Most consumers who purchase health insurance through the marketplace qualify for premium subsidies that reduce monthly premiums. Households earning less than 400% of poverty level usually qualify for these subsides.
Individuals without access to affordable employer-sponsored or Medicaid coverage may apply for coverage during either an open enrollment period or special enrollment period, and could qualify for cost-sharing reductions as well.
1. You must be a U.S. citizen or national
As part of their application for marketplace insurance and premium subsidies, individuals are required to disclose their citizenship status during the application process. This information is only collected to ensure eligibility for benefits; no immigration enforcement purposes will be served by collecting this data. Individuals residing with or in the household of an applicant who are filing taxes can claim an exemption by filing an IRS form together.
Certain qualifying life events allow non-citizens to enroll in health plans through their state health insurance exchange with financial assistance available; examples include marriage to an American citizen, changing legal status or completion of a year-long work or study visa; however these special enrollment periods do not apply to people currently incarcerated.
2. You must be lawfully present in the U.S.
Lawfully present refers to being within the United States legally. According to the Affordable Care Act (ACA), this criterion serves as the standard for eligibility in its insurance marketplaces and federal premium subsidies; states may use this standard when deciding if they offer state-funded premium subsidies on exchanges as well. Furthermore, eligibility criteria apply similarly for public benefits like Medicaid, Medicare and the ACA’s high-risk pool.
The Affordable Care Act (ACA) permits people to gain lawfully present status by meeting one or more qualifying events, such as becoming citizens or U.S. nationals or obtaining green cards. Noncitizens generally have less access to private health coverage as well as some public options such as Medicaid, CHIP and Obamacare marketplace coverage; those eligible for Deferred Action for Childhood Arrivals (DACA) remain ineligible for Medicaid and other forms of public coverage;
3. You must be a resident of the U.S.
To qualify for premium subsidies on the Obamacare Marketplace, you must either be a U.S. citizen or national, legal permanent resident, or lawfully present non-citizen without affordable coverage from another source (i.e. an affordable employer-sponsored group health plan, Medicare or Medicaid). To determine eligibility, it’s necessary to know how much the second least expensive Silver plan costs in your location.
Individuals whose earnings exceed 400% of the federal poverty level can apply for Obamacare insurance and receive financial assistance to reduce monthly premiums and out-of-pocket expenses. You can enroll in an Affordable Care Act-compliant plan through either the government’s online marketplace, eHealth or another licensed insurance broker like Aon Hewitt. Non-citizens may purchase short-term health coverage until becoming eligible for an ACA-compliant plan in full.
4. You must be a resident of a state with an exchange
The Affordable Care Act (ACA) mandates that most Americans obtain health insurance or face penalties; in exchange, Obamacare offers subsidies that make health coverage more cost-effective.
Under the Affordable Care Act (ACA), to qualify for premium tax credits you must reside in a state that offers an exchange and enroll during an open enrollment period; qualifying events like losing your job may allow for enrollment outside of an open enrollment period.
Most individuals with incomes between 100% and 400% of the federal poverty line qualify for premium tax credits that reduce health plan costs. The credit is determined based on the cost of second-least expensive silver plan available in your area – although the benchmark plan can change each year as health plan prices change.
5. You must be a resident of a state with Medicaid
Typically, to access the health insurance marketplace you must be a resident of that state; however, special enrollment periods (such as when changing jobs or having a baby) allow individuals to purchase coverage outside of open enrollment periods.
The 2010 health care reform law makes it easier for individuals and their families to obtain affordable health insurance policies, while protecting them from being dropped while sick, denied coverage due to preexisting conditions and giving them legal standing against insurance companies.
Obamacare allows states to expand Medicaid coverage, covering many more low-income people. Furthermore, financial support is provided for marketplace plans so people who earn too much to qualify for Medicaid but not enough to make even the second lowest cost silver plan affordable without subsidies may afford one of these plans.
