Who Is Not Eligible For Obamacare Health Insurance Subsidies?

Who Is Not Eligible For Obamacare Health Insurance Subsidies?

Who is not eligible for obamacare

The Affordable Care Act (ACA) established state-based health insurance marketplaces and subsidies to assist those needing help paying for insurance premiums. It expanded Medicaid eligibility as well as making preexisting condition coverage more available and accessible.

However, the American Health Care Act and Better Care Reconciliation Act would prevent many immigrant families from becoming eligible for Affordable Care Act tax credits as well as coverage through federal and state exchanges.

Uninsured Individuals

Uninsured individuals refers to those without any form of health coverage – either public or private – including Medicaid/CHIP coverage as well as Medicare or Indian Health Service plans.

Of those remaining adults without health coverage, most reside within low-income working families with one wage earner; more than 8 in 10 had incomes less than 200% of poverty in 2014.

However, the Affordable Care Act has made it easier for these families to secure and keep health insurance by expanding Medicaid and creating Marketplaces where individuals and families can shop and apply for private health plans.

Although many eligible individuals for Obamacare have become insured since 2014, many others still remain uninsured due to a lack of awareness around what options exist under ACA or financial assistance programs for purchasing insurance policies.

Uninsured Families

There can be numerous reasons for people going without health insurance, with the primary one being affordability issues. They could have lost their job or their employer is no longer offering benefits – or just needing to purchase one themselves at their own expense.

Obamacare attempted to address that disparity through numerous means, such as allowing students to remain on their parents’ plan until age 26; banning preexisting condition policies from insurance providers; and penalties for those not enrolling.

These changes have brought relief to many individuals; however, there are still those unable to gain coverage due to having too high of an income or insurance providers refusing them. This is particularly prevalent among Hispanics and low-income people.

Uninsured Children

At least 4.3 million children in the US do not qualify for Medicaid or CHIP coverage due to employer-provided health insurance not covering them, no access through exchanges to coverage for these parents, or family income being too high to be eligible for this form of aid.

Though the uninsured rate among children decreased from 13.9 percent in 1997 to 4.5 percent in 2015, its rise since has been most noticeable for low-income children, infants, and those with special needs.

Underinsured children have a higher risk of chronic illnesses like diabetes and are more likely to have unmet healthcare needs like doctor visits or prescriptions that go unmet. Furthermore, uninsured children tend to live in poverty more frequently than insured ones and this contributes to their growing number. However, the Affordable Care Act has helped increase overall coverage.

Uninsured Employers

Employers that do not offer health insurance or cover medical expenses of their employees could leave you without coverage due to a provision of the Affordable Care Act called the “employer mandate,” which mandates employers with 50 or more full-time equivalent employees (FTEs) provide minimum value group health coverage or pay a penalty fee.

Penalties for uninsured employees could reach $3,000 per employee. If you work uninsured and your employer doesn’t offer coverage, there’s an enrollment period known as Special Enrollment Periods, or SEPs, designed to assist in signing up.

During this special enrollment period (SEP), you can enroll in any marketplace plan for one year, or exchange-based plan subsidized with federal dollars. Keep in mind, though, that SEP only becomes available if a qualifying life event (such as marriage, having a baby or losing your job) occurs and can demonstrate they cannot afford individual market health insurance plans.

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About the Author: Raymond Donovan