Tax Credits or Subsidies - Do I Qualify?

You may qualify for premium tax credits, or subsidies, to help pay for your health insurance if your total Modified Adjusted Gross Income (or MAGI) is between 100% and 400% of the Federal Poverty Level (or FPL) and you meet these requirements:

  • You live in the U.S.
  • You are a U.S. citizen, U.S. national, or lawfully present in the U.S.
  • You are not currently incarcerated.
  • You are not eligible for other minimum essential coverage.
What if I have a medical condition?

Beginning in 2014, insurance companies are no longer allowed to ask any health questions on your application.  Pre-existing conditions are not an issue now. One question that is still relevant – Do you use tobacco?  Rates will be higher for tobacco users.

Will I lose my doctor?

With the passing of the ACA, new and smaller networks of doctors and hospitals were created. These smaller networks combined with a health insurance plan offer the lowest pricing. The smaller the network-the lower the plan cost. But when enrolling in a plan, you need to make sure that the network you attach to the plan has an adequate network to suit your personal needs. The cheapest rates are not always the best fit for you if you want to keep your doctors.

You may need to use a larger more expensive network.

Can I sign up any time?

Unless you have a life event such as having a baby, moving to a new area, or losing a job, you will only be allowed to purchase health insurance during the annual enrollment period.

The next open enrollment period for January 1 effective dates is expected to go from November 1 through December 15.

What if I do not pay my premiums?

If you purchased your plan outside of the federal marketplace, you generally have a 30 day grace period, after 30 days of non-payment the plan would lapse for non-payment.

For plans purchased through the federal marketplace, there seems to be a 90 day grace period. Therefore, the plan does not expire for 90 days.

What if  you want the plan to continue after a change of heart, say with two months of premiums past due , you will be required to pay all back premiums.

What are the enrollment dates ?

Although, the enrollment period for plans runs from November 1 through December 15 – you need to know that you will need to submit your enrollment by December 15th to secure a January 1st effective date.

Special events known as “Life Events” may allow you to enroll in a plan outside of the annual open enrollment dates.