The Affordable Care Act (ACA) marketplace was launched in 2013 to help individuals and families find affordable health insurance. A decade later, there is still a lot of confusion about using the marketplace, especially regarding who qualifies for coverage.
Since ACA open enrollment has already started for 2024, it’s imperative to determine if you’re eligible for coverage, cost-sharing reductions, and premium tax credits.
We will discuss the eligibility requirements and important dates you need to know before purchasing a policy.
Eligibility Requirements for ACA Open Enrollment in 2024
Some people shy away from the health insurance marketplace because they think it has strict eligibility requirements. However, the requirements are minimal; therefore, most people who don’t have affordable insurance through their employers qualify.
You must currently reside in the United States and be a citizen, a national, or have an eligible immigration status to enroll in a plan. If you meet that criteria and aren’t currently incarcerated, you can purchase a plan on the marketplace. You are eligible if you were previously detained but are now released.
If you qualify for a plan, you may also be eligible to receive cost-sharing reductions or premium tax credits.
Who Qualifies for Cost-Sharing Reductions?
The ACA marketplace was opened to make health coverage more affordable and accessible—one way it accomplishes that is by providing cost-sharing reductions to eligible individuals and families.
You may qualify for a cost-sharing reduction if your income level is up to 250% of the federal poverty level. The income-based eligibility requirements vary by state, and if you qualify, your plan will have lower deductibles, copayments, and coinsurance costs.
Also, the out-of-pocket maximum will be much lower than for those who don’t qualify. The discounts are based on income level; the less you earn, the more you will save through cost-sharing reductions.
Cost-sharing reductions are only available for Silver-level marketplace plans. Thus, you won’t receive the discount if you purchase a Bronze, Gold, or Platinum plan.
Because cost-sharing reductions are based on income, it’s possible to become ineligible if your earnings increase. If that happens after open enrollment, you’ll have access to a special enrollment period.
Then, you can choose a new plan based on your current income level and healthcare needs. This special enrollment period will open as soon as you lose coverage, meaning you must find a new plan to avoid paying higher costs.
Premium Tax Credit Eligibility
You may qualify for a premium tax credit even if you don’t meet the criteria for receiving a cost-sharing reduction. Premium tax credits are available to those with household incomes up to four times above the federal poverty level.
If you are eligible for a premium tax credit, you can apply it in one of two ways. First, you can use it to subsidize your monthly premiums, meaning you’ll spend less throughout the year. You simply apply the subsidy when making payments.
You can add the subsidy to your federal tax return if you prefer to receive a lump sum payment. The IRS will apply the tax credit, and you will receive a refund based on the amount of the credit.
Dates to Know Before Purchasing Insurance During ACA Open Enrollment
In most states, ACA open enrollment runs from Nov. 1 until Jan. 15, although some states have slightly different timelines. For instance, California’s open enrollment period goes from Nov. 1 to Jan. 31, while Idaho’s period starts on Oct. 15 and ends on Dec. 15.
Regardless of your residence, you must enroll by Dec. 15 if you want your plan to start on Jan. 1. Otherwise, your coverage will begin on Feb. 1. Finally, marketplace plans automatically renew each year to ensure continuity of coverage.
However, you won’t be automatically renewed into your existing plan if it’s no longer available on the marketplace. If that happens, the marketplace matches you to a new plan and automatically enrolls you.
If you don’t want the ACA marketplace to automatically renew your policy, you must change your plan or indicate that you wish to stop coverage by December 15. Otherwise, you will be re-enrolled and must wait until the next open enrollment period to make changes.
Find Out If You Qualify for Health Insurance Discounts
The ACA marketplace can be complicated, so some people don’t receive their eligible discounts due to errors and miscalculations. Yara Health Plans helps individuals and families find affordable, comprehensive coverage on the marketplace at no cost to customers.
Our certified ACA agents help customers determine if they’re eligible for discounts and guide them to ensure they purchase the best policies for their needs.
ACA open enrollment 2024 ends soon; contact Yara Health Plans today for assistance. An agent will discuss your situation and review options, so you’ll have the coverage you need in 2024 and beyond.