Affordable Health Insurance: ARPA Expansions

The American Rescue Plan Act of 2021 (ARPA) has put into place several temporary expansions to the Affordable Care Act (ACA) provisions that can help Americans access health coverage at affordable prices. In general, these benefits apply to people who purchase health insurance in the Marketplace (created by the ACA) because they do not have an affordable option available through employment. The expansion has two dimensions: 1) more people are eligible for help paying the health insurance premiums for plans purchased in the Marketplace, AND 2) those who are eligible for help are now eligible for MORE help, so that their share of the monthly premium can be reduced.  People who are unemployed will especially benefit.

The Health Insurance Marketplace is now open for enrollment through August 15, so if this information makes you want to enroll in a plan OR change the plan you chose, you should be able to do so in the next few weeks. NOTE: The law took effect March 11. The agency in charge of the Health Insurance Marketplace expects to be ready to implement many of the changes on April 1. Suggestion: if you call or log in to the Marketplace in early April, ASK if the new rules are yet in place. It might be worth waiting a week or two in order to be sure the changes have been built into the system.

More Help. The ACA created a maximum cost people would have to pay for health insurance premiums, stated as a % of your income. The ARPA dramatically reduced that percentage of income for 2021 and 2022.  For example, suppose you are a 2-person household with income of $43,000/year (which is just under 250% of the poverty level); under the ACA your share of the premium for a benchmark silver plan would have been 8% of your income; under the new ARPA guidelines, your share of the premium cost for that same silver plan is just 4% of your income. Implications:

  • Some people who previously decided health insurance was too expensive will NOW decide it is affordable under the new rules.
  • People who chose a less-expensive bronze plan despite its higher deductible and copays may NOW decide a silver plan is worthwhile.
    This is of special value to those who are at or below 250% of the federal poverty mark, because these folks are eligible for plans that sell for a “silver” price but have smaller deductibles and copays so that they are more like a gold or platinum plan. In other words, folks under the 250% level can get a premiere plan for a budget price.
    It’s sort of like getting a brand-new luxury SUV for the price of a 2014 compact sedan!
  • If you are already enrolled in a Marketplace plan, there is a good chance that your share of the monthly premium is reduced under the new rules. Consider contacting the Marketplace (800-318-2596) sometime later in April.

More People Eligible.  Under the original ACA rules, if your income was over 4 times the poverty level, you were not eligible for help paying for health insurance. Under the ARPA expansion, people of any income level are eligible if the cost of the Marketplace plan would exceed 8.5% of their income. This will be especially valuable for those in their 50’s and 60’s, since health insurance premiums rise with age. This provision is also in effect for 2021 and 2022. 
Implication: some people with incomes above the 400% threshold may have compromised to save money by purchasing health coverage that was poorer quality (that is, it does not meet the ACA standards related to broad coverage and value). With the new cap of 8.5% of income regardless of income level, these folks might now be able to purchase a high-quality plan for an affordable price.

Huge Benefit for Those Unemployed at ANY time during 2021.  Note: this benefit is ONLY in effect in 2021.  If you receive(d) Unemployment Income at ANY time during the 2021 calendar year, special rules apply for your eligibility. With regard to eligibility for help paying for health insurance in the Marketplace, any income above 133% of the poverty level will be disregarded. That means these households will be eligible for the “platinum-like” silver plans for FREE – the premiums will be entirely covered by the subsidy.  Note: all other qualifications must also be met. For example, if you have workplace coverage available that is considered affordable, then you will not be eligible for the free silver plan.  However, if you are unemployed now, take advantage of the free silver plan. If you get a new job in a couple months that provides insurance, you can then drop the silver plan.
For those whose incomes are below 100-133% of poverty, they will be eligible for Medicaid coverage (also free), even in states where Medicaid was not expanded.

COBRA Subsidy. For people who lost health coverage due to being laid off or having their work hours reduced, the government will cover the cost of their COBRA premiums for up to six months, from April 1 – September 30, 2021. Check with your employer about how this might help you. Even if you lost your job months ago and did not sign up for COBRA at that time, you should now be able to sign up for COBRA.
Note: if you are in this group, you might also benefit from Marketplace insurance or Medicaid, so be sure to evaluate all your options.

