There are an estimated 100,000 individuals enrolled in non-group coverage that is ACA-compliant who can enroll in Pennie™ coverage with access to savings under this legislation.
The American Rescue Plan Act (ARPA) includes provisions specific to the Affordable Care Act (ACA) resulting in significant impacts, including large savings, for Pennsylvanians seeking individual market coverage and those already enrolled in coverage through Pennie™.
This is the largest coverage expansion since the ACA passed in 2010. The eligibility enhancements under this law allow for money to be put back in the hands of people and provide potentially life-altering coverage and relief to many Pennsylvanians who may be struggling with the pandemic and its economic repercussions.
What’s included in ARPA?
The plan includes an increase in the eligibility for, and the amount of, premium tax credits for Pennsylvanians at all income levels during the 2021 and 2022 plan years. Those earning more than the current cap of 400% of the federal poverty level — about $51,000 for an individual and $104,800 for a family of four in 2021 – will be newly eligible for subsidy tax credit.
Under this law, no one will pay more than 8.5 percent of their income in premiums for the second lowest cost silver plan, the benchmark plan, in their county. In some cases, lower-income enrollees could have their premiums eliminated completely.
How does this affect existing Marketplace members?
These eligibility changes also affect the current customers in the marketplace. Under this law, most of the existing enrollees will have an increase in the amount of the financial assistance they receive each month, this also includes individuals who will now become eligible for these Advanced Premium Tax Credits.
Once the changes are implemented, customers will see a decrease in their monthly premium payments. This is also an opportunity for individuals to check if they would like to move to a different plan.
How does this play out for a real member?
- Scenario A: A 40-year-old single woman, nonsmoker who lives in Philadelphia with a $19,140 annual income. Under the old law she would be paying an estimated $66/month for the benchmark plan. Under this new law, she will now be paying $0/month. Savings of $792
- Scenario B: a married couple, who are both 64-year-old, non-smokers from Dauphin County with an annual income of $77,580. Under the old law, they would be seeing a monthly payment of around $2,400 and now under the new law, they will be paying $550, capped at 8.5 percent of their income for the benchmark plan. Savings of $22,200
What if a member enrolled in off-exchange coverage?
Another key target audience affected by this law is those Pennsylvanians enrolled in off-exchange coverage. Individuals enrolled in individual coverage without a subsidy should check to see if they would be better buying a plan on the exchange.
My Benefit Advisor’s team of certified specialist are available to make sure customers on the individual market are aware of these savings and to assist those who wish to make the transition and take advantage of this increase in financial assistance. Please contact My Benefit Advisor at (855) 874-0267 or www.mybenefitadvisor.com/indvidual.