ACA HEALTH INSURANCE FAQs
- What is ACA Health Insurance?
- How do I qualify for an ACA tax credit?
- What’s the application process?
- When can I apply?
- What are my other options?
What is ACA Health Insurance?
The Affordable Care Act, colloquially referred to as Obamacare, was enacted in 2010. It offers a tax credit to qualified individuals to lower the cost of their health care plans. The main goal of the act was to make affordable health care available to a wider group of people. The law also expanded the Medicaid Program, though not all states have changed their programs to allow this. Georgia is one of the states that hasn’t expanded as of 2024.
The Act penalized those who did not enroll in a health insurance plan when it was first enacted. However, the Tax Cuts and Jobs Act appealed the penalty. The ACA tax penalties are no longer in effect on a federal level as of 2019 and onwards. While some states still enforce this, Georgia is not one of those states, so there is no additional state tax if you do not have health insurance.
How do I qualify for an ACA Tax Credit?
Qualifications are determined by several factors. Some of those are the number of people you file on your taxes and your total household income as well as income that comes from sources other than work income. You must file a tax return for the year you are applying for. If you’re legally married, you’re required to file jointly to qualify for a tax credit.
Your gross income – what you make before anything is taken out – is used to calculate if you qualify for a tax credit to lower your insurance costs. Your income is compared to the Federal Poverty Level and if it’s between 100% – 400%, your cost is lowered. If your income is more than 400% FPL, you may still qualify for a premium tax credit. If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment Period. The Department of Health and Human Services announces a new FPL annually. Qualifying once doesn’t guarantee you will still be qualified the following year.
If you don’t qualify for a tax credit, you can still receive a plan offered through the Health Insurance Marketplace or direct through the insurance company during open enrollment. You’ll be required to pay the full price of the plan. However, there are still other options especially if you need coverage before the next open enrollment.
What’s The ACA Application Process?
We use the platform Healthcare Marketplace (Healthcare.gov) to process an application and to see if you qualify for an advanced premium tax credit. Once we determine if you qualify, we can see the insurance companies and plans offered in your area. Then we can assist you in deciding which plan is best for you. We will discuss the deductibles, copays, providers, and prescriptions before you make your final decision.
When Can I Apply?
The ACA Annual Open Enrollment is November 1st – January 15th. If you want coverage to start January first of the new year, you have to enroll by December 15th. Enrolling between December 16th and January 15th will result in a February 1st effective date. If you miss this deadline, you will most likely have to wait until the next AEP to receive ACA coverage. There are Special Enrollment Periods for certain circumstances such as moving to another state, loss of group coverage, marriage or death.
If I missed my open enrollment period, what are my options for health insurance?
Short term medical plans were specifically created to for people to receive coverage while waiting for health insurance enrollment periods. They can also offer additional coverage in emergency situations. Short term medical plans typically cover most all approved medical care according to the level of plan you choose. Some plans might offer drug coverage as well.
Indemnity plans can pay two ways, either a set amount or a pre-determined percentage of the reasonable and customary charges for a given service. Providers are the ones who define the fees for services. This may vary from physician to physician, but the amount that the indemnity plan will pay is pre-determined. There’s no provider network, so patients can choose their own doctors and hospitals. Some plans will allow reimbursement direct to the client.
Medi-Share is a healthcare sharing program. They are a not-for-profit company. As a Christian ministry, the concept is based on the Biblical principle of bearing one another’s burdens.
All three of these plans can be purchased any time of the year because there is no set enrollment period. Some do require health questions.
Talk to an Agent about plan benefits and premiums today!
Your agent will find the plan that’s right for you by taking into consideration your location, income, prescriptions, and medical needs. We represent numerous companies that offer Health Insurance. The plans offered will vary based on your location. Insurance doesn’t have to be hard; we’re here to help!
