This webpage specifically addresses ACA health insurance enrollment as it pertains to the Federal Marketplace. However, the information on this webpage generally is applicable to Marketplaces in all states.
What is ACA?
ACA is the nickname given to the Affordable Care Act, which was passed under President Barack Obama in 2010. The Affordable Care Act is a federal law that makes major changes to the nation’s health insurance system. Some of those changes include:
1. The Creation of a Health Insurance Marketplace
Under the Affordable Care Act (ACA) individual Health Insurance Marketplaces were established in all 50 states to allow consumers to shop and compare health plans. Some states chose to run their own Health Insurance Marketplace while others, like North Carolina, opted for a federally-run Health Insurance Marketplace. North Carolina residents may be eligible for tax credits to help pay for parts of their health insurance premium if they purchase insurance on the Federal Marketplace.
2. The Expansion of Medicaid
The Affordable Care Act (ACA) also called for the expansion of Medicaid to cover people whose household income is below 138% of Federal Poverty Guidelines. However, the expansion was not mandatory and some states, like North Carolina, chose not to expand the program.
3. A Mandatory Requirement to have Health Insurance
Under the Affordable Care Act (ACA), nearly all Americans must purchase and maintain health insurance coverage, or else pay a penalty when filing their tax returns. There are limited exceptions granted to certain individuals already receiving government assistance, or those with financial hardships.
Am I required to enroll in ACA?
The Affordable Care Act (ACA) only requires everyone that can afford health insurance to purchase it. You do not have to enroll in ACA, and may be covered by an insurance plan outside of the Federal Marketplace. The Affordable Care Act (ACA) has set minimum essential coverage guidelines that all plans must follow, whether or not they participate in the Federal Health Insurance Marketplace.
If you are already covered through an employer-sponsored group health plan, you are not required to switch to individual insurance through ACA.
Who is exempt from the ACA Enrollment Mandate?
You may be exempt from the Affordable Care Act’s mandatory requirement to have health insurance if:
- You are already covered through a government sponsored health program, such as Medicaid or Medicare.
- Your income is below the threshold for filing taxes.
- All plan options on your state’s Marketplace would require you to pay more than 8% of your household income for health insurance.
- You have suffered a financial hardship that makes you unable to afford coverage.
- You qualify for a religious exemption.
- You are not a U.S. citizen, are a member of a federally-recognized Indian tribe, or are incarcerated.
WNC Health Insurance can help you determine if you are eligible for an exemption from ACA’s enrollment mandate! Call us at: 828-348-2583, or toll free: 855-395-5552
Am I eligible for ACA enrollment?
Any legal U.S. citizen who does not qualify for Medicare, Medicaid or CHIP, and who wants to purchase private insurance is eligible to enroll in ACA – even if you already have individual insurance or insurance through your employer. However, not everyone who enrolls may qualify for premium subsidies.
Learn more about how to enroll in a healthcare plan through ACA.
Health Insurance Subsidies
If your household income is between 100% and 400% of Federal Poverty Guidelines, you may be eligible to receive government subsidies for health insurance premiums when you enroll in a plan through ACA.
If you are switching from an employer-sponsored group health plan that already meets minimum coverage and affordability requirements under the Affordable Care Act, you will not be eligible for subsidy assistance and may lose any contributions your employer currently makes towards your premiums.
What if I miss Annual Open Enrollment?
If you miss the ACA health insurance enrollment deadline and do not qualify for a special enrollment period, you will need to wait until the next annual open enrollment period begins to purchase health insurance, whether on or not you enroll at the Health Insurance Marketplace. It is also likely that you will need to pay a shared responsibility penalty for all uninsured members in your household when filing your tax returns, unless you are eligible for an exemption from the mandatory health insurance requirement under the Affordable Care Act.
Annual Open Enrollment for 2015 health insurance plans closed on February 15, 2015! and will not re-open until November 1, 2015. Learn more about how to enroll in a healthcare plan through ACA.
WNC Health Insurance agents are available to answer all of your ACA health insurance enrollment questions!