills," the foundation reports.

It's important to not miss the Dec. 15 deadline because unless you qualify for a special enrollment period, you won't get another chance until next year. 

Where can I find help?

The state-based call center is available at 855-459-6328 to assist Kentuckians with questions about  where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week, excluding holidays.

Click here to find a Kynector, who can provide in-person help with applying for health coverage at no cost. Click here for information on how to assign an authorized representative to apply for or manage your benefits, Kynectors, and insurance agents, who can also help you sign up for benefits. 

Healthcare.gov provides a shopping tool to allow you to preview 2021 plans and estimated prices before you log in.

Healthinsurance.org also offers an Open Enrollment 2021 Guide.

The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.