Is the Healthcare.gov marketplace finally “affordable?”

Published: May 17, 2021 6:16 PM EDT
Updated: May 17, 2021 6:24 PM EDT

Since March, millions of people have gone to the Healthcare.gov exchange to take advantage of expanded government subsidies during a special enrollment period opened up to help during the pandemic. When the American Rescue Plan (ARPA) passed it did not just provide stimulus checks, it also expanded the affordability of health insurance plans purchased through the Affordable Care Act marketplace.

In the past, anyone making more than $51,000 did not qualify for subsidies. For a couple, that cutoff was $68,000 and increased a bit higher with each family member covered by a plan.

“It was a cliff,” said Margot Kast, an independent insurance agent in Naples.

The ARPA allows for subsidies for people who have incomes over 400% of the poverty line and increases the amount of assistance for lower income Americans that were already eligible for that help.

Kast said now it is more like a plateau, and she’s been able to find savings for households making up to $200,000 and even $300,000 a year.

She showed an example of a 60 and 62 year old couple making $70,000 a year, eligible for several plans with no monthly premiums. Last year, that same couple would have paid $2,000 a month for the same plan. It’s important to note that many plans still include very high deductibles: That means the insurance company doesn’t pay for anything until a person has already paid a certain dollar amount out of pocket on their own.

“It actually creates an incentive to continue earning money,” Kast said. “Before, there was almost a disincentive to earn money.”

According to Kaiser Family Foundation, the number of people eligible for a subsidy to purchase Marketplace coverage increased by 20%.

“After doing the research, you feel like it’s too good to be true because, in the past, we never qualified for subsidies,” said Molly Capiga, a stay at home mom from North Fort Myers, whose husband makes a squarely middle class salary.

The Capiga’s purchased a plan during the special enrollment period that costs just $98 a month. Previously, they were paying $645 a month for a plan with a $12,000 deductible. Their new plan has a similar deductible.

Capiga’s husband is not offered insurance through his job =, so they’ve been purchasing private insurance for the past five years. She said, every year, their monthly costs would increase while their deductibles also increased.

“It was really hard to budget, and then when something goes up [$200]-$300 a month, it’s absolutely on the verge of being unaffordable,” Capiga said.

But all of the expanded subsidies come with a huge price tag for every American taxpayer. The Congressional Budget Office estimates that it will increase the federal deficit by $34 billion over the next 10 years.

“I’ll defer to to the President and the White House in terms of how they’re going to work on the budgetary issues,” said Dr. Rachel Levine, the assistant secretary for the United States Department of Health and Human Services. “But I think that quality, affordable health care is absolutely necessary for everyone in the United States, and that’s been more evident during the COVID-19.”

As of publication, a spokesperson for the White House failed to provide further insight on those budgetary issues.

Dr. Levine pointed to the success of the program as evidence that it is money well spent. She said that, as of mid-May, there were about one million new enrollees on marketplace plans on top of the additional two million people who had existing plans.

Anyone with an existing plan is able to renew their plan with additional qualifying subsides.

“It’s a big deal. This might be as big as when the Affordable Care Act just started,” said Kast, who estimated that she’s helped hundreds of people save money with new marketplace plans since March.

If you or your spouse are offered insurance through an employer, chances are you are not eligible for a plan on Healthcare.gov, but Kast said it is worth exploring if your coverage changed in any way over the past year.