Dive Brief:
- HHS released data this week estimating that up to 2.5 million people who currently pay for off-marketplace individual coverage may be eligible for tax credits if they purchase their 2017 coverage through the ACA marketplaces.
- It highlighted that six states in particular have a high number of these off-marketplace consumers that could potentially take advantage of marketplace-only tax credits: California, Texas, Florida, North Carolina, Illinois and Pennsylvania reportedly each have more than 100,000 such individuals.
- The HHS noted currently there are more than 9 million people already receiving financial assistance for ACA health coverage, and pressed the public to check their options on HealthCare.gov or their state marketplace to find out if they too could benefit.
Dive Insight:
The administration is releasing the data as it pushes further education and outreach efforts to bolster lower than expected ACA enrollment, and to especially attract more young and healthy consumers to help balance the overly sick risk pool that has contributed to insurer losses and departures, and to skyrocketing premiums among many of those remaining.
Many consumers may be unaware that they qualify for assistance, or even if they do, may not realize its value in that the assistance would protect them from future premium increases because it rises in tandem, the HHS said. It has stressed since August that because of the rising tax credit assistance, 73% of current marketplace consumers will still be able to find 2017 coverage for under $75 per month just as in 2016.
The HHS cited a recent Commonwealth Fund survey that concluded only 52% of uninsured adults were even aware of the financial assistance that is offered to qualifying individuals through the ACA marketplaces.
The new data indicate there are about 6.9 million people buying off-marketplace insurance, of which all but 1.9 million could enroll in marketplace qualified health plans (QHPs). Those 1.9 million either fall under Medicaid or in the Medicaid coverage gap, or are ineligible for ACA coverage due to immigration status.
Among both on and off-marketplace consumers, more than 70% of all those who are currently insured and eligible for QHPs have incomes that could qualify them for tax credits, the HHS said. When adding QHP-eligible uninsured individuals, nearly 80% of all those eligible for QHPs could qualify for tax credits based on income.
The future of the marketplaces may very well ride on the success of the HHS in ensuring that individual market consumers understand their options–and see them as worthwhile.