Secret Platinum

It's been about a week since the Centers for Medicare & Medicaid Services published the official 2024 ACA Open Enrollment Period Public Use Files, and I'm still digging through the mountain of data & demographics.

Today I want to address the question of Actuarial Value (AV)...that is, what percent of medical expenses (in aggregate) a given healthcare policy actually pays for. As a quick reminder, ACA policies are generally broken into four AV categories, labeled by metal levels: Bronze, Silver, Gold and Platinum, which generally cover roughly 60%, 70%, 80% or 90% of enrollees in-network medical expenses per year (there's a fifth category in front of Bronze called Catastrophic plans, but these have limited eligibility and hardly anyone enrolls in them anyway).

I say generally because there's a bit of wiggle room here:

...as of 2023, the de minimus range has been reduced, imposing the following actuarial value ranges for metal-level plans:

Back in late 2021, Colorado launched their own new, state-based ACA financial subsidies on top of federal subsidies which have already been enhanced (at least through the end of 2025) via the American Rescue Plan and Inflation Reduction Act:

The financial help you can get to lower your out-of-pocket costs are healthcare discounts called Cost-Sharing Reductions. Connect for Health Colorado is the only place you can apply for financial help to lower the cost of private health insurance. Due to the American Rescue Plan, Coloradans are now eligible for more savings than ever before.

Consider a Silver plan if your Health First Colorado (Medicaid) coverage recently ended or your income is over the limit to qualify

Connect for Health Colorado launched a new state-funded program recently to provide even more healthcare savings to people shopping on the Marketplace for 2022 whose income is just over the limit to receive Health First Colorado (Medicaid) and who enroll in a Silver-level plan.

Last week I gave a heads up about the imminent launch of the American Rescue Plan's "Unemployment Insurance Benefit" provision at HealthCare.Gov:

This, again, is a Big Deal for this year. Paired with the beefed-up APTC table, what it means is that if you're on unemployment this year you effectively don't have to pay anything for a benchmark Silver plan. I'm not sure if you have to be unemployed for the full year or not...the wording above sounds like even someone who's only on unemployment for one or two weeks would still be counted as having 133% FPL.

Sure enough, just about anyone who is either currently receiving unemployment benefits or who did earlier this year (or later this year, for that matter) is likely eligible for a FREE ($0* Premium) Silver CSR 94 plan...otherwise known as #SecretPlatinum:

Back in March, I noted that one of the more interesting provisions of the American Rescue Plan is that anyone who receives unemployment benefits at any time during calendar year 2021 is eligible for maximum ACA subsidies:

Sec. 9663 – Application of premium tax credit in case of individuals receiving unemployment compensation during 2021

For 2021, provides advanced premium tax credits as if the taxpayer’s income was no higher than 133 percent of the federal poverty line (FPL) for individuals receiving unemployment compensation as defined in section 85(B) of the Internal Revenue Code.

This, again, is a Big Deal for this year. Paired with the beefed-up APTC table, what it means is that if you're on unemployment this year you effectively don't have to pay anything for a benchmark Silver plan. I'm not sure if you have to be unemployed for the full year or not...the wording above sounds like even someone who's only on unemployment for one or two weeks would still be counted as having 133% FPL.