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Applying for Coverage on the ACA Exchange

Understand the benefits of the ACA. If you choose to get health insurance through the ACA exchanges, then you can qualify for a subsidy. Subsidies are available to people with family incomes between 100% and 400% of the poverty level.[5](A “family” includes single people.) You must, however, purchase the insurance through the exchange to qualify.

  • The government will also provide assistance with covering out-of-pocket expenses for those with particularly low incomes. You must be enrolled in at least a Silver plan to qualify.
  • To estimate the amount of your subsidy, visit this website and use its Health Insurance Marketplace Calculator.

Check when you can enroll. You cannot enroll in an insurance plan offered through the ACA at any point in the year. Instead, the open enrollment period typically runs from November 1 until January 31 of each year.[7] It may shift depending on the year.

  • If you miss the enrollment period, then you can still purchase short-term coverage. However, you will not get a subsidy and you may also have to pay a fee each month.[8]
  • You might qualify for a “special enrollment period,” which can be triggered by a life event, such as the birth of a child or moving to a new state.[9] If you qualify, then you can purchase a plan on the exchange regardless of the time of year.
  • The ACA is in a constant state of flux. Sometimes deadlines are extended, and exemptions or “special enrollment” requirements often shift or change. Accordingly, you should call 1-800-508-6754 with questions about your particular circumstances.

Create an account. You must visit healthcare.gov and create an account. First, pick your state. Then create a username and password, which you should write down someplace handy. You will need to login each time you visit the website.

Complete the application. In order to complete an application, you will need information about your finances. For example, you should gather information about:[10]

  • Social Security Number
  • Citizenship or legal resident information
  • Job and income details, including all self-employment income
  • Current health care coverage information

Receive a determination. The government will send you a PDF explaining whether you qualify for a subsidy, how much, and/or whether you qualify for Medicaid. The PDF should also tell you what steps to take next.

Shop for health insurance policies. The ACA has created different “tiers” of health insurance policies: Catastrophic, Bronze, Silver, Gold, and Platinum. These tiers are based on how the costs are shared between you and the insurance company.[11] Generally, the higher the tier, the more you pay in premiums but the more the company pays in co-insurance.

  • Catastrophic. These plans are available only for those under 30 or for people who have a qualifying exemption. Under this plan, the insurance company pays less than 60% of the total average cost of care.
  • Bronze. Under this plan, the insurance company pays about 60% of the cost of care; you will pay around 40%.
  • Silver. The average for a silver plan is 70% for your insurer and 30% for you.
  • Gold. The average for a gold plan is 80% for the insurer and the remaining 20% paid by you.
  • Platinum. With the platinum plan, your insurer pays 90% on average and you pick up the remaining 10%.

Apply. You can select a plan and apply for it through the healthcare.gov website. You cannot be turned down for a pre-existing condition, so approval is virtually automatic.[12] Once you are approved, you will be sent information from the health insurance company.

  • Remember, if you have to purchase insurance outside the exchange, then an insurer can still discriminate based on a pre-existing condition.[13]

Make monthly payments. Because you are not receiving insurance through a job, you will need to make monthly premium payments to the health insurance company. If you receive a subsidy, the health insurance company should apply the subsidy to your premium before sending you the bill.

  • Keep records of payments and pay in a timely manner. If you do not pay your insurance each month, then you may end up having to pay a penalty.