The Affordable Care Act (“ACA”), Obamacare, Marketplace, Exchange.  Regardless of how you refer to it, it is a program that affects a majority of the population.  It’s surprising that most people do not know more about the details of the Health Insurance Marketplace considering its household reputation.  If you are still uninsured or considering changing plans, here are a few facts about the program that help create a more in-depth understanding.

Who the Marketplace is Meant for

This program is meant for individuals without health coverage through a workplace, private insurer, parent’s coverage, or Medicare/Medicaid.  If the plan you currently have does not meet the minimum requirement as set by the ACA, then you are responsible for a tax penalty if you do not qualify for an exemption.  A full list of minimum requirement plans can be found here.

If you are covered by your workplace but your dependents are not, they may qualify for subsidies through the Exchange.  This is only in the event that your workplace insurance will not cover them.  It is not applicable if you made a conscious decision not to enroll them.

Medicare enrollees are not allowed to switch to the Marketplace in any capacity.

The Cost

The finalized cost is based on the annual household income.  Subsidies are common among applicants, and healthcare.gov offers a quick test to check your eligibility.

Subsidies offer a range of benefits including:

  • Premium tax credit creates lower monthly bill costs as well as lower costs on deductibles and copayments.
  • Medicaid & CHIP (Children’s Health Insurance Plan) is coverage that offers households with low-income, disabilities, or unique situations with low, if not free, coverage. Keep in mind that children may qualify for CHIP even if the parent/guardian does not for Medicaid.

The Application Process

There are four ways to apply: online, by phone, in-person, or by paper application.

The Deadline

Open Enrollment  for 2016/2017 is between November 1st and January 31st.   You must apply by December 15th if you want to be enrolled for the full upcoming calendar year starting January 1, 2017.

If you need insurance outside of the Open Enrollment period, you may qualify for the Special Enrollment Period in the event a unique situation occurs.

The Penalty

There is always the option to go without the minimum insurance, however this comes with a penalty.  For the upcoming 2017 tax season, the penalty will be whichever is higher: 2.5% of the household income or $695/adult and $347.50/child.

There are possible exceptions to keep you from paying the fee, which can be found here.

Consider applying for health insurance during this season of Open Enrollment.  Health care costs are higher today than other time in history, and the support received from having health insurance saves you outrageous amounts of money.  You never know when an accident may happen, be prepared!

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