Obamacare subsidy calculator *
Estimated annual subsidy
Edit, 5/11/2021: This article was written in March 2020, at the start of the COVID pandemic. We’ve updated it with information applicable for 2021, including details about the one-time special enrollment window in 2021, and the extra subsidies that are available as a result of the American Rescue Plan.
We all have plenty to fear from the coronavirus: serious and life-threatening illness, sudden loss of job or income, physical separation from loved ones.
If there’s any silver lining, it will come through social solidarity. With a highly contagious disease circulating, the health of each of us is the health of all us. After a slow start, federal and state governments are moving swiftly to provide guidance and relief: free coronavirus testing, paid sick leave, increased unemployment insurance, loans to small businesses, and cash relief to individuals.
To slow the spread of the disease, it’s essential that Americans have access not only to coronavirus testing but to affordable care should they become ill – just as many may lose job-based insurance. To that end, the Affordable Care Act is on standby, as the financial help it provides to those who lack access to job-based insurance or Medicare is based on income.
Many Americans who lose their jobs will be eligible either for Medicaid or for subsidized private plan coverage in the ACA marketplace. The tips below will help you seek and find coverage if you need it, or get your costs reduced if you’re already covered through the marketplace and your income drops.
Need coverage? Here’s where to start.
To make use of the information below, these websites are starting points:
Apply for Medicaid: State Medicaid websites
Medicaid expansion states: Medicaid expansion map (these are states where Medicaid eligibility has been expanded as called for in the ACA; coverage is available to non-elderly adults with income up to 138% of the poverty level)
Coverage of COVID-19 testing, treatment
The Families First Coronavirus Response Act, created by House Democrats and signed by President Trump in March 2020, makes COVID-19 testing and associated office visits free for all Americans – that is, those with employer-sponsored or ACA-compliant individual market insurance, Medicare, Medicaid, or no insurance at all.
Treatment (beyond testing) for those who require it is covered according to the terms of your own insurance. Currently, the deductibles and copays or coinsurance stipulated by your plan apply, though many insurers have opted to waive some or all of those fees for a limited time.
How can you get ACA coverage if you lose your job?
If you lose your job – and your employer-sponsored health insurance with it – you become eligible for a special enrollment period in the ACA marketplace. That’s true anytime, but the rules are much more relaxed in 2021. Because of the COVID pandemic and the enhanced premium subsidies provided by the American Rescue Plan, there’s a one-time enrollment window that runs through August 15, 2021 in most states. Although the rules do vary a bit in some of the fully state-run exchanges, residents in most states can use this window to newly enroll or switch from one plan to another, without needing proof of a qualifying event (loss of coverage is always a qualifying event, but in most states, you don’t need to show proof of this if you’re enrolling during the extra enrollment window that’s available in 2021).
You can apply through HealthCare.gov if you’re in one of the 36 states that use the federal website. Fourteen states and Washington D.C. run their own ACA exchanges. You can also get assistance from a licensed broker through this site. You can also get started via the HealthCare.gov Help Line, 1-800-318-2596, or by calling the helpline posted on each of the state-based exchanges.
Depending on your total income for the year, you’re likely to qualify for substantial premium subsidies in 2021. This ACA subsidy calculator can give you a sense of how large your premium subsidy might be. The American Rescue Plan has eliminated the “subsidy cliff” for 2021 and 2022, increased the size of premium subsidies for those two years, ensured that people receiving unemployment benefits in 2021 can get robust coverage with no premiums (or very low premiums, depending on the plan they select), and it provides full COBRA subsidies through September 2021 for people who involuntarily lost their jobs or had their work hours reduced.
To get a quick sense of how much you may pay for coverage in the ACA marketplace, and what plans are available at what prices, you can use the “See plans and prices” preview tool if you’re in one of the 36 states using HealthCare.gov. Most state-based exchanges have similar tools. If you answer about a half-dozen questions about income, age, family size etc., you will see what’s available. Unlike in an actual marketplace application, you maintain anonymity in this preview.
In the 36 states (and the District of Columbia) that have implemented the ACA Medicaid expansion, you should qualify for Medicaid if you lose your job – or you’re a freelancer who loses much of your income – and your monthly income going forward is below 138% of the federal poverty level ($1,481 for an individual, $3,048 for a family of four*). Apply through your state Medicaid office or website.
Important note for those whose income falls abruptly, e.g., to zero: While the ACA marketplace (HealthCare.gov for 36 states, state-based exchanges in 14 states and D.C.) calculates subsidy eligibility and Medicaid eligibility on the basis of yearly income, state Medicaid departments determine Medicaid eligibility on the basis of monthly income.** Accordingly, if your earnings before layoff or loss of work were substantial, and your income going forward is zero or below the Medicaid threshold, you should apply for Medicaid through a state office or website, not through the ACA marketplace.
Note that the enhanced federal unemployment benefits provided by the CARES Act (and extended under subsequent COVID relief bills) are not counted in determining eligibility for Medicaid and CHIP, but are counted in determining eligibility for ACA marketplace subsidies.
If you are currently insured through the ACA marketplace and your income drops, you can report a qualifying life event through HealthCare.gov (in 36 states) or through your state-based exchange (in the other 14 states and D.C. ). With a reduced income, you may pay less for your monthly premium, or you may newly qualify for cost-sharing reduction (or more CSR if you already have it). You may also be newly eligible for Medicaid – which is usually zero-premium – if you are in one of the 36 states (or D.C.) that have enacted the ACA Medicaid expansion.
Coverage if you are uninsured
If you are uninsured and did not lose your insurance within the last two months, normally you would not be able to obtain ACA-compliant insurance until the next open enrollment period in the fall, with coverage effective in January of the coming year. But because of COVID and the American Rescue Plan, a one-time enrollment window is available in 2021. It continues through August 15, 2021 in most states, although there are some states with earlier deadlines (the deadline ended in April in Idaho, for example) or much later deadlines, some as late as the end of 2021.
If you can’t afford ACA-compliant coverage
As a result of the American Rescue Plan and the extra enrollment window in 2021, most people who need health coverage can obtain it at reasonable costs. But it’s worth noting that the family glitch still exists, as does the Medicaid coverage gap in the dozen states that have refused to accept federal funding for Medicaid expansion.
For individuals who don’t qualify for premium subsidies as a result of the family glitch or the Medicaid coverage gap, short-term health insurance plans may be an option. These lightly regulated plans exclude coverage for pre-existing conditions, are not required to cover essential health benefits covered by ACA-compliant plans. They’re also not required to cover coronavirus testing or treatment. Short-term plans are also not currently sold in all states. Check the availability of short-term plans in your state.
Get covered if at all possible
If this all sounds complicated, it sometimes is. But affordable insurance is available to most Americans, and with the tools above you will likely find your way. In many cases, application and enrollment can be completed within an hour.
Again, in-person help is available, either from a licensed agent or nonprofit assisters chartered by the ACA. You can find the latter through the “Get Help” tabs at HealthCare.gov and the state exchanges.
* * *
* While the marketplace uses Federal Poverty Level totals for the year in which open enrollment occurs (2020 for 2021 coverage), Medicaid uses current-year numbers (2021 at present).
** Thanks to John Graves for highlighting this point.
Andrew Sprung is a freelance writer who blogs about politics and policy, particularly healthcare policy, at xpostfactoid. His articles about the rollout of the Affordable Care Act have appeared in The Atlantic and The New Republic. He is the winner of the National Institute of Health Care Management’s 2016 Digital Media Award. He holds a Ph.D. in English literature from the University of Rochester.