Frequently-asked questions by tag
If I don’t enroll in a plan by the open enrollment deadline, what are my options?
January 12, 2023 – Your options for coverage are very limited if you don't enroll in a plan by the end of open enrollment in your state. The open enrollment…
What type of health insurance exchange does my state have?
December 13, 2022 – As of the 2023 plan year, there are 18 fully state-run health insurance marketplaces (SBMs), three state-based marketplaces that use the…
My wife and I each make about $40,000 a year. If we file our taxes separately, can we each qualify for an exchange subsidy?
December 1, 2022 – Q. My wife and I each make about $40,000/year. If we file our taxes separately, can we each qualify for an exchange subsidy? A. No. …
Are visits to the chiropractor or physical therapist covered under the Affordable Care Act?
December 1, 2022 – Q. Are visits to the chiropractor or physical therapist covered under the Affordable Care Act? A. All ACA-compliant individual and small…
Does every business with 50 or more employees pay a penalty if it doesn’t offer ‘affordable, comprehensive’ insurance?
December 1, 2022 – Businesses with 50 or more full-time equivalent (FTE) employees are required to offer comprehensive, affordable health insurance coverage…
Should I buy the health plan my college offers? or buy through an ACA exchange?
December 1, 2022 – Most student health plans offered by colleges and universities are fully compliant with the ACA, with just a few exceptions that don't…
Can I buy coverage in the exchange that starts January 1 and stop paying for my COBRA insurance at that point?
November 29, 2022 – Q. After I lost my job, I went on COBRA which lets me keep my former employer's insurance for 18 months. It is good insurance, but more…
How does my access to employer-sponsored coverage impact my eligibility for subsidized coverage through the exchanges?
November 21, 2022 – A. Fortunately, the IRS has issued new rules, effective in 2023, to allow some families to take advantage of premium subsidies in the…
What happens if I don’t make my premium payment by the end of the grace period?
November 8, 2022 – If you fail to pay your premiums and exhaust the grace period for plans offered in a health insurance marketplace, you will lose your…
Are smokers unable to afford insurance under the ACA?
November 2, 2022 – Q. I've heard that under the ACA, smokers have to pay 50% more for insurance – and that, even if they qualify for a tax credit, the…
If my income changes and my premium subsidy is too big, will I have to repay it?
October 20, 2022 – If a person receives a premium subsidy in the marketplace and then ends up with a total annual income higher than they projected, they may…
Is pediatric dental coverage included in exchange plans?
October 5, 2022 – There is no penalty for not having pediatric dental on your policy – and in most exchanges, you can purchase a plan without pediatric…
If my income is less than expected this year, I might be eligible for Medicaid. What can I do to cover my bases?
September 1, 2022 – Q: I'm self-employed, so my income varies from one year to the next. I enrolled through the exchange and projected an income that makes me…
If all Silver plans cover the same benefits and percentage of costs, why do premiums vary by carrier?
July 5, 2022 – Q. If all of the Silver plans in an exchange must offer the same benefits, and cover 70 percent of the cost of those benefits, why do…
I earn too much to qualify for a subsidy. Why should I buy through an exchange?
May 23, 2022 – The American Rescue Plan (ARP), enacted in March 2021, makes health insurance coverage more affordable for millions of people who buy their…
If I enroll in the exchange, will that coverage take effect immediately?
May 16, 2022 – If you enroll through your marketplace your coverage effective date mostly depends on whether you're enrolling during open enrollment or a…
Does the Affordable Care Act make it easier to get individual health insurance?
May 12, 2022 – It's easier to get individual health insurance under the Affordable Care Act, but consumers in the individual market need to be aware that…
Would my 21-year-old’s subsidy be based on his income – or mine?
April 26, 2022 – Q. My 21-year-old son is in college. I know he could stay on my employer's plan until he is 26. But he might be able to get better coverage…
Can health insurance policies still have lifetime or annual benefit maximums?
