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More Central Texans can take advantage of expanded Affordable Care Act subsidies starting April 1

American Rescue Plan Act increases health insurance premium assistance for most current enrollees; Opens subsidy eligibility to those previously ineligible

/EIN News/ -- Austin, Texas, March 26, 2021 (GLOBE NEWSWIRE) -- Sendero Health Plans wants Central Texans to know that they may be eligible for significant help with their monthly premium for Affordable Care Act (ACA) Marketplace health insurance plans, which is now even true if someone did not previously qualify for income-based subsidies. 

The recently passed American Rescue Plan Act of 2021 (ARPA) creates opportunities for those earning more than four times the federal poverty level to receive help on ACA Marketplace health insurance plans for the first time. Additionally, the ARPA caps a household’s premium contribution on a Silver plan to 8.5 percent of their annual income, down from 9.8 percent in previous years, which means many current Bronze plan holders can move to lower deductible Silver plans for the same monthly cost. The newly expanded subsidies take effect April 1.  

“This enhanced subsidy plan can be a huge lift for Central Texans who may have difficulty affording health insurance,” said Wesley Durkalski, president and CEO of Sendero Health Plans, Central Texas’ only community-supported non-profit Marketplace health insurance provider. “Even if you didn’t qualify for help with your monthly payment in the past, you may be able to see significant assistance under the new ARPA provisions, or even have your premium fully-covered.” 

Starting April 1, those earning up to 150 percent of the federal poverty level will be able to get Silver plans for a zero-dollar premium and significantly reduced deductibles. In the past, households at all income levels were required to contribute toward a portion of the Silver plan, the middle-tier plan offered on the Marketplace and the most-popular one due to reduced out-of-pocket costs as compared with a Bronze plan. 

"The changes contained in the ARPA means that lower-income individuals who might have wanted to enroll in a lower- deductible and out-of-pocket cost Silver plan, but couldn’t afford the monthly premiums, may now qualify for a Silver plan at no or a low monthly cost,” Durkalski said. “It’s a huge win for the overall health of Central Texas. More people will have access to high-quality health care."  

Enroll in March to have health insurance effective April 1

While the new premium subsidies begin April 1, Sendero is encouraging Central Texans to enroll now for health insurance in order for it to be effective for all of April. 

“We are urging our family, friends and neighbors to enroll in March and enjoy the peace-of-mind in knowing they will be protected should they experience surprise health care costs starting April 1,” said Durkalski. “While new ACA enrollees will not see the new subsidies that reduce monthly costs until April 1 for plans effective May 1, right now the government’s plan is that enrollees will have the opportunity to claim a tax credit for any higher April costs on their 2021 taxes.”  

Other benefits under the ARPA Marketplace guidelines 

Central Texans with household incomes up to 400 percent of the federal poverty level will see increased premium assistance. For example, according to the Kaiser Family Foundation, a 40-year-old with a household income at 200 percent of the federal poverty level would pay an average of just $510 a year for a Silver plan premium, versus $1,664 a year in past years. 

Those with incomes above 400 percent of the federal poverty level will be eligible for marketplace subsidies for the first time ever. Additionally, their premium contributions for a Silver plan will be capped at 8.5 percent of their household income. 

“We expect to see a big enrollment increase for those who are just above 400 percent of the federal poverty level. These are the households that also have struggled to afford health insurance and were forced to choose between paying high deductibles and out-of-pocket expenses for expensive insurance premiums or look for short-term or alternative health care solutions,” Durkalski said. 

The changes to the ACA Marketplace premium subsidies are not permanent at this time: They are effective only during the 2021 and 2022 calendar years. 

Those who already enrolled for a 2021 Marketplace plan during the 2020 Open Enrollment period can take advantage of these changes, too. Current enrollees need to go to  HealthCare.gov or to Sendero’s website for its members to request the higher subsidy and will also be able to change their plans during the current Enrollment period which runs through May 15, 2021.  Details for implementation of retroactive assistance are still being worked out, but subsidies for current enrollees are retroactive to January 2021.  

Sendero Health Plans offers guidance to those who wish to take advantage of the new ARPA expanded premium subsidies. Those with questions or who would like to enroll directly in a marketplace plan can visit Sendero’s website at www.SenderoHealth.com or by calling 1-844-800-4693. 

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Sendero Health Plans Inc., formed in 2011, is a community-supported nonprofit Health Maintenance Organization affiliated with the Travis County Health District, known as Central Health. Sendero is dedicated to improving the health of the community by providing affordable, quality healthcare coverage, especially for Travis County residents with low income. Sendero offers its IdealCare plans on the Federal Health Insurance Marketplace and is available in Travis, Williamson, Hays, Bastrop, Burnet, Fayette, Lee and Caldwell counties.


Bill Noble
Sendero Health Plans
512-296-4651
bnoble@noblestrategic.com