What Are Marketplace (ACA) Health Insurance Plans?
Marketplace health insurance refers to any type of health insurance that’s offered under the Affordable Care Act (ACA). It is also known as “health care reform,” and it was created in 2010.
When President Obama signed the bill into law in March of that year, he said, “This is not just another tax cut for America’s wealthiest individuals. This is a down payment on the future. This will reduce our deficits while still investing in things like research to find cures and prevention methods.”
A marketplace or ACA health insurance policy gives you access to affordable, quality healthcare. This kind of insurance can be very helpful if you don’t have the ability to purchase coverage through an employer, Medicare, Medicaid, or Tricare.
Who Are Eligible for ACA Marketplace Healthcare Plans?
President Obama signed the Affordable Care Act into law on March 23rd, 2010. This new health care reform was designed to make sure that more Americans have access to quality, affordable coverage.
However, many people don’t know who is eligible for these new insurance policies. So here are some key facts about the ACA Marketplace Healthcare Plans:
If you want to get covered by an ACA Marketplace Healthcare Plan, then you need to be a legal resident of the United States for at least six months. You also need to have been living in the U.S. for at least one year prior to the day that you apply for benefits.
Healthcare insurers offer different types of policies to their customers depending on their age, income and type of treatment required. In fact, in 2022 Affordable Care Act (ACA) no longer makes it mandatory for everyone to buy coverage under the program.
The key thing about this healthcare insurance is that you don’t have to pay anything upfront; instead you can choose any policy based on your needs and budget. The major benefit of these insurance companies is that once you enroll, you won’t have to go through a tedious process every time when you get sick or need medical assistance. You will also have access to many other benefits like maternity leave, etc.
To be eligible for the Obamacare Marketplace, you should not be covered by Medicare Part A and B. This means that you are ineligible if you have Medicare Advantage or supplemental plans in place.
You can see the details of your current health plan with your provider or contact them to find out whether you qualify for ACA marketplace.
Age
This is the most important factor to consider while buying a health insurance. If you are below 65 years, then normally you are able to qualify for a plan.
Income level
As mentioned earlier, you can choose any plan based on your income. In fact, it is calculated as 150% of the federal poverty line. It is based on the state that you reside. For example, The minimum acceptable limit for 2022 in Texas is $13,590 and the maximum is $54,550 for a single person with no dependents. Again, the actual value varies from state to state. So before applying, you must know what is your annual household income.
Once you do that, you can compare the plans and pick the one which suits you best. But there are certain factors like deductibles, copayments, and coverage limits etc. which are also considered.
The most common types of insurance plans are:
Catastrophic – This is for people who are under 30 or for people who have a hardship or affordability exemption.
Bronze – Bronze plans are the cheapest option and offer basic benefits such as hospitalization, doctor visits, emergency services, maternity leave etc. The drawback is that it is usually the highest coinsurance/deductable of all plans. It is good for people who do not plan on going to the doctor often, but would like to have something to fall back on.
Silver – Silver plans are more comprehensive than bronze. They cover additional costs such as prescription drugs and routine doctor visits. This plan also has savings. If you qualify for cost-sharing reductions…you must pick a silver plan. You can save a lot of money per year if you’re eligible for a premium tax credit and can enroll though a special enrollment period.
Gold – Gold plans are a good option and include all of the coverage found in a silver plan.
Platinum – This plan offers the highest monthly premiums and the lowest costs when you get care. The dedcutibles are very low as well. It is a good choice if you are willing and able to pay the high premiums.
Who Are Not Eligible for ACA Marketplace Healthcare Plans?
Some of the reasons why you are ineligible for these plans are:
- You have less than $13,590 income and dependents.
- If you qualify for Medicaid.
- If you are not a U.S Citizen or legal resident
- Some people are not eligible because they don’t live in the United States.
- Some people who aren’t eligible for the ACA are those who are older than 65 and qualify for Medicare.
- Some people are not eligible because they are incarcerated.
What Is the Lowest Income Level to Qualify for ACA Marketplace Healthcare Plans?
As you may know, the Affordable Care Act (ACA) was passed by Congress in 2010 to help make health care more affordable for all Americans. The law included provisions that would allow people who earn less than 400 percent of the federal poverty line ($45,960 for an individual; $94,200 for a family of four in 2016., to be eligible for government subsidies.
The following chart shows how much money you need to make before you can get financial assistance from the federal government to purchase insurance on the Marketplace.
You can use this information to determine whether or not you will qualify for these subsidies. If you have any questions, please contact your local Social Security office.