Primary Source: Kaiser Health News Details for the % of income (paragraph 3) from Kitces.com
For more information see: https://www.healthcare.gov/more-savings/

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Health Insurance Marketplace Reopens

Normally the health insurance marketplace is open just once a year in the fall (Nov 1 – Dec 15). This year, however, the government is opening the federally-run Marketplace today (February 15) for three months. Since Iowa uses the federal marketplace (www.healthcare.gov), this opportunity is available to Iowans. For readers in other states: many of the state-run health insurance marketplaces are also opening for the same three-month period.

Are you worried about choosing a health insurance policy? ISU Extension is offering a one-hour online workshop called “Smart Choice Basics” to help you understand key factors to consider when choosing a policy. The workshop is free, but pre-registration is required. Two options are available – choose the one that fits your schedule, and preregister today!

In the health insurance marketplace, Americans who do not have quality coverage available on the job can enroll in insurance plans that cover the ten essential benefits (including prescriptions, mental health care, rehabilitation, and more). In addition, you may qualify to get help paying the premiums, through the Premium Tax Credit. You may be eligible for a Premium Tax Credit if your income is below: $51,000 (single); $68,900 (couple); or $104,800 (family of four). Find out more at www.healthcare.gov. NOTE: if you are very near the income limit, you are eligible for only a small amount of help, but it does cap the percentage of your income you’ll need to pay for health insurance.

Keep in mind: You can always have a “special enrollment period” in the marketplace if you lose your insurance (e.g. leave your job, get divorced, or other reason). This new opportunity can be helpful for people who didn’t sign up when they could have, but have now decided that they need insurance after all.

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Understanding Health Insurance

This time of year many Americans make health insurance decisions. If your health insurance comes through your employer, you may be making plan choices in the next month or so, and if you purchase insurance individually, open enrollment is November 1 through December 15. Are you equipped to make informed choices about your health insurance?

ISU Extension and Outreach offers two free on-line workshops on health insurance topics:

  • Smart Choice Basics focuses on the key things to know before you sign up for a specific health plan. It’s useful to people who get their insurance through their employer as well as to people who need to purchase insurance on their own. It also addresses questions about how to get help paying for health insurance via the HealthCare.gov Marketplace. It is being offered November 19 and December 1 (6 p.m. each day).
  • Smart Use: Smart Actions for Using your Health Insurance Wisely. This workshop focuses on seven key actions for consumers to take, including keeping track of the health care they receive, reviewing their bills carefully and disputing errors, understanding deductibles and co-pays, and more. It is being offered November 2 and December 8 (6 p.m. each day).

Understanding key health insurance principles can save you money year-round. It also gives you the confidence to ask useful questions about health costs and bills, and to make informed choices about when and where you receive the health care you need.

Pre-registration for the health insurance workshops is required.
Questions? Contact Barb Wollan or Brenda Schmitt. The flier is attached below if you’d like to share it with others.

These two workshops were developed by a team of experts from across the nation led by University of Maryland Extension. They are conducted locally by trained Iowa State University Extension and Outreach specialists.

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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October Dates to Remember

Around this time of the year, I get a surge of individuals wanting me to prepare the previous year’s taxes. Then I remember…October 1 is the first day to file the FAFSA for college financial aid. Some colleges award scholarships and financial assistance on a first-come, first-served basis.

October Dates to Remember

October 15 is the new deadline to file your return if an extension was filed earlier this year.  If you filed for an extension on your taxes, October 15 is also the last day to contribute to a SEP IRA for self-employed people and small business owners.

Sometime in the fall, usually beginning in October or November, most employers hold their open enrollment period so you can change your employee benefits for the upcoming year. Review your health election, 401(k), and other employee benefits like life and disability insurance to see if they’re still meeting your needs. Do you have a flexible spending account (FSA)? Use those funds for qualified medical expenses or child care expenses by the end of the year. That money generally won’t roll over into next year. If you have a health savings account (HSA), that money will roll over and is tax-deferred, so consider maxing it.

