ACA "Family Glitch-Fixed

United States -- January 2, 2023: The Affordable Care Act (ACA) marketplaces had been unable to provide financial aid to millions of consumers
due to the "family glitch." 

With a new rule that was finalized in October by the Biden administration estimated one million additional people will sign up for affordable marketplace plans as a result of the new regulation.
It is now the responsibility of marketplaces to execute and publicize this new path to more inexpensive health insurance.

Background

Affordable Care Act (ACA) markets and subsidies were established to help those without access to group or government health insurance purchase private plans that meet their needs.
Those who are offered inexpensive insurance through their employer or a family member's employer are ineligible to receive subsidies through the Marketplace.  Before the Affordable
Care Act was passed, a family's employer plan was considered "affordable" if the employee's premium contribution for self-only coverage was less than about 9.5% of their household income.
This meant that even if the contribution for dependent coverage was higher, the dependents were ineligible for subsidized marketplace plans.
The "family glitch" has prevented over 5 million people, especially low-income women and children, from receiving subsidies through the marketplace.

State-based marketplaces, providers, and patient advocates have all made it a priority of policy to rectify the "family glitch," with many pointing to a misunderstanding of the Affordable Care Act
as the root cause. With the new rule implemented by the Biden administration, dependents who are offered costly employer-based family coverage will be eligible for marketplace subsidies beginning
with the 2023 plan year.
However, for the family glitch to be resolved, the markets will need to put in place new infrastructure, engage in extensive outreach, and guarantee that customers have access to adequate
enrollment support and sufficient time to sign up for cheaper coverage.

Site Maintenance for Eligibility and Enrollment

Since the family glitch repair broadens the population that can get marketplace subsidies, it necessitates updating the algorithms used to determine how much money each person would receive from
the federal marketplace (HealthCare.gov) and the state marketplaces. HealthCare.gov and several state-run exchanges have been modified to accommodate this change, so that individuals whose dependents are now eligible for subsidies can sign up for coverage without leaving their homes. Under other markets where technology upgrades are still in progress, temporary fixes have been implemented. In New York, for instance, consumers can use an online calculator to get a rough idea of whether or not an offer of workplace coverage is reasonable before getting in touch with customerservice for a definitive determination of subsidy eligibility.

Strong Outreach to Alert Consumers

Many dependents who will benefit from the family glitch repair may be unaware of their new subsidy eligibility because the rule was only approved a few weeks before the yearly open enrollment period. This population may be difficult to reach because of negative perceptions of the marketplace caused by their previous inability to qualify for subsidies under the old rules.Some markets are conducting targeted outreach to the kinds of customers who will most benefit from the new policy. People who may have been denied subsidies due to the error were identified by the federal marketplace so that they may be contacted directly. People who may be eligible for tax credits in 2023 under the new regulation are being notified by mail in Minnesota's marketplace, while in Connecticut's marketplace, customers are being notified by text message.

Marketplaces also attract the attention of business owners. When compared to the marketplace in Idaho, which is actively working with employer groups and human resource organizations, the marketplace in the District of Columbia is initiating an education campaign incorporating chambers of commerce, such as the local restaurant association.

Assuring Adequate Enrollment Support

Aside from providing information about available plans, marketplaces also help people enroll in them. Those affected by the familial glitch previously had to decide between expensive insurance or going without protection. Now that they have access to market subsidies, customers like these can make decisions, but families still have options. As a result, some families may choose to keep all members of the family under the same plan rather than sending some to the marketplace so that everyone pays the same premium and shares the same deductible and out-of-pocket maximums and provider networks and prescription drug formularies.

The Biden administration is educating navigators and brokers on implications of the fix so they can help consumers before deciding whether or not to enroll in Marketplace coverage. In addition to training resources, state-run exchanges are informing service providers of possible client eligibility.

Spreading the Word About New Year's Enrollment Opportunities

Newly qualified dependents have the opportunity to enroll in affordable marketplace plans during open enrollment, but they might not find out about it until after the deadline has passed. Those whose employer-provided health insurance is no longer "affordable" as a result of the rule change will be eligible for a special enrollment period during the first 60 days of 2023. However, due to open enrollment and the coming conclusion of the COVID-19 public health emergency, certain markets may require more resources to continue providing sufficient outreach when the public health emergency is lifted. Marketplaces may wish to think about a targeted special-enrollment period later in 2023, similar to the successful COVID-19 special-enrollment periods in 2020 and 2021, to address the low levels of consumer awareness and the difficulties associated with the sign-up process in some states. For example, Vermont is thinking of expanding special enrollment options for people who are now qualified for subsidies thanks to the new rule.

Anticipating the Future

The number of uninsured has dropped to a record low thanks to the ACA, but many families have been affected by the family glitch . By resolving this issue, the ACA will be able to fulfill its promise of expanding affordable health insurance beyond those who now have access via their employers. Still, the effectiveness of the repair will rest heavily on the ACA's markets as they upgrade their infrastructure, spread the word about the new opportunity, and educate customers about their new coverage choices.

 
WNCTIMES by Marjorie Farrington

Information Source: Schwab, Rachel, et al. “Implementing the Family Glitch Fix on the Affordable Care Act’s Marketplaces.” Implementing Family Glitch Fix on ACA Marketplaces | Commonwealth Fund, 8 Dec. 2022, www.commonwealthfund.org/blog/2022/implementing-family-glitch-fix-affordable-care-acts-marketplaces.