Who Is Not Eligible For the Affordable Care Act Marketplace?

Who Is Not Eligible For the Affordable Care Act Marketplace?

Who is not eligible for the affordable care act

The Affordable Care Act (ACA) makes health insurance easier to find and afford for many Americans, here are a few key points you need to remember when determining your eligibility for the Marketplace.

Under the Affordable Care Act (ACA), plans and issuers are mandated to offer dependent coverage until children reach 26. This rule applies both to married and unmarried children alike.

1. You’re not a U.S. citizen or legal resident

Millions of Americans benefit from accessing affordable health insurance under the Patient Protection and Affordable Care Act, commonly referred to as Obamacare. Consumers earning limited income qualify for financial aid to lower their health care costs through either the ACA marketplace or exchange, or Medicaid in certain states.

Noncitizens generally have less access to private coverage and eligibility restrictions apply when applying for public options like Medicaid, the Children’s Health Insurance Program (CHIP), and Marketplace coverage. As of 2021, half of lawfully present immigrants lacked coverage compared to just over 1 in 8 citizens who lacked insurance policies.

Noncitizens who fulfill certain criteria may qualify for coverage via the Affordable Care Act Marketplace and Medicaid in some states. For example, asylees and refugees legally present in the country for at least 12 months legally or those granted conditional residency status could potentially enroll during special enrollment periods in their state’s health insurance marketplaces.

2. You’re a non-citizen

Since 1996, noncitizens who do not meet the “qualified immigrant” standard set forth by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 could only access health-related and other supplementary government services if they met the Personal Responsibility and Work Opportunity Reconciliation Act standard for “qualified immigrants.” Thankfully, with the Affordable Care Act expanding eligibility for comprehensive Medicaid coverage and marketplace insurance subsidies. Furthermore, DHS issued a final rule clarifying their interpretation of public charge inadmissibility grounds of inadmissibility grounds so noncitizens could access essential community support services like healthcare without fear of immigration consequences.

Research indicates that uninsured noncitizens often face additional barriers when seeking health care, are less likely to utilize available health services and more likely to delay or forgo necessary procedures, leading to costly complications later. Children of noncitizen parents are also more likely to remain uninsured than their counterparts who are citizens. Regardless, noncitizens still qualify for premium tax credits and marketplace coverage under the Affordable Care Act provided they meet income and residency criteria within their state of residency.

3. You’re ineligible for Medicaid

Millions of uninsured people can gain health insurance through Obamacare/ACA marketplace plans. To qualify, individuals must legally reside within the US; all aspects of Obamacare use this standard – premium tax credits and cost-sharing reductions being used as payments towards deductibles/copays/coinsurance coverage etc).

States that expanded Medicaid under the ACA allow anyone, regardless of immigration status, to apply for Medicaid coverage. In non-expansion states however, federal law generally requires most immigrants to wait five years before becoming eligible for any public benefits like Medicaid coverage or similar solutions.

The Affordable Care Act prohibits insurers from imposing age or family size restrictions on individual marketplace plans or employer-sponsored plans offered through employers, which means young adults can remain on their parents’ health plan until age 26 and families can remain covered under one policy. To see if you qualify for marketplace coverage or financial assistance use our eligibility calculator.

4. You’re ineligible for ACA subsidies

Subsidies provide middle and low income families with affordable marketplace plans in their state. Subsidies reduce the net cost of benchmark silver plans in your area based on how much money you earn and your state’s average cost of coverage; both ARPA and IRA have enhanced these subsidies, which will remain available up to 2025.

The Affordable Care Act (ACA) includes additional assistance to cover out-of-pocket costs such as deductibles and copayments, which is only available if you select a marketplace plan with cost-sharing reductions. States offering these additional financial benefits tend to have significantly lower uninsured rates than those who don’t; legislative proposals in previous Congress aimed at increasing both premium tax credits and cost-sharing assistance were yet to be enacted into law.

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About the Author: Raymond Donovan