Donate

Coverage Options:

Health care coverage and Employer-provided Insurance
Health care coverage and the Marketplace
Health care coverage and Medicaid CHIP
Health care coverage and medicare
Health care coverage and tricare
Health care coverage and veterans health

  • Bob is an adult who is uninsured and not currently eligible for Medicaid in his state. His state has chosen to not expand Medicaid up to 138% FPL. In 2014, the individual mandate will still apply to Bob, unless one of the exceptions applies. Bob will be required to purchase insurance either in the individual market outside of the Marketplace or inside the Marketplace. If Bob earns between 100% and 400% FPL, he will have access to premium tax credits to purchase insurance in the Marketplace. If Bob earns between 100% and 250 FPL, Bob will have access to cost-sharing subsidies when purchasing insurance in the Marketplace. If Bob earns more or less than these thresholds, then he will not have access to the tax credits or subsidies to purchase insurance in the Marketplace, although he can still purchase insurance inside or outside of the Marketplace and, indeed, he will still be required to have some sort of insurance.

 

  • Sally is a pregnant woman who is uninsured and not currently eligible for Medicaid in her state. Her state has chosen to expand Medicaid up to 138% FPL. In 2014, Sally will earn 130% FPL. Because the Medicaid expansion does not cover pregnant women, Sally will not be newly eligible for Medicaid under the expansion, even though her income itself is less than 138% FPL. In 2014, however, the individual mandate will still apply to Sally, unless one of the exceptions applies. Sally will be required to purchase insurance either in the individual market outside of the Marketplace or inside the Marketplace. Because Sally earns between 100% and 400% FPL, she will have access to premium tax credits to purchase insurance in the Marketplace. Because Sally earns between 100% and 250 FPL, she will have access to cost-sharing subsidies when purchasing insurance in the Marketplace. If Sally earned more or less than these thresholds, however then she would not have access to the tax credits or subsidies to purchase insurance in the Marketplace, although she can still purchase insurance insides or outside of the Marketplace and, indeed, she will still be required to have some sort of insurance.

 

Disclaimer. This website is a resource only and should be used for information purposes. Please work with your health care providers, insurance councilors, etc. to determine the best solution for you.


Sign up for E-mails, Dateline Magazine, and other ways to stay connected.