ARP Special Edition Broker Newsletter

With President Biden’s signing of the American Rescue Plan Act, there are some changes to the Marketplace program that are important for you to know.

Summary

Many Marketplace members will have access to increased premium tax credits that can lower their monthly premium or increase their coverage. These are available for selection starting April 1. During the current Special Enrollment Period that runs though August 15 2021, all consumers can confirm their eligibility and re-enroll.

The American Rescue Plan Act has raised the subsidy amounts for Advance Premium Tax Credits (APTC) that lower member monthly premiums. Members will be receiving communications about this from CareSource via email and inserts included in member invoices.

Member Communications

Navigate Click here to view the communications pieces members will receive.

Key Points to Know

  • Members who may not have qualified for APTC before may qualify now. This generally includes members whose income was too high (>400% FPL).
  • Members may change plan levels or carriers. An existing enrollee is not restricted to specific plan levels or specific issuers. They can change plan levels and/or change issuers.
    • NOTE: If a member changes carriers, they will lose amounts they’ve accumulated to their Deductible and MOOP. Members in Georgia will also lose amounts they carried over from 4th quarter 2020. CareSource will allow existing members to carry their accumulated amounts onto their new plan if they choose to switch plans but stay with CareSource.
  • CareSource’s NEW Zero Cost Telemedicine Partner benefit is effective 4/1/2021 and will only be available in Georgia, Indiana and Ohio. At this time MYidealDOCTOR is the only partner identified for all 3 markets. CareSource will look to expand this into Kentucky as well for 2022.
  • Members must re-apply to use the new APTC. While there is no “shopping period” for this change, members have the ability to reapply until August 15, 2021 without a separate qualifying life event.
  • APTC is only available to members enrolled in ACA compliant coverage On Exchange.
  • If members re-enroll with CareSource they keep any money they’ve spent toward their deductible and out of pocket max, even if they change plans (e.g., from Bronze to Silver).
  • The increase in APTC gives members a chance to lower their premium or increase their coverage.
  • Even members who are currently fully subsidized, paying $0 premium, should re-apply as the increased subsidies could allow them to afford a higher level of coverage and reduce their cost shares (deductibles and out of pocket expenses for care).
  • There is no longer a “maximum income” to qualify for APTC. Instead, subsidies are provided to anyone whose cost for a Second Lowest Cost Silver Plan (SLCSP) would be more than 8.5% of their income, or less, if they are earning less than 400% of the Federal Poverty Level, or $51,520 for a single person.
  • Consumers making less than 150% of FPL, $19,320 for a single person or $39,750 for a family of 4, now qualify for a fully subsidized Silver plan. Even better, these consumers qualify for cost share reductions (CSR) which will significantly lower their out-of-pocket expenses – many members going from a Silver plan to a CSR Silver will on average see their deductible go from over $5,000 to less than $500.
  • Our optional Dental, Vision and Fitness plans have additional costs that are not covered through APTC. However, it is possible that a member could pick a different plan and still pay the same amount with these added benefits.
  • If a member has already paid an upcoming premium but re-enrolled to take advantage of the new APTC, any extra amount they may have paid toward their premium will be carried over as a credit balance on their next invoice.
  • It is possible that some members’ premiums may increase on re-enrollment due to an age change. Premium is based on a person’s age as of the effective date of the plan. If an enrollee had a birthday after January 1 and before the new effective date, they may have aged into a higher pricing tier. This also applies to enrolled dependents of the main policyholder.
  • CMS will be providing further guidance & system functionality for consumers who have received unemployment this year, however that will not be ready till later this summer.

If you have additional questions or require assistance, please reach out to our Broker Service department at salessupport@caresource.com