Health plans

More Americans Should Enroll in Affordable Care Act Health Plans as Costs Fall and Benefits Rise

Yes youI shopped the Affordable Care Act market for a health plan in recent years only be disappointed with its price tags, you might want to try again.

More Americans than ever are eligible for federal grants to reduce their health insurance spending in 2022, including millions of people under 65 and the self-employed, who run small businesses or have no business. employer offering sufficient social benefits.

“There are many plans that can meet your needs, and they are more affordable than ever,” said Joseph Bayura, director of product development for individual and small group sales at UPMC Health Plan.

In Western Pennsylvania, the 2022 Marlet offerings to bring more, less expensive options coupled with improved advantages, such as $ 0 monthly silver level plans, virtual-focused plans with a $ 0 telehealth co-payment and Following choices for residents in rural counties.

“Were seeing a mean of $ 100 inferior bonuses on the other side the plank,” noted Invoice Tuthill, vice President of Marlet strategy for federal markets for High note, who along with UPMC offers TO THAT plans on the other side Western Pennsylvania.

In addition to premium and co-payment reductions, the plans offer more benefits such as dental coverage, hearing aids, and new types of packages tailored to certain types of health care priorities.

A new UPMC plan offers free virtual care visits not only for mental health, but also for primary and urgent care appointments. Tuthill points to some Highmark plans offering a service that will send an assistant to someone’s house to help with housework or gardening for a few hours.

Highmark has expanded into new territory for its ACA-backed insurance plans – including with a new narrow network plan now open to residents of Westmoreland County, just as Highmark’s Allegheny Health Network is building more medical facilities there.

“It’s huge for us,” Tuthill said. “Westmoreland County is a community we love, and we haven’t had this low cost option for a few years. ”

Enrollment is open until January 15, 2022 – although plans must be purchased by December 31 for coverage to begin January 1 of next year. Pennsylvanians can enroll in ACA-compliant health insurance plans through the state-run exchange at

Here are five things to know about buying ACA 2022 individual health insurance:

There is no longer a so-called “subsidy cliff”.

Large numbers of people who were previously excluded from grants may now be eligible, and the discounts given to people of all income levels have become larger across the board – thanks to regulatory changes and cash injections built into American Rescue. Plan Act passed by Congress in March.

“The US bailout has really increased the subsidies,” said Louise Norris, an individual health insurance broker affiliated with consumer research

In addition to injecting $ 1.9 trillion into pandemic relief, the legislation made a significant change by removing the so-called “grant cliff” that limited contributions to those earning less than 400% of the budget. federal poverty level. Last year, those excluded from grants included those earning more than $ 51,520 per year for an individual, more than $ 69,680 for a couple, or more than $ 106,000 per year for a family of four.

The Congressional Budget Office estimates that 1.7 million more people – more of which currently uninsured – could enroll in health plans through the markets in 2022 due to increased premium subsidies.

Eliminating the income-based cliff, however, does not mean that everyone receives a grant. Eligibility always depends on financial need based on health costs not exceeding 8.5% of household income. So if the annual premium costs of an ACA referral plan are already less than 8.5% of what you earn, you will not be eligible for the federally subsidized rebate.

Even if you’ve already liked your old ACA-backed plan, you’ll probably want to redo your shopping.

Indeed, the 2022 offers present general premium reductions combined with better benefits than in recent years, especially compared to 2016, 2017 and 2018, when many insurers left the market and the smaller insurers that had left the market. focused only on the ACA market. sank.

“For people who have been in ACA or people who have always been eligible for ACA grants but for whatever reason did not enter the market, the economy for them is totally different.” , Tuthill said.

Don’t forget access – and network or off-network – if choosing the doctors and facilities covered by your plan is important to you.

The two main insurers in the Allegheny County area and much of western Pennsylvania are Highmark and UPMC. Both reported an increase in registrations during the special registration period brought on by the pandemic and in the first weeks since the 2022 plans became public.

“One thing Covid has taught us is the importance of having insurance for the unexpected,” Bayura said.

Each offers limited network plans that could save you money, but the savings may not be as valuable to some as keeping their doctors or the right to choose where to go for treatment.

Not so long ago, UPMC dominated the ACA home market in the region and was the only option in many areas.

Highmark says it only had a 5% market share in western Pennsylvania in 2019, after ending its ACA plans in more than a dozen counties amid uncertainty over the future of the market in 2016. By next year, Highmark officials said they expected to claim nearly 20% of the region’s individual ACA market.

“We feel that we are getting a very large share of new first-time buyers,” Tuthill said. “Obviously, UPMC has all these members who have been with them for a long time, and many of them are happy and they stay there. But when people shop, they often change. So we expect that market share to grow quite vertically this year as well. ”

Last year, UPMC was the only option in at least six rural counties in which Highmark now offers alternatives.

More and more buyers are opting for the “gold” tiered plans to get the most out of their extra federally subsidized dollars.

With their larger grants to spend, more and more individual insurance buyers are opting for slightly more expensive higher tier plans rather than the cheapest option, according to initial data and local representatives of the assurance.

“The US bailout is putting more money on the ACA credit card than people have to spend,” Tuthill said. “What we’re seeing more than we expected is people saying that with that extra $ 100 a month I’m actually going to use it to buy a better plan.”

A few years ago, less than 10% of buyers opted for Gold plans at Highmark, according to Tuthill. In 2020, nearly 20% of people chose gold plans. Today, almost 50% of new buyers are turning to gold levels.

Free help is available for advice on choosing the best plan for you.

Assistance is available through the State Pennie Stock Exchange. For assistance from a Pennie representative, call 1-844-844-8040 or visit

Highmark and UPMC have customer service employees to help out at insurance stores and kiosks throughout the region as well. Contact Highmark Inc. sales representatives at 1-888-714-3798. Contact Plan Santé UPMC at 1-877-563-0292.

Natasha Lindstrom is a writer for Tribune-Review. You can contact Natasha at 412-380-8514, or via Twitter .