Important FAQs

The Open Enrollment Period is the time each year when you can sign up for a health insurance plan through the ACA marketplace. Typically, it runs from November 1 to December 15. If you miss this window, you may still be able to get coverage if you qualify for a Special Enrollment Period.

A Special Enrollment Period allows you to sign up for health insurance outside of the Open Enrollment Period if you experience a qualifying life event, such as:

• Losing your existing health coverage.
• Getting married or divorced.
• Having or adopting a child.
• Moving to a new area with different health plan options.
• You generally have 60 days after the qualifying event to enroll in a new plan.

Subsidies are available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL). These subsidies help reduce the cost of monthly premiums. Some people may also qualify for cost-sharing reductions if they select a Silver-tier plan, which lowers out-of-pocket costs like deductibles and co-pays.

Additionally, those with incomes below 138% of the FPL may qualify for Medicaid in states that have expanded the program under the ACA.

Yes! Under the ACA, insurance companies cannot deny you coverage or charge you higher premiums based on a pre-existing condition, such as asthma, diabetes, cancer, or even pregnancy.

Health insurance plans under the ACA are divided into four “metal” categories based on how you and your plan share costs:

• Bronze: Lower premiums, higher out-of-pocket costs. Insurance covers about 60% of costs.
• Silver: Moderate premiums and out-of-pocket costs. Insurance covers about 70% of costs. Also, eligible for cost-sharing reductions.
• Gold: Higher premiums, but insurance covers about 80% of costs.
• Platinum: Highest premiums, lowest out-of-pocket costs. Insurance covers about 90% of costs.

If you miss both the Open Enrollment Period and do not qualify for a Special Enrollment Period, you may have limited options:

• Short-term health insurance: Some states offer short-term plans, but these may not provide the same level of coverage as ACA-compliant plans.
• Medicaid or CHIP: You may be eligible for Medicaid or the Children's Health Insurance Program (CHIP) based on your income.
• Employer-based coverage: If available, you can explore health insurance options through your job.

When applying, you will need to provide:

• Proof of identity (e.g., driver's license, passport).
• Income information (e.g., pay stubs, tax returns).
• Immigration status, if applicable.
• Social Security numbers for all household members who are applying for coverage.
• Employer and income details for everyone in your household.

The marketplace website provides a cost calculator where you can enter details about your household income, family size, and location to get an estimate of your monthly premium, subsidies, and out-of-pocket expenses.

While the federal penalty for being uninsured has been eliminated, some states still impose penalties for not having coverage. Beyond the financial penalty, not having health insurance can leave you responsible for all medical bills in case of an illness or emergency.

Most marketplace plans have provider networks—a list of doctors, hospitals, and other healthcare providers that have agreed to provide services at a discounted rate. Before enrolling, check the plan’s network to make sure your preferred doctors are included. You can do this by:

• Visiting the insurer’s website.
• Using the marketplace’s doctor lookup tool.
• Contacting the insurance company directly.

You can only change your health plan during the Open Enrollment Period unless you qualify for a Special Enrollment Period due to a qualifying life event. However, if you experience a significant change in income, you may be eligible for a subsidy adjustment or different plan options.

Small businesses with fewer than 50 employees are not required to provide health insurance to employees under the ACA. However, businesses with fewer than 25 employees may qualify for a Small Business Health Care Tax Credit if they offer insurance. The ACA also provides a Small Business Health Options Program (SHOP) marketplace to help businesses provide coverage to their workers.

Before the end of the Open Enrollment Period, you’ll receive a notice about your current plan’s renewal. You can either:

• Automatically renew your existing plan.
• Update your information (such as income or household changes) and choose a new plan. It’s important to review your options each year, as plan details and costs can change.

You can get help with your ACA application in several ways:

• Navigators: Trained, unbiased professionals who can help you apply for and enroll in a plan.
• Call the Marketplace: The official marketplace helpline offers assistance over the phone.
• Community Help: Many local organizations offer free, in-person assistance