April 18, 2022 – All new individual and small-group plans have covered essential health benefits (EHBs) since 2014, and there cannot be dollar limits on…
How is vision care covered under the Affordable Care Act?
March 10, 2022 – The Affordable Care Act requires coverage for pediatric vision care as one of the essential health benefits. But there is no requirement…
If I have insurance through my employer, can my spouse get coverage through the exchange?
December 16, 2021 – Q. I have insurance, with a small fee, through my employer. However, my husband is unemployed and to cover him on my insurance is almost…
I’m 21, single with no kids, living with my parents and going to school full time. Do I apply for health insurance as a household of one and list only my income?
September 14, 2021 – Q. I am a 21-year-old dependent living with my parents and going to school full time. I'm not married and have no kids, so do I apply for…
Do Gold exchange plans offer more generous coverage than Bronze or Silver plans?
September 13, 2021 – Q. I have read that the Gold plans sold in the exchanges offer more generous coverage. What exactly does a Gold plan cover that isn't…
If I sign up for a Bronze plan during open enrollment, can I bump my coverage up to a higher level several months later if I find out that I need surgery?
August 18, 2021 – After open enrollment ends, you normally can't change your policy until the next open enrollment period, unless you experience a qualifying…
I am on Medicare and Social Security. My wife is self employed and needs insurance from the state exchange. How do we figure our household income?
August 18, 2021 – Q. I am on Medicare and Social Security, my wife recently became self-employed and needs insurance from the state exchange. How do we…
I’m 60 and retired. I can get insurance from my former employer but it’s very expensive. Do I qualify for insurance under the exchanges?
August 18, 2021 – But for retirees, the guidelines are more relaxed. Retirees who have access to a plan that provides minimum essential coverage can still…
Did health insurance premiums go up or down for 2021?
August 18, 2021 – Q. I've seen a lot of differing headlines about health insurance rates for 2021 – some say rates increased, some say they decreased, and…
My doctor posted a sign saying she ‘doesn’t take Obamacare.’ What should I do?
August 3, 2021 – Q. My doctor posted a sign saying she doesn't take Obamacare. What should I do? A. It depends on your relationship with your doctor. If…
My health insurance options from my employer are on an exchange. Is this part of Obamacare?
July 31, 2021 – If the health insurance options from your employer are on an exchange, it could be a private exchange – not the Affordable Care Act's…
Can small businesses use the ACA’s health insurance marketplaces (exchanges)?
June 1, 2021 – The Affordable Care Act included an enrollment platform called SHOP (Small Business Health Options Program), an exchange where businesses…
Are child-only policies available through the exchanges?
May 27, 2021 – You can purchase a child-only policy for your daughter, either in the exchange or off-exchange. If you qualify for a subsidy to help pay…
Who is keeping track of whether I buy health insurance through the exchanges?
May 25, 2021 – Regardless of where you get your health insurance, you (and the IRS) will get a tax form from your employer, insurance company, or exchange…
Are dental benefits included in ACA’s marketplace health plans?
May 5, 2021 – A: Pediatric dental is one of the ACA's essential health benefits. But there's no requirement that dental care for adults be…
We get health insurance through my job, but the coverage isn’t very good. Can I enroll in an exchange plan instead, and get a subsidy to help pay for it?
January 25, 2021 – Just about anyone can enroll in an exchange plan. But eligibility for a subsidy depends on how much your group plan costs and the quality…
If I have access to health insurance, can my husband’s company deny me coverage?
January 22, 2021 – The ACA requires employers with 50 or more workers to offer coverage to employees and their children (until age 26), but not a spouse. But…
My parents are 68, but recently moved to the U.S., so they don’t qualify for Medicare. Can they buy insurance in the exchange?
January 18, 2021 – If your parents are 65 or older, but don't qualify for Medicare because they have not lived in the U.s. long enough, they can purchase a…