ACA marketplace enrollment is open. Here's what's new this year. [The Philadelphia Inquirer]

Nov. 3—Pennie and Get Covered NJ — the Affordable Care Act insurance marketplaces run by Pennsylvania and New Jersey — are open for 2022 enrollment with better deals on health plans than previous years.

Buying health insurance can be daunting, especially for people who are used to being covered through an employer. But the coronavirus pandemic has reinforced the importance of having health insurance. And with extra financial help available through the federal pandemic relief package, more people can qualify for low-cost plans.

"People who have struggled in the past to fit health insurance into their household budget should take another look," said Zachary Sherman, Pennie's executive director.

Here's what to know for 2022 enrollment.

When is 2022 open enrollment for Pennie and GetCoveredNJ?

Enrollment has started, and the deadline to sign up in Pennsylvania is Jan. 15. New Jersey residents have until Jan. 31. For coverage that starts Jan. 1, people must sign up by Dec. 15. Anyone who signs up after Dec. 15 will start coverage Feb. 1.

Where do I go to sign up?

Pennsylvania and New Jersey have their own ACA marketplaces. Pennsylvania residents sign up through Pennie.com. New Jersey residents use GetCovered.NJ.gov. States that do not have their own marketplace, including Delaware, use the federal marketplace, healthcare.gov.

Am I eligible for ACA marketplace coverage?

Anyone can buy insurance through the ACA marketplaces, but they are designed for people who do not have insurance through an employer, and are not eligible for Medicare, which covers seniors and people with disabilities, or Medicaid, which is for low-income individuals and families.

How can I get an ACA tax credit?

Tax credits to offset the cost of plan premiums (the amount you pay per month) are based on projected annual income. Prior to the pandemic, only people who earned less than 400% of the federal poverty level — about $51,000 for an individual — were eligible for a tax credit. But to help people who lost employer-based insurance during the pandemic, federal lawmakers expanded tax credits to ensure no one paid more than 8.5% of their income. The increased tax credits will be available again for 2022.

How much do plans cost?

Several factors influence cost: what type of plan you choose, the number of people being covered and their ages and household income.

Plans are rated by "metal" level: Bronze plans have the lowest premiums but highest deductibles, which is the amount you spend out-of-pocket on health care before the plan begins paying at a higher rate. Silver plans, the most popular option, have higher premiums but lower deductibles. Gold and platinum plans have even higher premiums with still-smaller deductibles.

Federal pandemic relief legislation increased the amount of tax credits and who is eligible for them, with low-income families getting the most help.

For example, a 40-year-old Philadelphia resident earning $19,000 a year would have paid $66 a month for a silver plan, and was able to get the same plan for $0 a month in 2021 after tax credits were raised.

You can put your tax credit toward a plan of any "metal level," though it will cover a greater portion of the cost of silver or bronze plans, which are less expensive than gold and platinum plans.

COVID-19's tax-season surprise: You may have to pay back part of your ACA insurance subsidy

What happens if I estimate my income incorrectly?

Tax credits are based on income, with low-income individuals receiving the most financial help and no one paying more than 8.5% of their earnings for a marketplace plan. As part of the enrollment process, you will need to estimate your income for the coming year. Consider your previous years' income, whether you expect to change jobs or, if you are unemployed, whether you may regain employment.

People who overestimate their income and do not get as much of a tax credit as they should will get the money when they file their taxes. Those who underestimate their income and receive a larger tax credit than they should will have to pay it back at tax time. You can avoid this problem by updating your marketplace profile as soon as you experience a change in your income.

Does unemployment count as income?

Yes. If you expect to receive unemployment in 2022, include it in your projected income calculation.

Are pre-existing conditions covered?

Yes. Under the ACA, insurers are not allowed to deny coverage or charge higher rates to people with pre-existing conditions. All marketplace plans cover a wide range of health services, including basics such as primary care visits, prescription medications, prenatal care and mental health. If the insurance agent or website you are using to sign up asks for information about pre-existing conditions or indicates services for certain medical conditions won't be covered, you may be buying a plan that is not full medical insurance.

How do I know if a health plan is a scam?

There are several other kinds of insurance plans, such as short-term limited-duration and indemnity plans, that are not bound by the ACA's rules and offer much thinner coverage, but are often marketed to people shopping for marketplace plans. These plans may exclude certain types of services, such as childbirth, or refuse to pay for services related to a pre-existing condition — for instance declining coverage for lung cancer treatment to a former smoker.

Plans that pay specific dollar amounts for services or limit the amount they will spend on your care are not real health insurance.

"If they're saying you qualify because you're healthy — real health insurance doesn't make you eligible based on health status," said Dania Palanker, an assistant research professor at Georgetown University's Center on Health Insurance Reforms.

A recent secret shopper study by Palanker and her colleagues found that, often, these so-called "junk" health plans not only offer less coverage, but cost more than marketplace plans.

The best way to be sure the plans you are buying are legitimate is to shop through your local marketplace. If you need help, use the search tool on the Pennie or GetCoveredNJ website to find an insurance agent licensed to sell marketplace plans or a volunteer enrollment specialist affiliated with the marketplace.

Get help signing up

Pennsylvania

Pennie.com or 844-844-8040

Pennsylvania Health Access Network helpline 877-570-3642 "type":"text

New Jersey

Getcovered.nj.gov or 833-677-1010

Center for Family Services helpline 877-962-8448

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