American Rescue Plan: Major Health Insurance Coverage Provisions

On March 11, 2021, President Biden signed into law the American Rescue Plan, enacting within it major provisions to expand access to health insurance coverage.

 

Eliminates ACA insurance premiums for individuals up to 150% FPL: Nonsmokers with household incomes under 150% FPL will pay $0 for the benchmark plan (second-lowest-cost silver plan available in the exchange in a rate region).

Increases subsidies (APTCs):  Expands health insurance  coverage subsidies at every income level, for CY21 and CY22, limiting top required premium contributions for health insurance to 8.5% household income for the cost of benchmark plan (the second-lowest-cost silver plan available).

Households above 400% FPL eligible for premium subsidies: Fixes the previous subsidy cliff that had ended health insurance premium subsidies for households earning over 400% FPL. Now, those above 400% FPL may receive APTCs such that premiums for the benchmark plan do not exceed 8.5% of household income.

Premium enhancements is retroactive to the start of CY 2021. Current enrollees may start claiming any applicable extra subsidy immediately, or they can wait and claim it on their 2021 tax return.

Household income
(percent of the FPL)
Current law’s premium contribution %requirement American Rescue Plan’s premium contribution percentage
Up to 133% 2.0% NA
133% up to 150% 4.0% NA
Up to 150% 0.0%
150% up to 200% 6.3% 2.0%
200% up to 250% 8.05% 4.0%
250% up to 300% 9.5% 6.0%
300% up to 400% 9.5% 8.5%
400% and higher N/A 8.5%

Source: U.S. Senate Passes American Rescue Plan – 10 Key Updates for Healthcare Providers

See also: Subsidy Calculator, Kaiser Family Foundation

ACA premium subsidy and CSRs for Unemployed: Subsidizes 100% of premiums those with household income over the federal poverty level who are unemployed at any point in 2021, covering the premium for benchmark plan, if they lose their job through September 30, 2021.

Persons receiving unemployment compensation in CY 2021 qualify for CSRs for silver plan if income between 100%-400% FPL. Disregards income >133% FPL for purposes of determining CSR amounts.

Federal subsidies 100% for COBRA continuation coverage: Subsidize 100% of COBRA premiums through September 2021 for laid-off workers.

 

How many people in Wisconsin might benefit?

Uninsured: In 2019 – the most recent year for which data are available, and prior to the COVID-19 pandemic — Wisconsin had about 325,000 uninsured residents. The table below displays their income levels. This shows that about 266,000 Wisconsin residents, with incomes above 100% FPL may benefit from these subsidies.

Income Level

Number uninsured

<138% FPL

97,006

138-399% FPL

172,646

>400% FPL

55,274

Total Uninsured

324,926

< 100% FPL uninsured

59,235

Total Uninsured with incomes above 100% FPL

265,691

 

Unemployed: The Wisconsin Department of Workforce Development reports that, for CY20, Wisconsin had 192,793 unemployed.

 

Sources:

 Karcher J, Norris D, Benz K. America’s Rescue Plan: Impacts on private health coverage. Milliman. March 3, 2021.

National Conference of State Legislatures

Norris L. How the American Rescue Plan Act would boost marketplace premium subsidies. March 5, 2021.

U.S. Senate Passes American Rescue Plan – 10 Key Updates for Healthcare Providers