Healthcare Resources for Individuals
This page will be updated continuously to reflect the most recent information. This page was last updated on May 20, 2021.
***WHAT IS NEW IN THE AMERICAN RESCUE PLAN***
The American Rescue Plan provides assistance for individuals to pay for COBRA continuation health coverage or to purchase health insurance on the ACA marketplaces.
Health Insurance Affordability
The American Rescue Plan includes premium assistance of 100 percent for COBRA continuation coverage for eligible individuals and families April 1, 2021 through September 30, 2021. This will allow individuals who lost their job-based health insurance to keep their insurance and receive federal funding to pay for the full COBRA premium.
- COBRA coverage lets people who have job-based health coverage keep it for a period after they lose their jobs, have a reduction in hours or are furloughed. Usually, people have to pay the full cost of the premium on their own.
In general, individuals potentially eligible for premium assistance must elect COBRA continuation coverage within 60 days of receipt of the relevant notice or forfeit their right to elect COBRA continuation coverage with premium assistance. Please speak with your employer and health plan if you think you may be eligible for COBRA premium assistance. Click here for more information on COBRA assistance in the American Rescue Plan.
ACA Marketplace Plans
The American Rescue Plan also significantly reduces premiums for ACA marketplace plans for 2021 and 2022.
- It increases premium tax credits, which will eliminate or reduce premiums for most current marketplace enrollees.
- It also ensures that no marketplace enrollee, regardless of income, will spend more than 8.5 percent of their income on premiums by offering them premium tax credits.
- In addition, the American Rescue Plan exempts low- and moderate-income families from having to repay the premium tax credit they received in 2020. This will protect people who experienced unexpected changes in income in 2020 from having high repayments when filing their taxes.
- The American Rescue Plan also includes protections for people who have recently lost their jobs. It guarantees that people who receive unemployment benefits in 2021 receive zero-premium, platinum-level coverage when enrolling through the ACA Marketplace.
Visit healthcare.gov to enroll through August 15, 2021 and to learn how to receive increased premium tax credits for 2021 ACA marketplace coverage. Increased premium tax credits have been available for consumers since April 1, 2021.
Current enrollees in a marketplace plan must update their application and reselect their current plan on or after April 1 in order to receive the extra tax credits for the remainder of the year. They should complete this step by the end of the 2021 Special Enrollment Period on August 15.
If current enrollees do not update their application on or after April 1, they will still receive the additional tax credit when they file their taxes in 2022. However, they are encouraged to update their application and review options for less expensive coverage, including options with lower out-of-pocket costs.
If consumers change plans during the Special Enrollment Period, they should consider how much they have paid toward their deductible in 2021, as deductibles may be reset to zero. This would mean paying additional out of pocket expenses. Consumers who have contributed significant payments toward their deductible and wish to change their plan should check with their insurance company about options.
For individuals who do not currently have an ACA marketplace plan
Consumers who do not yet have coverage and are planning to enroll in a marketplace plan should apply and select a plan through the Special Enrollment Period, which is open through August 15, 2021. New enrollees should make sure their applications have been updated since April 1, 2021 to receive the increased premium tax credits for 2021. Consumers who have received unemployment compensation during 2021 may be able to receive another increase in premium tax credits. HealthCare.gov will have more information available in the summer.
For more information about the American Rescue Plan and ACA marketplace coverage, please visit the Centers for Medicare & Medicaid Services’ fact sheet here.
The Food and Drug Administration has issued the first three emergency use authorizations for vaccines to prevent COVID-19, and more vaccines are under development. These vaccines have been found to be safe and effective, but their availability is limited at this time. The vaccines are free for all individuals.
For most private insurance plans, the CARES Act requires coverage for COVID-19 vaccines without cost-sharing. Specifically, this coverage is required to begin fifteen days after a favorable rating or recommendation from the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices. In addition, private health insurance plans are required to cover all the costs of a COVID-19 vaccine, even if an out-of-network provider administers it.
Typically, the Affordable Care Act requires that preventive services and vaccines be covered by private insurance starting on the first day of the plan year beginning after a favorable rating or recommendation, so the CARES Act requires this coverage to begin sooner.
The CARES Act requires a vaccine that the Food and Drug Administration has authorized or approved and its administration to be free to beneficiaries with Medicare Part B and those with Medicare Advantage who receive the vaccine from an in-network provider.
Medicaid and CHIP cover recommended vaccines for children without cost-sharing. Currently, the COVID-19 vaccine is NOT recommended for children under the age of 16.
For adults in Illinois, Medicaid must cover vaccinations without cost sharing. For other groups eligible for Medicaid, such as low-income parents, states have flexibility to determine whether to provide coverage of vaccines. Please contact your plan for more information on vaccine coverage.
The federal government will pay for the costs of the vaccine and its administration for uninsured individuals.
Testing for COVID-19
The Families First Coronavirus Response Act requires health insurers to cover the COVID-19 diagnostic test at no cost to individuals, when the test is medically necessary. This includes private health plans, Medicare, Medicare Advantage, Medicaid, CHIP, TRICARE, veterans’ plans, federal workers’ health plans and the Indian Health Service.
- This means that individuals are not responsible for deductibles, coinsurance or co-pays for a COVID-19 test or for the visit associated with receiving that test.
- Plans may not use tools like prior authorization to limit access to the test.
- Insurers must also cover the cost, without cost-sharing, of a patient’s visit to a provider, urgent care center, or emergency room to receive this testing.
- However, these requirements do not apply to certain types of private health plans that are not in compliance with requirements of the Affordable Care Act, such as short-term limited duration plans. Please contact your insurance plan with any questions. For the purpose of testing, these individuals count as uninsured under the Families First Act. See below.
What if I am uninsured?
The Families First Act provides funding to reimburse providers for testing uninsured individuals, including those enrolled in short-term limited duration plans. If you are uninsured, please talk to your provider about receiving a test.
In addition, states have the option to extend Medicaid eligibility to uninsured populations for COVID-19 diagnostic testing, and this testing would be available with no cost-sharing.
On January 28, 2021, President Biden signed an executive order that reopened the health insurance marketplace for a special, three-month enrollment period beginning on February 15 and ending on May 15, 2021. Americans without health insurance who want health insurance can purchase options through the Affordable Care Act marketplace here.
Prescription Drug Coverage for Medicare Beneficiaries
During the COVID-19 public health emergency, a senior on Medicare can get up to 90 days of a prescription if that is what their doctor prescribed, as long as there are no safety concerns. Medicare drug plans will also allow beneficiaries to fill prescription early for refills up to 90 days, depending on the prescription.
In the past, Medicare drug plans only let beneficiaries receive a 30-day supply of their prescription.
Over-the-Counter Medical Products
The CARES Act allows patients to use funds in Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs) and Health Reimbursement Arrangement (HRAs) for the purchase of over-the-counter medical products, such as non-prescription pain relievers and cold/flu medications, without a prescription from a physician. In addition, menstrual care products have been added to the list of qualified health care expenses under FSAs, HSAs, and HRAs.
For more information and resources, please visit the following websites: