Am I eligible?
Health insurance marketplaces are open to serve people in every state. Uninsured people can apply for free or low-cost health insurance if they are low income, or get financial aid to help buy a plan. Small businesses and non-profit agencies can also get affordable coverage for their employees in these marketplaces.
Who is eligible to apply for health insurance in the marketplace?
If you don't have health insurance coverage or if you lose your insurance through a layoff or a divorce or for any other reason, this new program is for you!
To apply for coverage, you will need to be a resident of the state where you are applying. You will also need to be a U.S. citizen (either born in this country or a naturalized citizen) or a lawfully present immigrant such as a person with a green card, a refugee or a woman who has been trafficked. If you're not sure whether you fit the definition of lawfully present immigrant, you can learn more about that here.
Immigrants without legal status typically can't buy coverage in the marketplace, though. There are some exceptions for pregnant women, children and people with serious illnesses, and for people who qualify for emergency coverage through Medicaid.
If you already get health insurance through your job, that won't change. One exception is if your employer requires you to pay more than 9.5% of your income as your part of the cost of your insurance. If that is the case, then you can apply for more affordable insurance in the new marketplace to replace your employer health plan.
Who can get the free or low-cost insurance plans available in the marketplace?
Everybody who applies for coverage through the marketplaces will be screened to see if they qualify for free or low-cost public insurance under the Medicaid program. So, you will find out if you qualify when you apply!
Low-income parents, children, pregnant women, seniors and people with disabilities are eligible for Medicaid coverage in every state. But what it means to be low-income is different from state to state. In some states, like New York, that have expanded their Medicaid programs, a single person who earns up to $16,105 a year qualifies for Medicaid. A family of four that earns up to $32,913 a year qualifies. However, in states that have refused to accept federal dollars to expand their Medicaid programs, the qualifying income level may be lower.
What if you earn too much to qualify for free or low-cost Medicaid in your state? Can you still get financial help to afford health insurance?
Yes! People who earn too much to qualify for Medicaid in their states can apply for financial assistance to help pay the cost of private health plans that will be sold through the state marketplaces. The amount you can earn and still qualify will depend on your family size. See this chart to find out if you might qualify.
This financial aid will be given out using a sliding scale. The lower your income, the more financial assistance you will get.
Can I get help figuring out which health plan is right for me and how to enroll?
Yes! In every state, there are “navigator” or “in-person assistor” agencies that can help people figure out which health plan best meets their needs and the needs of their families. You'll be able to get help from trained staff either on-line, by phone and in-person. They can also walk you through the steps to enroll in the health plan you choose. To learn more about how to choose a health plan click here. To learn about how to apply, click here.
What happens if I choose not to get health insurance in 2016?
The health care law now requires everyone to have some type of health insurance coverage. Those who do not comply with the law will face a tax penalty on their 2016 tax returns, unless they qualify for an exemption. More information about this individual mandate, exemptions and tax penalties can be found here.
Renewing Marketplace Coverage for 2016
If you obtained a health care plan through the Marketplace in 2015 your current coverage will continue until December 31, 2015. If you want to continue having coverage in 2016, you must renew your current plan or choose a new one by December 15th, 2015. It is a good idea to comparison shop the health plans every year to make sure you have the best plan for your budget. Please be aware that insurers may change your policies and services in the new year and your premium, deductible and copay costs may go up. You should receive a notice from your insurer describing any changes in your plan for 2016, but contact your insurer directly if you have any questions. You should also get a notice from your health insurance marketplace (either healthcare.gov or the state-based marketplace in some states) about your renewal options.