ACA Marketplace Coverage
You are generally eligible to buy health insurance from the ACA Marketplaces, and may be eligible for premium subsidies, if:
- You have a household income at least equal to the Federal Poverty Level (FPL).1
- You do not have access to affordable coverage through an employer (including a family member’s employer).
- You are not eligible for coverage through Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
- You have U.S. citizenship or are lawfully present in the U.S. and you are not currently incarcerated.
New or notable for the 2024 plan year
You may be eligible for substantial subsidies to help you pay your premiums. (Congress increased the size and availability of premium subsidies in 2021’s American Rescue Plan Act and extended those subsidies through 2025 in the Inflation Reduction Act of 2022.) The net result: insurance is more affordable for almost everyone who buys coverage on ACA’s individual Marketplace.
- Individuals and families earning up to 150% of the FPL are eligible for silver tier health insurance with $0 premiums and significantly reduced deductibles and copays.
- Individuals and families earning between 150-400% of the FPL will get substantially larger premium subsidies than in previous years.
- Individuals and families earning above 400% of the FPL – who, prior to 2022, were ineligible for premium subsidies due to income – are eligible for subsidies, ensuring that they won’t pay more than 8.5% of their annual income in premiums for a benchmark Silver plan.
- Some states (CT, MD, NY, NM, MA, VT, WA) will supplement the federal premium tax credits with state funded subsidies, further reducing premium costs for eligible individuals. Some states (CA, CO, CT, NM, MA, VT) will provide additional cost-sharing reductions, easing out-of-pocket burdens for eligible individuals.
- Some Marketplaces will offer standardized plans: plans that offer uniform deductibles, cost-sharing, and out-of-pocket limits, making it easier to compare among the standardized plans on the basis of benefits covered.
- Many consumers receiving premium subsidies will be able to purchase gold tier coverage for a $0 premium.
Important note: premium subsidies and cost-sharing reductions are only available for health plans sold on the ACA Marketplaces. Start your search at healthcare.gov.
The federal government has also invested nearly $100 million to fund 57 returning Navigator organizations for the 2024 open enrollment period. Navigators (and other enrollment assisters) help consumers find the right health coverage option, complete their Marketplace application, and enroll in coverage.
Your how-to list for the Open Enrollment Period (OEP)
- Timing. If you get insurance through your job, check with your human resources department to find out when your company’s open enrollment period begins and ends. If you get your health insurance through the ACA Marketplace, the OEP runs in most states from Nov. 1, 2023, to Jan. 16, 2024. However, to get coverage that begins on January 1, you must sign up by Dec. 15.
- For people with Medicare coverage, open enrollment runs from Oct. 15 to Dec. 7.
- Enrollment in Medicaid, for those eligible, is open 365 days a year.
- Don’t just focus on premium costs! Make sure to consider what your OOP spending will be under the plans available to you (deductibles, co-pays, coinsurance).
- If shopping on healthcare.gov, don’t be put off by ”list” prices. Most purchasers will qualify for tax credits that lower the cost of premiums. Depending on income, you may also be eligible for assistance with your OOP spending, so long as you purchase a silver-tier plan.
- Scope of Coverage. When reviewing potential health plans, read all plan provisions carefully. Check that your providers are in-network; research whether your products are covered; beware of copay accumulator adjusters.
Be an active participant
Don’t simply auto-renew your existing coverage: shop around and compare all your options. In some states, new insurers are entering the Marketplace, while in other states, insurers are exiting.
If purchasing your own health plan on the individual market, start your search at healthcare.gov. Avoid short-term health plans, health sharing ministries, and other forms of non-ACA-compliant coverage: these “skinny” plans do not provide sufficient coverage OR financial protection.
Current consumers who do not actively select a plan by December 15th will be automatically re-enrolled into their 2023 plan or a suggested alternate plan for 2024. The Marketplace will notify consumers after December 15th if they have been automatically re-enrolled and those consumers can still actively switch to other plan coverage before the close of the OEP in January (although their plan selection will not go into effect until Feb. 1).