Can’t Afford Health Insurance? The Affordable Care Act Pays All or Most Health Insurance Costs for Many PeoplePosted on: December 6, 2022
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When Can I Apply?
Anyone can sign up from November 1, 2022, to January 15, 2023.There will be a similar sign-up period each year.
People with income under 150% of the poverty level can apply at any time. A chart below gives the 150% poverty levels.
Anyone can sign up for or change these health plans for 60 days after some big changes in your life. These are things like:
- losing a job
- losing health insurance
- changes to who is in your family
- losing Medicaid
Who Can Get Help?
As set out with the income charts below, different help is available depending on your income.
No one gets excluded for having a pre-existing health problem.
You may qualify now even if you could not before. Changes in 2021 and 2022 give more people low-cost health insurance.
But you cannot get this help if:
- You get Medicaid
- You have Medicare
- Your annual income is under 100% of poverty (These income figures are listed below.)
- You are not a U.S. citizen or national or lawfully present in the U.S.
- You are in prison
- You do not live in the U.S.
- You already have “affordable” and adequate health insurance through a job. (This is discussed some below. The rules became more helpful in December 2022.)
The types of help available to different groups
The income figures below will be used for eligibility for 2023.
People with annual incomes under 100% of poverty
Persons with annual income under these amounts cannot get the special help with health insurance costs.
|Number of People in Your tax household||Annual (Yearly) Household Income|
|For each additional prson, add||$4,720|
150% of poverty
For incomes below this you can apply any time. People with incomes below this can pick a Silver Plan and have no monthly premiums. With the Silver plan they get help for copays and deductibles, too.
|Number of People in Your tax Household||Annual (Yearly) Household Income||Monthly Average|
|For each additional person, add||$7,080||$590|
250% of poverty
For incomes below this, premiums are reduced, and with a Silver plan copays and costs when getting care are kept very low
Like other health insurance, you only pay part of your medical costs when you get health care or prescriptions. If your income is under 250% of the Federal Poverty line and you sign up for a “Silver Plan,” the costs you pay when you go to the doctor go way down. This only applies to Silver plans.
This can make silver plans better than the other plans (bronze, gold, or platinum) for people with income under 250% of poverty. Even if a Bronze plan may have lower monthly premium, a Silver plan may be less expensive for people under these incomes who use their insurance.
Read more about this special help for Silver plans here.
|Number of People in Your Tax Household||250% Annual Income limit||Monthly Average|
|For each additional person, add||$4,720||$983|
400% of poverty
For incomes below this, premiums are reduced, so your health insurance costs less each month
400% of poverty is $54,360 for a single person, $73,240 for a couple. It is about $111,000 a year for a family of 4. and even higher for larger families.
A chart that includes the 400% income amounts is here.
Higher than 400% of poverty
Above those limits, you can still get a very high deductible policy if your health costs are over 8.17% of your income. This is called a Catastrophic policy.
There is new help for parents whose health insurance through the job costs too much
Starting December 12, 2022, there is new help for people with jobs, whose health insurance costs too much.
Check to see if health insurance though your job costs more than 9.12% of your household income. If it does, you are allowed to apply even though you could get insurance through your job. This insurance may cost less than through your job.
See if adding a spouse and children makes health insurance through your job cost more than 9.12% of your household’s income. If it does, then the dependents can get help with health insurance costs through the federal Marketplace.
For more about this see https://www.healthreformbeyondthebasics.org/rule-eliminates-family-glitch
How do I apply?
There are two options for signing up on your own:
Visit www.healthcare.gov or Call 1-800-318-2596
What if I need help signing up or finding a plan?
Go to this site to find someone who is not selling something, who will help you find a plan: https://localhelp.healthcare.gov/
You will need to agree to file federal income taxes for the years you receive the insurance.
Frequently Asked Questions
How can I see how much this will cost?
You can get an idea of what a plan will cost you before you apply or sign up.
Is there a deadline to sign up?
People with income under 150% of the poverty level can apply at any time. For everyone else, there are important deadlines. Do not miss the deadline.
Anyone can sign up from November 1, 2022, to January 15, 2023. If you sign up before December 15, your insurance can start January 1. If you sign up between December 15 and January 15, the insurance starts February 1.
You may be able to sign up earlier if you had some big events in your life. Anyone can sign up within 60 days of any of these events:
- Getting married
- Having a baby
- Adopting a child
- Losing Medicaid
- Losing your current health insurance. (Even if you lost insurance because you moved.)
Coverage will usually start the next month
For more information about applying outside the usual November to January 15 times see https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
If I sign up, am I covered for medical bills I already owe from being sick or hurt?
No. Health insurance will not cover a bill from before your coverage starts. Coverage never starts before the first of the month after you apply. Sometimes the delay is longer. For bills you already owe consider applying for Medicaid. Medicaid can cover bills up to 3 months before you apply.
People under age 65 with monthly income under 138% of the poverty line usually qualify for Medicaid. People in some other groups with higher and lower incomes who live in Louisiana can also get Medicaid.
This chart shows 138% of the poverty line for monthly income for different household sizes.
|Number of People in Your Household||138% Monthly Income|
|For each additional person, add||$542.80|
When do I count my income?
The health insurance program counts your expected income for the calendar year. You are eligible based on what your income will probably be for the year, even if your income is higher or lower when you apply.Total income for the year is what counts
Why are tax households used?
To help make quick application decisions and reviews, IRS income tax data is used. So income tax rules apply to many parts of the program: what income is counted, who gets grouped together on an application, use of annual income, etc.
The one exception is for victims of domestic violence, as discussed below.
What kind of health coverage is this?
The insurance comes from private insurance companies. Money to help pay the costs comes from the federal government. This is part of the Affordable Care Act, or “ACA.”
The insurance is from names you may know, like Aetna, Blue Cross Blue Shield, Cigna, Humana, United, and so on.
Each company’s plans at a particular level (bronze, silver, gold, or platinum) must meet government standards for that level.
Usually, gold and platinum plans cover more and have lower copays when you get care. But for people with incomes under 250% of poverty, Silver Plans usually have the lowest cost when you get care.
Details can be different from company to company.
What paperwork do I need to sign up?
You need the social security number and income information for each person who will be on your federal income tax form next year.
Does my household include my spouse if I am a victim of domestic violence, domestic abuse, or spousal abandonment?
No. You do not have to file jointly and can still qualify for tax credits.
If you are living apart from your spouse because you are a victim of domestic violence, domestic abuse, or spousal abandonment and want to sign up for your own health plan separate from your abuser or abandoner, you are treated as “unmarried” in your Marketplace application. These people can say they are unmarried, without penalty for mis-stating your marital status.
For more about who is in your “household” for these insurance applications, see https://www.healthcare.gov/income-and-household-information/household-size/