Massachusetts General Hospital, 100 Cambridge St, Ste 1600, Boston, MA 02114. Email:
Am J Manag Care. 2022 Aug;28(8):404-408. doi: 10.37765/ajmc.2022.89199.
The 2021 American Rescue Plan Act (ARPA) increased the availability and magnitude of premium tax credits (PTCs) for consumers purchasing individual marketplace plans in 2021-2022. Millions currently purchase PTC-ineligible plans off of the marketplace. We estimate the proportion of off-marketplace enrollees who would be eligible for the expanded PTCs under ARPA, calculate PTC amounts for eligible enrollees, and examine factors influencing plan choice that could inform outreach efforts.
We analyzed data from a survey of a random sample of off-marketplace enrollees in California in 2017 (n = 829).
Using survey data including self-reported income, household size, and employment status combined with 2021 benchmark premium data from Covered California, we estimate eligibility for PTCs and potential PTC amounts under ARPA among off-marketplace enrollees. We adjust for both survey design weights and poststratification weights.
Among off-marketplace enrollees, we estimate that approximately 12% are potentially ineligible for PTCs because they reported incomes less than 100% of the poverty level or because they had access to employer-sponsored coverage for their family through themselves or their partner. The median annual PTC in 2021 for eligible off-marketplace enrollees was $311 but varied greatly by age, family or individual plan, and household income (5%-95% range, $0-$14,836). In 2017, 69% of off-marketplace enrollees were unaware that they had to enroll in marketplace plans to receive PTCs, and 51% received enrollment assistance from insurance brokers.
These findings suggest the need for targeted outreach to encourage off-marketplace enrollees to switch to marketplace plans.
2021 年美国救援计划法案（ARPA）增加了 2021-2022 年消费者购买个人市场计划的保费税收抵免（PTC）的可用性和额度。目前有数百万人从市场上购买不符合 PTC 条件的计划。我们估计根据 ARPA，有多少不符合市场条件的参保人有资格获得扩大的 PTC，并计算符合条件的参保人的 PTC 金额，并研究影响参保人计划选择的因素，这些因素可以为外展工作提供信息。
我们分析了 2017 年加利福尼亚州随机抽样的非市场参保人调查数据（n=829）。
使用包括自我报告收入、家庭规模和就业状况在内的调查数据，并结合 2021 年加州保险交易所的基准保费数据，我们估计非市场参保人 PTC 的资格和 ARPA 下潜在的 PTC 金额。我们调整了调查设计权重和后分层权重。
在非市场参保人中，我们估计约有 12%的人可能没有资格获得 PTC，因为他们报告的收入低于贫困线的 100%，或者因为他们通过自己或伴侣获得了雇主为家庭提供的保险。符合条件的非市场参保人在 2021 年的 PTC 中位数为 311 美元，但因年龄、家庭或个人计划以及家庭收入（5%-95%范围，0-14836 美元）而异。在 2017 年，69%的非市场参保人不知道他们必须注册市场计划才能获得 PTC，51%的人从保险经纪人那里获得了注册协助。
这些发现表明需要有针对性的外展工作，鼓励非市场参保人转至市场计划。
