At open enrollment, anyone may apply for coverage through the marketplace as long as they are legal citizens without access to affordable employer group health coverage or Medicare, and don’t receive cost assistance through an exchange.
Household incomes between 100-400% of the poverty line may qualify for premium subsidies. Outside of open enrollment, you can only enroll in a Marketplace plan if a qualifying life event occurs.
Obamacare (also known as the Affordable Care Act) can be applied for by anyone meeting certain eligibility requirements: they must be U.S citizens, U.S nationals or lawfully present in the US; individuals whose household income falls between 100-400% of federal poverty level can qualify for financial assistance to lower premiums and out-of-pocket costs.
Families and individuals without health coverage through an employer may purchase private health coverage on the marketplace in their state. Even without qualifying for subsidies, there are plans ranging in cost from less than $10 a month up to more than $600 monthly premiums on offer in each plan.
Enrolling in a plan during Open Enrollment or when life-altering events trigger Special Enrollment Periods is easy and hassle-free if you visit New York State of Health – your state’s official healthcare marketplace – to explore your options and apply for cost assistance. Open enrollment starts November 1 and concludes on January 31.
People whose annual income falls within 400% of poverty qualify for Obamacare premium subsidies. Employer-sponsored group health coverage or Medicare may still qualify, as long as its costs exceed 9.61% in 2022 and 9.12% in 2023; some people without affordable employer-sponsored plans may still purchase marketplace coverage with subsidies.
Two million to six million individuals have historically been affected by the “family glitch,” an affordability gap created when exchanges only make affordability determinations for individual-only plans and not family ones. A legislative fix would address this problem by altering how affordability tests work, though doing so would increase federal spending by around $45 billion.
3. Small Businesses
In addition to providing access to the Marketplace for purchasing commercial health insurance plans, the Affordable Care Act also offers small businesses options for offering group coverage – these can include purchasing private plans through SHOP exchange or working with professional employer organization (PEO).
Both options can be cost-effective solutions for small businesses to avoid penalties associated with the Affordable Care Act (ACA), including ensuring it meets employee affordability requirements.
2023 plans must cost no more than 9.12% of an employee’s income to meet the Affordable Care Act’s affordability requirement and be calculated with our premium subsidy calculator. If you’re uncertain whether your employer-sponsored plan meets this threshold, an SBDC advisor can assist with understanding which provisions of ACA apply specifically to your business and HRAs (health reimbursement accounts) which offer pre-tax funds for use towards health expenses by employees.
Obamacare — or the Patient Protection and Affordable Care Act (ACA) — provides individuals and families with many choices for marketplace coverage, depending on your income level. You could qualify for cost assistance such as premium tax credits or cost sharing reduction subsidies depending on how your application is filed.
No matter if you are self-employed, work at a small business, or are employed by an employer that doesn’t offer health insurance plans – whether self or employer sponsored – open enrollment runs annually from November 1 through January 15. In special circumstances you can enroll outside this period based on qualifying life events.
If your income exceeds 400% of the poverty line but falls within 400% of it, you can still purchase Obamacare coverage through the marketplace by purchasing a short-term plan which is less expensive and doesn’t include as many benefits than an ACA-compliant policy. However, these short-term plans don’t have to conform with ACA regulations, and using one consistently for more than 12 months could incur penalties from Medicare or state governments.