Who Is Not Eligible For Affordable Care Act Health Insurance?

Who Is Not Eligible For Affordable Care Act Health Insurance?

The Affordable Care Act offers individuals, families, employers and government agencies many ways to obtain health insurance. Uninsured individuals have several options under the ACA such as federal, state and Marketplace coverage at reduced prices.

The Affordable Care Act (ACA) includes advanced premium tax credits to enable people with incomes between 100 percent and 400% of the Federal Poverty Level (FPL) to purchase subsidized coverage on the Marketplace. These subsidies protect individuals from rising premiums and reduce out-of-pocket expenses.


In 2013, the Internal Revenue Service interpreted the Affordable Care Act’s “firewall” provision to mean that people who received an offer of affordable employee-only coverage from their employer would not qualify for premium tax credits (PTCs) to purchase marketplace coverage. This left many families with an untenable choice between going without coverage or spending a significant portion of their income on employee-sponsored coverage.

The American Medical Association (AMA) has long advocated for the closure of this loophole and a modernized approach to family health care. Finally, the Biden administration has taken action with its final rule that uses family coverage costs as criteria for determining eligibility for PTCs – providing more affordable choices to millions of households nationwide.


Under the Affordable Care Act (ACA), all employers with 50 or more full-time equivalent employees must provide health insurance coverage or face financial penalties. This rule, known as the “Employer Mandate,” applies to both for-profit and non-profit businesses alike.

The employer mandate imposes two kinds of penalties for noncompliance: one for not providing coverage and another for failing to provide minimum value and/or affordable coverage.

Under the Affordable Care Act (ACA), an Affirmative Action Leasing entity (ALE) must offer health coverage that meets both affordability and minimum value criteria to all of its full-time employees. Furthermore, dependents of those employees – defined as biological or adopted children up to age 26 – must also have access to this plan.

If the ALE fails to provide coverage for one month, they face a penalty of $2,320 divided by 12 times the number of full-time employees minus 30. Furthermore, this penalty includes the cost of sharing an employee’s premium that must not exceed 9.5 percent of their household income.

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About the Author: Raymond Donovan