Affordable Health Insurance is Available to Millions of Americans! How Many Americans Get Marketplace Insurance for $0 or $50 or Less?

More than half (56.8 percent) of uninsured non-elderly adults in HealthCare.gov states could find a zero- or low-premium plan.

Specifically, 42.5 percent may have access to a zero-premium plan and 56.8 percent may have access to a low-premium plan for $50 or less per month. This suggests that many uninsured individuals may be eligible for affordable coverage but may be unaware they have eligibility for coverage and/or financial assistance, may not know how to enroll in coverage, or may struggle with the complexity of insurance and/or the enrollment process.

However, it is important to note that premiums are only one component of health coverage costs.

Consumers should also consider out-of-pocket costs, such as deductibles, copays, and coinsurance. Zero- or low-premium plans may have higher consumer cost-sharing than higher premium plans. It is important for consumers to balance plan features when they select a plan.

Many of the zero- or low-premium plans are bronze plans with high deductibles.

Consumers need to be aware of out-of-pocket costs associated with different plan options. The median QHP deductibles – without cost-sharing reductions – for individuals in HealthCare.gov states by metal tier in 2021 are approximately $6,992 for bronze, $4,879 for silver, and $1,533 for gold. For those eligible for cost-sharing reductions (people with incomes between 100 and 250 percent FPL), these deductibles are typically substantially lower for silver plans. For example in 2021, comparable median deductibles for silver plans with cost-sharing reductions were $3,318 for 73 percent AV silver plans (available to those with income of 200 and 250 percent FPL), $620 for 87 percent AV (available to those with income between 150 and 200 percent FPL), and $74 for 94 percent AV (available to those with income between 100 and 150 percent FPL).

Access to zero- and low-premium plans varies across demographic groups.

Historically, policies, laws, and practices have limited health insurance options for communities of color. The uninsured population disproportionately includes Black and Latino individuals, younger adults, individuals living in rural areas, and individuals with incomes between 100-400 percent of FPL. The uninsured population is also more likely to defer or forgo needed health care, resulting in higher potential for poor health outcomes.

It is important to address the barriers that prevent uninsured individuals from accessing affordable health coverage.

This includes raising awareness of the availability of zero- and low-premium plans, providing assistance with enrollment, and simplifying the enrollment process. It is also important to address the underlying inequities that contribute to the high number of uninsured individuals, such as racial and ethnic disparities in income and access to health insurance.

ix Certain preventive services, such as an annual check-up and diagnostic screenings, are typically available before the deductible is met and with no cost-sharing, i.e. these services are accessible to a person before they have to pay toward their deductible.

Zero- and low-premium plans are more available to Black, Latino, and Native American adults who lack insurance and could qualify for APTCs.

This suggests the ACA can help address disparities in health coverage in these populations.

Rural areas have slightly higher access to zero- and low-premium plans than urban areas.

This may be because average income in rural areas is lower and more individuals qualify for larger subsidies.

The American Rescue Plan (ARP) increases and expands eligibility for the ACA Marketplace premium subsidies.

This will make zero- and low-premium plans more available to many consumers and uninsured individuals.

The ARP also includes unemployment provisions that allow individuals who received unemployment compensation in 2021 to be deemed to have an income not in excess of 133 percent FPL for the purpose of calculating eligibility for APTCs and cost-sharing reductions.

This will further increase availability of zero- and low-premium plans.

There is evidence that zero-premium and low-premium plan availability encourages uninsured people to enroll in the Marketplace.

Increasing consumer awareness of such plans is an important part of the strategy to increase health insurance coverage.

The ARP includes provisions that build upon the ACA, including enhancing and expanding Marketplace subsidies.

These changes will further improve the affordability of coverage for uninsured individuals as well as those already enrolled in Marketplace health plans, likely leading to more individuals enrolling in health insurance coverage in the coming months.