November 1 is just around the corner and is the opening day of the federal health insurance marketplace enrollment for 2021 coverage. Iowa State University Extension has online class scheduled to help individuals choose wisely, the kind of health insurance they need.  The Smart Choice Basics class is intended for individuals that are 65 or younger and helps you select the right plan. Smart Choice Actions teaches individuals how to make wise use of the health insurance plan and intended for adults of any age.  Both workshops are 1 hour long at begin at 6:00 PM.  For dates and registration information, go to…

10/26/20  Smart Choice Basics

11/2/20  Smart Use

11/19/20 Smart Choice Basics

12/1/20  Smart Choice Basics   

12/8/20  Smart Use

Brenda Schmitt

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Laid Off? Health Insurance Options

It’s tough to live on reduced income after a reduction in hours or a job loss, but unemployment benefits can help to bridge that gap, at least for a while. The expanded eligibility and expanded benefit amount provided through federal legislation in response to COVID-19 has helped thousands of Iowans.

Losing employment (or even reduction in hours) often means that workers also lose their health insurance coverage. Depending on the situation, that loss may be even more disruptive than the loss of income. Fortunately, there are some good options available for obtaining affordable health insurance outside of your workplace.

Free Insurance. If your income is below a certain threshold, you may be eligible for free health coverage through the state, and you can apply at any time during the year. This coverage is available to everyone, regardless of whether they are disabled or have children in the home, thanks to the fact that Iowa signed on to the expanded Medicaid portion of the Affordable Care Act.  The income guidelines for this option depend on family size:  for a single individual, the 2020 income limit is nearly $17,000; for a family of four, it is nearly $35,000. There are some nuances in the recording of income, so even if your income is a little above the limit, it is worth applying – you may be eligible. ALSO – even if your income for the first six months of the year puts you over the limit, it is still worth applying if your situation has changed, because the income limits are considered on a month-by-month basis. To apply, contact the Department of Human Services at 855-889-7985.

Coverage for Children. Through Healthy and Well Kids in Iowa (Hawk-I), children and teens under age 19 are eligible for free or nearly-free health coverage up to much higher income levels, so if you are having trouble affording health insurance for your children use the same DHS phone number (855-889-7985) to inquire and apply.

Income too high for free coverage? There are still options! The high cost of health insurance often means that even those with average incomes may find it unaffordable. Through the Health Insurance Marketplace, you can find high-quality health insurance plans; you may be eligible for help in paying the premiums if you do not have access to an affordable employer plan and if your income is below a generous limit. The 2020 income limit here is $49,960 for a single individual, and $103,000 for a family of four. You will be expected to pay part of the premiums, based on your income, but the government will pay the rest. The Kaiser Family Foundation’s Health Insurance Subsidy Calculator will provide a good estimate of the help you might receive.  

To enroll mid-year in coverage through the Health Insurance Marketplace, you must be eligible for a special enrollment period; generally that ends 60 days after your previous coverage ends. Learn more or enroll at www.healthcare.gov or by calling 800-318-2596. Many community health centers offer assistance in considering options and enrolling, as well. 

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Nursing Home Residents: Keep your economic impact payment

If finances are tight, the federal economic impact payment being issued through the CARES Act for coronavirus relief may have a big impact on your well-being. Unfortunately, residents of care facilities in many states (including Iowa) are being told incorrectly that they must relinquish their payment.

This problem occurs when an individual is receiving Medicaid benefits to help cover the cost of their care. Nursing home administrators, acting on misinformation, believe they must recover the extra income to defray Medicaid costs. However, the CARES Act specifically labels the payments as “tax credits,” and tax credits are exempt from income and resource limits placed on those who are benefiting from certain government assistance programs.

Nearly every United States household should receive an economic impact payment, including households that receive Social Security, Supplemental Security Income (SSI), or Veterans Administration benefits. The payments should be deposited automatically to the same account where you receive either your tax refund or your SSA, SSI, or VA income. The IRS, which is responsible for issuing the payments, offers a lookup resource to help people track their payment. Note: the look-up link for those who do not file a tax return is separate from the link for tax filers; be sure to use the correct link.

If you have loved ones living in care facilities, especially if they are receiving Medicaid benefits to help cover the cost of care, be on the watch for any attempts to get them to turn over their economic impact payment to the facility. If this has already occurred, it should be refunded; contact the Iowa Attorney General’s office for help if needed. Note: it is important to keep in mind that nursing home administrators who try to claim the payment are not trying to steal; they are trying to do the right thing, but are simply misinformed about what the law requires.

Source: Federal Trade Commission

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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COVID-19 and Unemployment Insurance Benefits

This is a stressful time for individuals and communities across Iowa and we are dealing with many unknowns. Communities are impacted by the temporary closure of businesses, schools and other public facilities or events, and in some cases, quarantines. While these actions are necessary steps to help reduce exposures, it may bring financial uncertainty for many people who could experience a loss of income due to illness or workplace closures.

If you do experience unemployment, remember there are supports in place for you and your family. Iowa unemployment benefits are available to individuals who are unemployed through no fault of their own. If your employer needed to shut down operations and no work is available, you would be eligible to for unemployment benefits. Unemployment claims that are filed as a result of COVID-19 will not be charged to employers.

Many people wonder if they can receive unemployment benefits if they need to stay home from work to care for a dependent, family member or if their child has school cancellations. The answer is, “It depends”. A good approach is to contact your employer regarding potential telecommuting, sick leave, PTO, FMLA, Disability and other options they may be offering.  If those options are not available, you may file for unemployment insurance benefits to determine your eligibility.

Also note, an employer can require an employee to stay at home for the fourteen day isolation period if they have traveled out of state or had contact with someone who visited an area affected by COVID -19. Your employer should attempt to provide paid leave but if that is not available, employees might be eligible for unemployment insurance benefits.

To learn more about filing an unemployment claim, contact your local Iowa Workforce Development Center or apply online at:  https://www.iowaworkforcedevelopment.gov/file-claimunemployment-insurance-benefits.

Mary Weinand

Guest Blogger: Mary Weinand, Iowa State University Extension Family Finance Field Specialist.

Brenda Schmitt

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Insurance Claim Denied? Appeal!

Stamp: Denied They are words we hope we’ll never hear: “your health insurance claim is denied.” It happens, though – millions of times each year. Sometimes a denial is legitimate – the treatment truly is not covered by the insurance policy. But at other times the claim was denied in error.

A recent study by the Kaiser Family Foundation revealed that, when faced with a denied health claim, fewer than one percent of consumers appeal.* The study did not explore why consumers don’t appeal. It is likely that sometimes they don’t appeal because they are so busy dealing with all their health problems and don’t have the energy to deal with it. In addition, I can imagine that consumers may be intimidated by the complexity of the insurance world; I can also imagine some people may not even realize that appealing is an option.

When I read how few people appeal, I was concerned. I want consumers to know they can appeal, and that they should appeal if they believe a medical treatment should have been covered by their policy. NOTE: insurance companies generally allow a specific window of time in which to appeal – probably 2-4 months – so try to deal with it fairly speedily.

Knowing you have the right to appeal is the first step. Contacting the insurance company to request a written statement explaining the reason for denial is step two.

From there, options vary. You may be able to enlist support from your medical provider to justify the medical necessity or clear up any coding errors. Beyond that, ask the insurance company to outline its appeal process, and follow it carefully, keeping copies of all correspondence. If your appeal is denied by the company, ask about an external appeal process — some types of plans include provisions for external review.

If you are not satisfied with how your appeal is handled, consider a complaint through the Iowa Insurance Division. ISU Extension’s Iowa Concern Hotline (800-447-1985) is another resource when you don’t know what steps to take next; their staff attorney provides legal education and may be able to help you identify additional options.  

