Frequently-asked questions by tag
If I have access to health insurance, can my husband’s company deny me coverage?
November 14, 2024 – 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…
Are visits to the chiropractor or physical therapist covered under the Affordable Care Act?
November 8, 2024 – All ACA-compliant individual and small group plans include coverage for physical therapy. Some individual market plans, sold via the health…
If I don’t enroll in a plan by the open enrollment deadline, what are my options?
October 16, 2024 – 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…
Can small businesses use the ACA’s health insurance marketplaces (exchanges)?
October 11, 2024 – The Affordable Care Act included an enrollment platform called SHOP (Small Business Health Options Program), an exchange where businesses…
If I enroll in the exchange, will that coverage take effect immediately?
September 9, 2024 – If you enroll through your marketplace your coverage effective date mostly depends on whether you're enrolling during open enrollment or a…
Do Gold exchange plans offer more generous coverage than Bronze or Silver plans?
August 27, 2024 – All plans (whether Bronze, Silver, Gold or Platinum) must cover the same essential benefits, including free preventive care; they all…
What type of health insurance exchange does my state have?
August 26, 2024 – As of the 2025 plan year, there will be 20 fully state-run health insurance marketplaces (SBMs), three state-based marketplaces that use…
If your income last year was higher than expected, do you have to pay back some of the advance premium tax credits that you received for Marketplace coverage?
August 22, 2024 – If you received advance payments of the premium tax credit for health insurance that you purchased last year on HealthCare.gov (or a…
I earn too much to qualify for a subsidy. Why should I buy through the exchange?
August 21, 2024 – The American Rescue Plan (ARP), enacted in March 2021, makes health insurance coverage more affordable for millions of people who buy their…
Is pediatric dental coverage included in exchange plans?
July 10, 2024 – There is no penalty for not having pediatric dental on your policy – and in most exchanges, you can purchase a plan without pediatric…
Should I buy the health plan my college offers? or buy through an ACA exchange?
March 23, 2024 – Most student health plans offered by colleges and universities are fully compliant with the ACA, with just a few exceptions that don't…
Are smokers unable to afford insurance under the ACA?
February 26, 2024 – The surcharge is thought to impede access to health insurance for smokers in many states. But Medicaid and state-based regulations are…
What happens if I don’t make my premium payment by the end of the grace period?
February 20, 2024 – If you fail to pay your premiums and exhaust the grace period for plans offered in a health insurance marketplace, you will lose your…
If I have insurance through my employer, can my spouse get coverage through the exchange?
February 14, 2024 – If you have insurance through your employer, and your spouse is unemployed, they can get insurance through the Marketplace but cannot get a…
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?
February 5, 2024 – After open enrollment ends, you generally can't change your policy until the next open enrollment period, unless you experience a…
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?
February 5, 2024 – For the purpose of determining subsidy eligibility, the IRS and the health insurance exchanges use an ACA-specific version of modified…
I’m 60 and retired. I can get insurance from my former employer but it’s very expensive. Do I qualify for insurance in the Marketplace?
February 5, 2024 – But for retirees, the guidelines are more relaxed. Retirees who have access to a plan that provides minimum essential coverage can still…
Can health insurance policies still have lifetime or annual benefit maximums?
January 19, 2024 – All new individual and small-group plans have covered essential health benefits (EHBs) since 2014, and there cannot be dollar limits on…
How does my access to employer-sponsored coverage impact my eligibility for subsidized coverage through the exchanges?
January 18, 2024 – Fortunately, the IRS issued new rules, effective in 2023, to allow some families to take advantage of premium subsidies in the exchange if…
Does the Affordable Care Act make it easier to get individual health insurance?
January 11, 2024 – It's easier to get individual health insurance under the Affordable Care Act, but consumers in the individual market need to be aware that…
Does every business with 50 or more employees pay a penalty if it doesn’t offer ‘affordable, comprehensive’ insurance?
January 10, 2024 – Businesses with 50 or more full-time equivalent (FTE) employees are required to offer comprehensive, affordable health insurance coverage…
Are child-only policies available through the exchanges?
January 2, 2024 – 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…
If my income is less than expected this year, I might be eligible for Medicaid. What can I do to cover my bases?
November 13, 2023 – Income volatility and its impact on subsidy eligibility have been addressed by various provisions of the ACA and IRS regulations. But since…
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?
September 8, 2023 – If your parents are 65 or older but don't qualify for premium-free Medicare Part A, they can purchase a private plan in the Marketplace and…
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?
July 31, 2023 – You can get your own health insurance policy, but since you're counted as a dependent on your parents' tax return, your household income…
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?
July 6, 2023 – The guidelines for eligibility are determined by total household income and the number of people in the household.…
How is vision care covered under the Affordable Care Act?
June 29, 2023 – The Affordable Care Act requires coverage for pediatric vision care as one of the essential health benefits. But there is no requirement…
Can I buy coverage in the exchange that starts January 1 and stop paying for my COBRA insurance at that point?
June 23, 2023 – You can buy insurance in the exchange during open enrollment and drop your COBRA insurance. Once you’re enrolled in a plan for January,…
Are dental benefits included in ACA’s marketplace health plans?
April 7, 2023 – Pediatric dental is one of the ACA's essential health benefits. But there's no requirement that dental care for adults be…
If all Silver plans cover the same benefits and percentage of costs, why do premiums vary by carrier?
July 5, 2022 – It's important to understand that the benefits offered by plans at the same metal level can vary significantly from one plan to another.…
Would my 21-year-old’s subsidy be based on his income – or mine?
April 26, 2022 – If you declare him as a dependent on your income tax, then your income would be included in determining whether he gets a…
Did health insurance premiums go up or down for 2021?
August 18, 2021 – The vast majority of Americans get their health insurance either from an employer or from the government (Medicare, Medicaid, CHIP,…
My doctor posted a sign saying she ‘doesn’t take Obamacare.’ What should I do?
August 3, 2021 – It depends on your relationship with your doctor. If you're not particularly attached to her, it might be easier to just find someone new.…
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…
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…
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…