Understanding the Affordable Care Act

Understanding how to qualify for health coverage under the Affordable Care Act (ACA) is important for those seeking affordable health insurance. Whether you're navigating income limits, special enrollment periods, or dealing with life events that change your coverage needs, it's important to know the steps and requirements to qualify for ACA plans. This blog will break down the basics in simple terms to help you determine if ACA coverage is the right fit for you or your family. 

What is ACA Health Coverage? 

The ACA, also known as the Affordable Care Act, was designed to make health insurance more accessible and affordable for millions of Americans. It provides health plans through the Health Insurance Marketplace, which is available for individuals who may not have coverage through their job, Medicaid, or Medicare. 

Eligibility Criteria: Do You Qualify? 

Eligibility for ACA health coverage depends on a few factors. Below are the main areas that determine if you're eligible: 

1. Income Limits 

One of the most important factors in qualifying for ACA coverage is your household income. The ACA uses the Federal Poverty Level (FPL) to determine how much financial help you can receive. Here’s what you need to know: 

• If your income is between 100% and 400% of the FPL, you may be eligible for subsidies to lower the cost of your premiums. 

• In states that have expanded Medicaid, you may qualify for Medicaid if your income is below 138% of the FPL. 

• If your income exceeds 400% of the FPL, you may still be eligible for some financial assistance through "expanded subsidies," depending on your state. 

It’s important to calculate your household income based on your tax return, as the Marketplace will use this information to determine your eligibility. 

2. Special Enrollment Periods (SEPs) 

The ACA offers Open Enrollment each year, but there are also Special Enrollment Periods that allow you to sign up or change your plan if you experience certain life changes. These periods are limited and typically last 60 days from the event. 

Here are a few common life events that might qualify you for a Special Enrollment Period: 

• Loss of health coverage: If you lose your job-based coverage, aging out of a parent’s plan, or losing coverage through Medicaid. 

• Change in household: Events like getting married, having a baby, adopting a child, or losing a dependent can make you eligible. 

• Change in residence: Moving to a new ZIP code, state, or even moving back to the U.S. from abroad can trigger eligibility. 

• Income changes: If your income changes to a level that qualifies you for different coverage, it may open up a Special Enrollment Period. 

Keep in mind that even if you miss Open Enrollment, these life events could still give you the opportunity to sign up for health coverage under the ACA. 

What If You Have a Life Event? 

A life event such as a marriage, divorce, or birth of a child can significantly impact your health insurance needs. Here’s how: 

• Marriage: If you recently got married, you and your spouse may qualify for a Special Enrollment Period. 

• Having or adopting a child: Becoming a parent qualifies as a life event, allowing you to add your child to your ACA plan. 

• Divorce: Divorce can trigger a Special Enrollment Period, especially if it results in the loss of coverage for one spouse. 

These changes mean that you won’t have to wait until the next Open Enrollment period to adjust your coverage or sign up for a plan. 

 In Conclusion 

Qualifying for ACA health coverage might seem overwhelming at first, but it’s all about understanding your income level, knowing when you're eligible for a Special Enrollment Period, and recognizing the life events that can impact your insurance needs. Whether you're applying for the first time or need to adjust your coverage after a life change, the ACA offers a safety net to ensure you have access to essential healthcare services. 

If you have questions or need assistance finding an ACA plan, call one of our Licensed Agents at Trusted Senior Specialists.

There is no cost or obligation for a consultation! 

We are available Monday through Friday from 8 AM to 8 PM CST,
and on Saturday by appointment.

You can reach us by calling: 1-855-952-1941 TTY: 711
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