The Affordable Care Act (ACA) offers a range of health insurance plans. Additionally, there are subsidies available to help cover the cost of premiums.
Applying for a Marketplace plan is available during Open Enrollment Period each fall or Special Enrollment Periods that coincide with life events. For more details about these options, check out our state-by-state guide.
Open Enrollment Period
The annual open enrollment period is a time when you can enroll or make changes to your health insurance plan. It’s the ideal opportunity to find coverage that meets both your budget and needs.
Open enrollment for Marketplace plans takes place between November 1 and January 15, although exact dates may differ by state. It is also during this time that applicants can apply for Medicaid and the Children’s Health Insurance Program (CHIP).
If you don’t have health insurance or are uncertain if you qualify, the Marketplace offers free one-on-one help from certified assistants who will answer your questions about coverage and financial assistance. They also provide a free eligibility screener as well as plan comparisons to help select the plan best suited to your budget and needs.
Individuals with qualifying life events, like losing other insurance, getting married or having a baby, and meeting income requirements may have access to special enrollment periods of 60 days that allow them to enroll in major medical health insurance plans.
Special Enrollment Period
There is an additional enrollment period outside the annual Open Enrollment Period that permits you to apply for Affordable Care Act-compliant health coverage. In most states, this window runs from November 1 through January 15; however, dates may differ by location.
Some exceptional circumstances qualify for a Special Enrollment Period (SEP), such as losing coverage, getting married and birth/adoption of a child.
If you have lost health insurance due to divorce, COBRA expiration, or the loss of Medicaid or New York’s Child Health Plus coverage, a Special Education Plan (SEP) may be available. In Vermont also, changes in income or household status may qualify you for this program.
The SEP can be used to enroll in a plan at a different metal level or switch to a more cost-effective one. For instance, you could re-enroll in an exchange plan that offers cost sharing reductions if your income has changed since last enrollment.
Another alternative for SEP coverage is to switch plans when moving to a different city or state. This option can be especially advantageous for people who own homes in multiple states, as it helps them establish residency in each one separately.
Eligibility Requirements
The Affordable Care Act (ACA) has many eligibility criteria that must be fulfilled to qualify. These include having a valid health insurance plan, living in the United States, or being covered under an employer-based plan.
Additionally, your income must be low enough to qualify for either the premium tax credit or cost-sharing reductions; this requirement is known as the “income affordability requirement.”
If you experience a qualifying event, such as losing coverage or moving, you can apply for a special enrollment period. During this time, you can purchase a health insurance plan that meets your needs at a lower price than what was available previously.
The federal government is also providing assistance to people with disabilities and end-stage renal disease or diabetes, so they can access free or low-cost medical benefits. If you don’t qualify for employer-based coverage due to a disability, there may be options available through Medicaid, Medicare, or the Affordable Care Act Marketplace.
How to Apply
If you don’t qualify for a special enrollment period under the Affordable Care Act, your only opportunity to sign up for an Affordable Care Act health plan is during open enrollment period. At this time, you can sign up online or through an accredited insurance broker such as eHealth.
The Affordable Care Act (ACA) seeks to reduce health costs and expand access to coverage for everyone. It encourages states to expand Medicaid programs and provides subsidies through marketplaces to pay for private coverage. Furthermore, it sets strict regulations on insurers so they don’t discriminate against sick patients or refuse those with preexisting conditions.
You can learn all about Obamacare in your state at HealthCare.gov website. They offer a wealth of tools to help you select a plan, calculate your premium tax credit and more – plus they have an estimator tool to estimate savings amounts.
