A record number of Texans and Americans are enrolled in the Health Insurance Marketplace (HealthCare.gov). What accounts for the spike in enrollment in 2021? This year Congress and the Biden Administration made multiple improvements that make getting coverage easier including enhanced affordability, enrollment assistance, access, and awareness.
Record Enrollment
Marketplace enrollment reached 1.4 million Texans and 12.2 million people nationally as of August 2021. When HealthCare.Gov reopened for enrollment this year from mid-February to mid-August, 417,000 Texans signed up. Enrollment in Texas since 2019 has increased faster than in any other state.
As shown in the following graph, “effectuated” enrollment in the Texas Marketplace has hovered around 1 million people in most years, but increased substantially — nearly 40% — in 2021. (“Effectuated” enrollment counts people who have both enrolled in a plan and paid at least their first month’s premium.)
Coverage at HealthCare.Gov is generally available to people who don’t otherwise have access to insurance through their jobs, Medicare, or Medicaid. Open enrollment for 2022 coverage will begin again on November 1.
Increased Affordability
Congress passed a COVID-19 relief package in early 2021 that boosted Marketplace subsidies, making it much cheaper for most people to enroll in HealthCare.Gov coverage. Financial assistance increased in 3 ways:
- Increased subsidies for people previously eligible with incomes under 400% of the federal poverty level (FPL).These enhanced subsidies, for the first time, allow those with incomes under 150% FPL (about $19,300/year for an individual and $32,900/year for a family of 3) to get comprehensive coverage with a $0/month premium and a low or no deductible.
- Ending the “subsidy cliff.” For the first time, people with incomes over 400% FPL (about $51,500/year for an individual and $87,000/year for a family of 3) can get financial assistance. Subsidy-eligible individuals earning above this income threshold have HealthCare.gov premiums capped at 8.5% of their income.
- New help for people receiving unemployment benefits. Individuals who receive unemployment benefits at any time in 2021 qualify for comprehensive coverage with a $0/month premium and a low deductible.
The first two subsidies will continue through 2022, but help for the unemployed is only available in 2021. The Build Back Better Act currently under discussion in Congress may extend all three subsidies, but it is not finalized yet.
These new subsidies took effect when HealthCare.gov reopened to enrollment earlier in 2021. Half of Texans who newly signed up got a plan that costs $10 a month or less, and Texans who’d already enrolled in HealthCare.gov insurance saw their premiums drop by 46% on average.
Here’s what an individual in Houston at two different annual incomes could pay with enhanced subsidies available through 2022:
- If earning $16,100 a year (about 125% FPL), a plan with no monthly premium and no deductible, or
- If earning $25,000 a year (nearly 200% FPL), a plan for $32/month with a $200/year deductible.
Improved Access
As noted earlier, in response to the pandemic, the Biden administration reopened Marketplace enrollment for 6 months in 2021, from February 15 to August 15. Generally, individuals can only enroll during Open Enrollment in the fall unless they’ve had a life change that lets them qualify for mid-year enrollment.
More Enrollment Assistance
Many consumers encounter difficulty enrolling. Professional enrollment assistance is available from Navigators, Certified Application Counselors, and brokers; however, 5 million Americans seeking enrollment assistance in 2020 were unable to find it. Huge cuts to the Navigator grant program from 2017-2020 substantially reduced access to assistance from Navigators.
In March 2021, the Biden administration increased grant funding to the two remaining Navigator organizations in Texas, and in August 2021 it made the largest-ever Navigator grant award. A total of 10 Texas community-based organizations were awarded $13.4 million in Navigator grants, up from 2 organizations and less than $2 million a year prior.
Increased Awareness
To ensure consumers knew about both the new mid-year enrollment window and more affordable coverage, the Biden administration made a significant investment in marketing. This followed years of limited marketing by HealthCare.Gov due to a 90% cut to funding for HealthCare.gov advertising during the Trump administration.
It should come as no surprise that when you make it easier and cheaper to get good coverage, more people enroll. In prior years, unnecessary barriers to coverage limited access for many Texans. Affordability, particularly prior to enhanced subsides, was a key barrier, but even basic awareness remains a challenge. In 2020 nearly two-thirds of uninsured adults had heard little to nothing about financial assistance at HealthCare.Gov. Meaningful federal efforts to address coverage barriers in 2021 have helped and are the reason Texas Marketplace enrollment is at an all-time high.