*Note: the data used in the KFF study was limited to plans offered through the healthcare.gov Marketplace; it is possible that appeals rates might be different for other plans, including employer-sponsored plans.

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Smile! For the Camera

On Super Bowl Sunday in my area it was so foggy you could not see your hand in front of your face. While many were preoccupied with football (or the commercials), there were others that were taking advantage of weather that easily conceals illegal activities.

Padlock

On Monday morning, my colleague found that the family’s storage unit, located a few blocks from their home, had been broken into. In total, there were 4 or 5 units that had been broken into, plus it was obvious that unsuccessful attempts were made on several other units.  An examination of the storage units that withstood the break-in attempts made it clear that the quality of the padlock is what made the difference in the safety of the contents. My friend was lucky because only tools and equipment were stolen — not the classic car they also had stored in the unit.

This is a common problem among rural properties.  Farmers often have buildings that they only spend time in during the spring, summer and fall months. Thieves will frequently enter these building and take a few small items. Their intent is to see if you notice that the small things are missing AND to take inventory of larger, more expensive items stored in the building. They may also leave something leaned or stacked in a certain way that would topple or need to be moved if someone entered the building. These tactics inform the thief whether someone does visit this building.  After several weeks, if the building still appears un-visited, they will come back and help themselves to the big-ticket items. A lot of farmers use trail cameras, (cameras used by hunters to study the activity of animals in the area) to monitor building sites or even their homestead.

With all the new and fairly inexpensive security equipment on the market – doorbells with cameras, spotlights with built-in cameras and small camera units – it is no surprise that the police are having an easier time catching thieves. It is also interesting to see the number of police and neighborhood postings on Facebook asking for help in identifying thieves that are caught on home security systems. As for my friend, it was suggested by local police to consider using a trail camera to keep an eye on their storage unit and, of course, to purchase a better lock.

Brenda Schmitt

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Winter Weather: Time to organize!

In much of Iowa, our recent winter weeks have held lots of days suitable only for staying indoors. We’ve canceled or postponed many plans, and some of our dogs have missed lots of walks because some days were just too cold or windy.

So what can we do with those snow days?  I have an idea!
No, it’s not binge-watching your favorite shows or movies, nor does it involve baking. You don’t need ME to suggest those!

My idea is less recreational, but much more valuable in the long term: go through your files!

Cleaning and organizing files is a task we tend to procrastinate. But in an emergency, and even in many non-emergency situations, we sure would like to turn to our files and immediately put our hands on the document(s) we need. When need arises, we’ll be glad we invested some time in getting organized.

Here’s the good news: it’s a task that can be broken up into small doses.

  • If you already have a filing system, you can just go through one or two files a day, to pull out old materials that are no longer needed, and make sure the most current information is in front.
  • If you do not have a filing system in place, start with a small stack of papers from wherever you’ve been storing them. Create file folders or envelopes for each category of papers you run across. For example, if the first paper you come to is about your car insurance, then create a car insurance file. Perhaps the next item will be college transcript – if so, create an education file.

Well-organized files have three characteristics:  1) they are clearly labeled; 2) the newest and most important information is in front; and 3) out-of-date and unimportant documents are removed. Determining what is important can be a challenge. Some tips for starters: 

  • Insurance – keep the most recent summary of coverage (declarations page). In addition, keep the full policy booklet if you have one, and any updates you receive about coverage details.
  • Mutual fund accounts – keep your quarterly statements until the year-end statement arrives; that should include all activity for the year, so you can discard the quarterly statements. Keep all year-end statements, with the most recent in front. Keep the most recent prospectus. There is no need to keep annual reports.
  • Monthly bills – once you get the next statement showing that your payment was received, you can safely discard the previous statement, unless you need it for tax purposes.
  • Warranties and purchase records for warrantied items – keep as long as you own the item. Keep the purchase information longer if the item affects your taxes.
  • Taxes – after six years, they can be discarded.

Personally, my biggest filing problem is old folders with labels that have fallen off – I need to go through and re-label files. Which filing task most needs your attention?

Barb Wollan

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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