Countdown to Coverage: Importance of Financial Assistance

CPPP's Stacey Pogue

UPDATE November 7, 2014: Earlier today the Supreme Court decided to hear King v. Burwell, a case about the subsidies in federally-facilitated Health Insurance Marketplaces. While this decision is troubling, there is no immediate impact to financial assistance available through the Health Insurance Marketplace. 84% of Texans received financial assistance in 2014 to access healthcare that fit their needs and budget, and that assistance will continue to be available. With only 8 days until the Marketplace opens, now is the time to estimate your costs, and find out if you qualify for financial help. More details and a calculator are in the post below.


The new Health Insurance Marketplace provides a useful way for people to find and compare quality health plans. But the ability to shop for plans easily isn’t what really makes the Marketplace work for families. The Affordable Care Act instituted, for the first time, a broad system to help low- to middle-income families pay for the cost of private health insurance. The financial help to reduce the cost of insurance makes the Marketplace and the coverage through it meaningful for many of Texas’ uninsured families.

84 percent of Texans who enrolled in the Marketplace during the first open enrollment period received financial help and, on average, they pay just $72 per month for insurance. That’s less than a monthly cable bill. Low-income families can qualify for very low-cost premiums for good plans. During the last enrollment period, I helped several low-income Texans enroll in good coverage with premiums under $1 per month.

The available financial help is meaningful, and it is key to getting Texans covered. But many of the uninsured simply don’t know about it. A recent poll found that 53 percent of uninsured Americans don’t know about the financial help in the Marketplace. The uninsured who didn’t try shopping in the Marketplace for 2014 coverage were much less likely to know that financial assistance was available than those who enrolled. In fact, the perception that insurance would be unaffordable was the primary barrier that kept people from actually looking. But the facts tell a different story – most enrollees get financial help and report that their premiums fit their budgets.

Texans may qualify for financial help if they earn between $11,600 and $47,700 per year for an individual, or $23,800 to $95,400 a year for a family of four. It is easy to get an estimate of your costs and savings using the Get Covered America Calculator. With the 2015 enrollment period starting on November 15, 2014, now is the time to plan and learn about the financial help available.

We knew going into the first open enrollment period that about 2 million Texans were eligible for Marketplace coverage with financial assistance. We know now that about 615,000 Texans enrolled in 2014 coverage with financial help. More than 1 million Texans likely remain eligible for low-cost Marketplace coverage but are uninsured. Ensuring they know about available financial help is a necessary step to connecting them to coverage. In-person enrollment assistance is one of the most effective ways to sign up for coverage and learn about financial help.



Leave A Comment