Income Level
Less Than 100% of Federal Poverty Line (FPL): Less than 1,400 per year
100-199% of FPL: Between 1,400 and 2,000 per year
200-399% of FPL: Between 2,000 and 3,000 per year
More Than 399% of FPL: More than 3,000 per year
When you buy healthcare coverage through the Marketplace, you’re paying based on a variety of factors including age, gender, tobacco usage, geographic area, family size, income, and medical history. So if you already have health problems or take certain medications, you might be able to pay less for insurance. However, there is one big catch. If you have a “pre-existing condition,” then you cannot be covered by any Marketplace plans. Pre-existing conditions generally refer to a medical issue that existed before you enrolled in the plan. These could range from being diagnosed with cancer or having an organ transplant to suffering from depression, anxiety, bipolar disorder, schizophrenia, diabetes, or other mental illnesses. In order to be eligible for Marketplace insurance, you must not have had such a medical problem within the previous 63 days.
The Affordable Care Act (ACA) requires all Americans to maintain continuous coverage throughout 2014 and beyond – even if they become sick. If your employer offers group health benefits, you can choose either the individual market or the small business exchange instead of your current job-based plan.
If you are self employed, you can purchase an individual policy on the Health Insurance Exchange website, as well as on private websites like eHealthInsurance.com, CompareCards.com, and InsureMyPolicy.
Can You Purchase ACA Marketplace Healthcare Plans with Pre-existing Conditions?
A pre-existing condition is a condition that existed before you applied for health insurance. If you have a pre-existing condition, you cannot be denied coverage under the Affordable Care Act. This is because you can purchase insurance through the Health Insurance Exchange. This means that if you have a pre-existing condition, you can buy insurance on the exchange. You can even get a plan that covers your pre-existing condition.
What Do ACA Marketplace Plans Not Cover?
Normally, you would have to purchase additional insurance to cover your dental, vision, and hearing care. ACA plans only cover medical services usually provided at a doctor’s clinic or hospital.
When Can You Purchase ACA Marketplace Healthcare Plans? What Are the Qualifying Events?
A life-changing event such as turning 26, moving to a new state or having a baby can have an impact on your health insurance. You may be able to purchase a new health plan during a special period if you have a life event. Natural disaster relief or pandemic relief are other reasons that some states may offer Special Enrollment Periods (SEPs).
If you have had a lapse in coverage of more than 63 days, you can purchase an individual market plan. Since 2018, you will be able to purchase a plans for the following qualifying events that can trigger a lapse in coverage.
* You lose coverage because of a divorce or legal separation
* You lose coverage because of a job loss
* You move out of your home
* Your income drops below the eligibility limits for your county or state
* You are no longer eligible for Medicaid or CHIP
* You lose employer-sponsored coverage
* You no longer qualify for a subsidy (if you receive one)
You may also qualify for tax credits if you’ve lost coverage due to a change in employment. In this case, you should have had COBRA coverage for 18 months. If you didn’t, then you could still get a subsidy.
If you don’t meet the requirements of either program, then you won’t receive any help.
Health Insurance Marketplace Subsidies
There are two types of subsidies available to marketplace enrollees. The first type, called the premium tax credit, works to reduce enrollees’ monthly payments for insurance coverage. The second type of financial assistance, the cost sharing subsidy, is designed to minimize enrollees’ out-of-pocket costs when they go to the doctor or have a hospital stay. In order to receive either type of financial assistance, qualifying individuals and families must enroll in a plan offered through a health insurance Marketplace.
Premium tax credit
The premium tax credit reduces enrollees’ monthly payments for insurance plans purchased through the Marketplaces.
There are four metal levels of coverage for the marketplace. They are: Bronze, Silver, Gold, and Platinum.
The bronze plan has the lowest premiums, but it’s also the least comprehensive of all three plans. This means that the enrollee will have to pay more out-of-pocket for covered health care services than they would with a silver plan. The gold plan has the highest premiums, but it has the lowest deductibles.
The premium tax credit can be applied to plans in all metal levels.
The catastrophic health plans with lower premiums and higher copayments also exist on Marketplace.
Premium tax credits cannot be applied to catastrophic plans. These plans are generally only available to individuals younger than 30.
Who is eligible for the premium tax credit?
In order to receive the premium subsidy, you must meet certain criteria. You cannot use it if you are already receiving benefits under one of the programs listed above.
You can’t use it if you don’t pay enough federal income tax. This includes people who aren’t required to file a return because of low income.
If you make too much money to qualify for the premium tax credit, you still might qualify for financial help. For example, if your gross income is $48,240 or less ($25,580 if you’re single), you could qualify for additional government support.
Conclusion
In conclusion, if you have a low income, you qualify for the premium tax credit if your household income is less than 400% of the federal poverty level. You may also qualify for premium tax credits if you have a child under age 19, or if you are blind or disabled.
If you need help picking a health insurance ACA plan, call us. We can help you find a plan that fits your needs.