Advanced Premium Tax Credits are tax credits from the federal government that lower the cost of monthly premiums for ACA Marketplace and State Based Exchange plans. They’re based on income and household size and are applied directly to your premium each month to make coverage more affordable.
In 2021, Congress temporarily enhanced these tax credits as part of the American Rescue Plan Act and extended them through 2025 with the Inflation Reduction Act. The enhancement made even more people eligible and made coverage significantly more affordable.
Yes, for now. But they’re set to expire at the end of this year unless Congress takes action to extend them. If that doesn’t happen, monthly premiums could go up for millions of people.
Nearly 200,000 Highmark ACA marketplace members currently benefit from these enhanced tax credits. That’s almost 9 out of 10 of our ACA Marketplace members. Without them, all of these members would see higher monthly premiums.
Right now, the median monthly premium for Highmark ACA members is about $160. If the enhanced tax credits expire, we expect many members could see their premiums rise as high as $320.
The Congressional Budget Office estimates that 7 million people could lose their health insurance within two years if the enhanced tax credits expire. It’s not just families who’d feel the impact — health care providers and local hospitals would, too, especially in small towns and rural areas.
Highmark is working closely with policymakers to help make sure hundreds of thousands of our members — and millions of people across the country — can get high-quality, affordable health insurance through the ACA Marketplace. We believe the ACA Marketplace is an important part of the U.S. health care system. It gives people who don’t get insurance through their job or a government program a way to get the coverage they need.
No, but your monthly premium could go up. If the tax credits expire and you find your new premium unaffordable, it’s a good idea to review your options during Open Enrollment. Highmark will continue offering a range of affordable health plans, and we’re here to help you find one that fits your needs and budget.
Yes. Advanced Premium Tax Credits will still be available based on your income and household size. You may also qualify for other cost-sharing reductions. But without the enhanced version, the overall savings may be smaller.
Yes, Highmark will notify all impacted members about any changes to their premium amounts well in advance of the effective date. We will provide information on your options and resources to help you understand the changes.
The exact amount your premium could increase depends on your individual circumstances, such as your income and household size. However, to provide an estimate, you can use the Keep Americans Covered calculator at https://calculator.americanscovered.org/. We will also provide personalized estimates in your renewal notice.
You will receive a renewal notice by early November, which will include information about your new premium amount. This will give you time to review your options and make any necessary changes.
Yes. By law, all ACA plans cover preexisting conditions, with no annual or lifetime limits.
The annual Open Enrollment Period for individual and family plans varies by state.
Anyone who qualifies for an ACA plan may enroll during this time period.
When you experience a major life event — like the birth of a child, the loss of a job, or a move to a new ZIP code — you may qualify for a Special Enrollment Period (SEP). An SEP typically gives you a 60-day window to enroll in a new individual or family plan and may occur at any time throughout the year.
All Highmark ACA plans cover the 10 Essential Health Benefits:
Some Highmark ACA plans include optional adult dental and vision coverage. All ACA plans include pediatric dental and vision coverage.
Find in-network doctors, hospitals, labs, mental health professionals, diagnostic and imaging centers, medical supplies and service partners, urgent care and retail clinics, and other health care services here
This will depend on the plan you select. Every plan comes with a formulary: a list of prescriptions covered by your health plan.
Yes. Mental health services are covered as one of the 10 Essential Health Benefits.
Yes. Substance use disorder services are covered as one of the 10 Essential Health Benefits.
*Only a requirement for purchasing plans on the marketplace. There is no citizenship requirement for purchasing plans directly though Highmark or other health insurance companies.
Depending on the life event that qualifies you for an SEP, you may need documentation like:
You may need to provide documentation for each person in your household verifying:
The annual Open Enrollment Period for individual and family plans varies by state.
Anyone who qualifies for an ACA plan may enroll during this time period.
When you experience a major life event — like the birth of a child, the loss of a job, or a move to a new ZIP code — you may qualify for a Special Enrollment Period (SEP). An SEP typically gives you a 60-day window to enroll in a new individual or family plan and may occur at any time throughout the year.
You can purchase individual or family ACA plans via:
APTCs and CSRs will only apply to plans bought through the marketplace.
APTCs and CSRs are also known as subsidies. These are tax credits that get applied directly to your premium or out-of-pocket costs.
Visit highmark.healthsherpa.com to see if you qualify for financial assistance. Your household size and annual income will help determine eligibility.
If you're happy with your plan and don't want to make changes, you don't have to do anything. Most plans auto-renew at the Open Enrollment deadline.
