Many of her clients don't believe it when Maryland tax preparer Diana Avellaneda tells them they might qualify for low-cost health insurance. Or they think she's trying to sell them something. In reality, she wants to help her customers take advantage of an underused feature of her state's tax forms that allows them to get financial assistance for health insurance.
Avellaneda said she wants people to avoid the financial risk of a medical emergency: "I have health insurance right now, and I feel very, very peaceful. So I want my community to know that."
The process is simple: By checking a box, taxpayers trigger a "qualifying event," enabling them to sign up for insurance outside the traditional open enrollment period and access subsidies that can bring the cost of that insurance down, if their income is low enough. Doing so also allows Maryland's comptroller to share a person's income information with the state's insurance exchange, created under the Affordable Care Act.
After checking the box, people receive a letter with an estimate of the kind of financial assistance they qualify for, whether subsidies for an exchange-based plan, Medicaid, or, for eligible minors, the Children's Health Insurance Program. Also, a health care navigator may call taxpayers offering them enrollment assistance.
Avellaneda said most of her clients who apply end up qualifying for subsidized insurance. Many are surprised because they had assumed financial assistance was available only to those with extremely low incomes. Avellaneda thought this as well until she did her own taxes a couple of years ago.
"I was one of the persons that thought that I couldn't qualify because of my income," said Avellaneda, with a chuckle.
A growing number of states — including Colorado, Massachusetts, and Massachusetts — are using tax forms to point people toward the lower-cost coverage available through state insurance marketplaces; by next year, it will be at least 10, including California, Maine, and New Jersey. Illinois is working on a program as well.
"We all file taxes, right? We all know we're filling out a bazillion forms. So what's one more?" said Antoinette Kraus, executive director of the Pennsylvania Health Access Network, who advocated for Pennsylvania to create a program modeled on Maryland's.
Often, efforts to enroll people in health insurance are scattershot because the data sets of uninsured people are incomplete. This can lead outreach workers to try to find people who have submitted unfinished Medicaid applications to try and sign them up for coverage.
But nearly everyone has to file tax paperwork, and that existing infrastructure helps states connect the dots and find people who are open to signing up for insurance but haven't yet.
"It's hard to imagine more targeted outreach than this. I think that's one reason it's become popular," said Rachel Schwab, who researches the impact of state and federal policy on private insurance quality and access at Georgetown University.
The rise of these initiatives, known as easy enrollment, is happening at a time of incredible churn for health insurance.
The end of some policies launched during the height of the covid-19 pandemic is forcing people to reenroll in Medicaid or find new insurance if they make too much money to qualify. At the same time, marketplace subsidies created in response to the pandemic have been extended through the end of 2025 via the Inflation Reduction Act. So having a simple way to connect people to health care coverage and make the most of federal dollars is a good idea, said Coleman Drake, a health policy researcher at the University of Pittsburgh.
He cautions that these initiatives won't get everyone covered. Data bears this out: Only about 10,000 Marylanders have gotten insurance this way since 2020, less than 3% of that state's uninsured population. The number in Pennsylvania is estimated to be small, too. Still, it's a step in the right direction.
"Uninsurance in general is extremely costly to society," said Drake. "Whatever we can do here to make signing up for health insurance easy, I think, is an advantage."
This article is part of a partnership that includes WESA, NPR, and KFF Health News.
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