Think Obamacare Health Plans Cost a Lot? That’s Not Always True


If you’ve lost your job during the pandemic, and with it your health insurance, you may think that Obamacare plans are too expensive and therefore not worth seeking. Or maybe you’re worried about whether the coverage will withstand legal challenges.

Think again, health care analysts say.

Most people seeking insurance through Obamacare marketplaces qualify, based on their income, for tax credits that significantly lower their cost of coverage. Two-thirds of customers on, the federal insurance exchange, can find a plan for $10 a month or less, according to Get America Covered, a nonprofit that advocates health coverage under the Affordable Care Act, also known as Obamacare. In some cases, tax credits can lower the monthly premium to zero. Many people are also eligible for extra financial help that reduces their out-of-pocket costs when they seek care.

An analysis by the Kaiser Family Foundation found that benchmark premiums for 2021 plans sold on the marketplaces had fallen more than 2 percent, on average. (Costs vary by location and plan type, so in some cases, premiums have increased.) In many states, new insurers are entering the marketplace or expanding their service areas, which tends to increase choice and lower costs.

“Coverage remains extremely affordable for the vast majority of customers,” said Joshua Peck, co-founder of Get America Covered.

Coverage under the Affordable Care Act is a critical safety net for people who lack job-based health insurance coverage, advocates say. An estimated 14 million people, including workers and their families, lost coverage during the pandemic, although it’s unclear if the job losses will be permanent. The 2010 law authorized the sale of subsidized private health plans through federal and state marketplaces for people without employer-based insurance, and expanded Medicaid, the federal-state health plan for the poor, in many states. The law protects people with pre-existing conditions and requires health plans to provide certain essential coverage, like preventive care.

One hurdle: Awareness of coverage available under the Affordable Care Act has dwindled since the law was passed. That’s in part because the Trump administration slashed funds for marketing and outreach by 90 percent, according to the Kaiser foundation. Just 59 percent of the public knows the law offers subsidies for marketplace health plans, down from 75 percent a decade ago, Kaiser found.

And many people are confused about the law’s status: As of this spring, fewer than a quarter of uninsured people knew the law remained in effect, Kaiser found.

That’s perhaps not surprising, given that the law has been subject to Republican-backed legal challenges. The Supreme Court heard arguments this week in a lawsuit seeking to overturn the law. If the law is invalidated, more than 20 million people could lose health coverage, according to an estimate from the Urban Institute.

Last month, Carolina Fortin-Garcia, a spokeswoman for the Center for Medicare and Medicaid Services, which oversees, said in an emailed statement that while the agency did not comment on pending litigation, it was preparing for a “successful open-enrollment period, which we anticipate will offer consumers more choices and the third straight year of lower premiums.”

During oral arguments on Tuesday, two conservative justices seemed to indicate support for the act, but the outcome of the suit is uncertain. The court isn’t expected to announce a decision until the middle of next year.

“We don’t know what will happen,” said Cynthia Cox, director of the Kaiser foundation’s Program on the A.C.A. But there’s no reason not to enroll if you need health insurance. If you sign up for coverage and plan subsidies are then eliminated, there’s no risk, she said, that you would have to continue paying premiums if you can’t afford them.

“You might as well have coverage while you can,” Ms. Cox said, especially given the risk of illness from the coronavirus. At the very least, plans compliant with the law have caps on out-of-pocket costs, limiting what patients must pay for a stay in the hospital. There is no guarantee that hospitals will waive the cost of treatment for uninsured patients with Covid-19, meaning people without coverage could face large medical bills.

Open enrollment on continues through Dec. 15 for coverage that begins on Jan. 1. (Some state marketplaces allow enrollment for much longer periods.) People affected by wildfires, hurricanes or other disasters may qualify for more time.

If you miss the open-enrollment deadline, you’ll have to wait a year to enroll unless you have a qualifying change in circumstances, like losing your health coverage, getting married or having a baby.

Here are a few things to know about open enrollment for Obamacare plans.

Where can I get help choosing a plan?

Enrollment help is available, but may be hard to come by in some areas, according to the Kaiser foundation, because federal funding for trained, independent “navigators” is limited. For federal marketplace plans, you can use the “find local help” tool, or call 1-800-318-2596.

Fourteen states and the District of Columbia run their own exchanges, so you should check their websites.

Some insurance agents and brokers, who may earn a commission for enrolling customers, also sell A.C.A.-compliant plans and can help narrow your choices. But some may not show you all the options in your area, and some may offer “short-term,” bare-bones insurance plans that don’t provide comprehensive coverage.

If an application includes questions about your medical history, ask why, because that suggests the plan doesn’t cover pre-existing health problems, said Erin Hemlin, director of health policy and advocacy at Young Invincibles, an advocacy group focusing on issues affecting young adults, including health coverage. To be sure you are being offered full coverage when shopping for a plan, she said, “always start at”

Is there a federal penalty for not having health insurance?

No. Congress eliminated the federal tax penalty for not having health coverage as of Jan. 1, 2019. A handful of states, however, impose their own penalties.

I’m already enrolled in an Obamacare plan. Do I have to shop for coverage again?

Advocates for health insurance coverage recommend that you update your financial information and look at the various offerings, rather than let your coverage renew automatically, to make sure you are in the most affordable plan. If your income fell because of the pandemic, you may be eligible for a larger tax credit to reduce your costs. Switching plans may mean changing doctors, so be sure to understand the details of less expensive options.