Health insurance enrollment on the Health Insurance Marketplace, which allows consumers to buy individual plans, usually begins at the start of November, with the end date varying by state.
The following questions will improve your understanding of how the Health Insurance Marketplace works and what coverage options are out there.
1) Who can buy coverage on the Health Insurance Marketplace?
Most people can purchase coverage on the Health Insurance Marketplace. To be eligible, you must live in the state of your Marketplace, be a United States citizen or lawfully present in the country, and not be incarcerated.
However, not all people who are eligible to buy health insurance on the Marketplace are eligible for subsidies (money the Marketplace offers to help you pay your premiums, the monthly cost of the coverage.) To qualify for subsidies (also called premium tax credits), people must meet additional requirements related to their income and eligibility for other coverage.
2) Can I buy a health plan on the Marketplace if I’m not a permanent resident?
In general, yes. Most immigrants who are in the country legally (who have permanent residency or work visas) can purchase a plan on the Health Insurance Marketplace. This group includes immigrants who cannot sign up for Medicaid (though they are documented, they don’t meet other requirements.)
Undocumented immigrants cannot purchase coverage on the Health Insurance Marketplace.
3) What happens if I purchase coverage on my state Marketplace with my spouse and we have a baby?
The Marketplace allows you to change your coverage outside the Open Enrollment Period if you experience what is called a “qualifying life event.” Events that trigger a Special Enrollment Period (SEP) are:
- Gaining a dependent (for example, giving birth or adopting a child.) Remember that you can only change your coverage when the baby is born, not for the pregnancy itself.
- Loss of eligibility for other coverage (for example, if you leave your job or are laid off, if your job hours are reduced, or if you lose student health coverage upon graduating.) Keep in mind that loss of eligibility for other coverage due to nonpayment of premiums does not trigger a Special Enrollment Period.
- Marriage
- Loss of “dependent” status (for example, due to divorce or legal separation, or turning 26 and losing coverage through a parent’s plan)
- Permanent move to another state or within the same state, if you move to a place outside your new plan’s area of coverage.
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
- For people enrolled in a Marketplace plan, an increase or decrease in your income affecting your eligibility for subsidies.
- Change in immigration status
- If the Marketplace, another federal agency, or another person acting in your name committed an error relating to your enrollment or eligibility.
When you experience a qualifying life event, the SEP will last 60 days from when the event occurred. If you can predict a qualifying event (for example, if you know when you will graduate and lose your student coverage), you can ask the Marketplace for a SEP 60 days in advance.
This way, your new coverage will begin immediately after the old one ends. However, on Marketplaces that use healthcare.gov, you cannot request a SEP in advance if you are losing coverage due to a permanent move.
States have the option of deciding whether to expand special enrollment opportunities for consumers. Check with your state’s Health Insurance Marketplace for more information.
4) Were people affected by hurricanes given more time to enroll in 2019 coverage?
Yes. Although the extension is not automatic, they could apply for extra time using a Special Enrollment Period (SEP) for exceptional circumstances. You can apply by contacting the federal Health Insurance Marketplace call center at 1-800-318-2596 (not through your account on healthcare.gov). You will have to demonstrate that you lived in or moved from one of the areas affected by hurricanes in 2018.
Affected areas are those that the Federal Emergency Management Agency (FEMA) designates as eligible to receive “individual assistance” or “public assistance.”
5) Where can I find my state’s Health Insurance Marketplace?
Click on your state on this map to find all the information you need about your state’s Health Insurance Marketplace.
6) I smoke cigarettes and buy my own health insurance. Can they charge me more because I smoke?
Yes, in most states, they can. Insurers can increase premiums by up to 50% for people who use tobacco, though many insurers apply a smaller surcharge for this. If you qualify for premium subsidies, they will not cover the tobacco surcharge. However, states can limit tobacco surcharges and some have decided to prohibit insurers from charging smokers higher costs.
7) I signed up for coverage on the Marketplace last year and I want to stay on the same plan for another year. Do I have to do anything during the Open Enrollment Period?
Your coverage may be renewed automatically; however, you might want to take some measures to renew your plan yourself during Open Enrollment. If you are receiving a premium tax credit, you should take this time to update your income and family information to see how much credit you are eligible for, based on the new premiums for the coming year.
The coverage renewal process can be slightly different depending on where you live. On state Marketplaces that use healthcare.gov, if you are currently enrolled in a Marketplace plan and do not take any action before December 15 (the date the marketplace closes), in most cases the Marketplace will automatically renew your coverage under this same policy for the coming year.
But insurers don’t always offer the same plans every year. If your plan is no longer offered and you do not do anything, the insurer will automatically enroll you in a different plan similar to the one you currently have.
8) How do premium subsidies work? Where do I apply?
In the same account you use to access your state’s Marketplace website, you will have the option to fill out a form to request financial assistance.
Premium subsidies reduce the premiums for most of the policies on the Health Insurance Marketplace. The amount of tax credit you might receive will depend on your income and the cost of Health Insurance Marketplace plans in your area. The Marketplace will determine how much you will have to pay, using a middle-cost Silver plan as a reference.
This contribution should increase on a sliding scale based on your 2019 income. If your income is close to the poverty level, the contribution you will have to pay based on the reference plan is 2.08% of your 2019 income. This amount will change depending on how much you earn.
Premium tax credits can be claimed at the end of the year, or you can use them in advance for a tax credit based on your estimated income for next year. If you decide to use your credit in advance, each month the government will pay 1/12 of the credit directly to your insurance company, which will then send you a bill for the rest of the premium (what you pay each month to have coverage.)
It’s important to keep in mind that when you apply for a premium tax credit during Open Enrollment, you might not know exactly what your income will be for the year of coverage, so you should apply using your best estimate. Later, when you file your tax return, the IRS will compare your actual income to the amount of subsidies you claimed in advance. If you underestimated your income and used more subsidies than you qualify for, you might have to repay the difference. If instead you used less subsidies than you qualify for, you can request the difference when you file your tax return in the spring.
You should report any change in your income throughout the year to the Marketplace so that your credit can be adjusted and you can avoid any large repayments at the end of the year. Even if you did not earn enough income to pay taxes, you should file a tax return to receive subsidies to help with your premium payments.
Sources: Kaiser Family Foundation, Centers for Medicare & Medicaid Services, healthcare.gov.
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