FREQUENTLY ASKED QUESTIONS
Please click on the questions below to view answers.
With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll in coverage.
Visit healthcare.gov for more info.
- Must live in the United States.
- Must be a U.S. Citizen or qualified alien during entire coverage period.
- Cannot be incarcerated.
By choosing to pay a higher monthly premium, you pay less when you need medical care. If you choose to pay a lower monthly premium, you pay more when you need medical care. You can choose the level of coverage that best meets your health needs and budget.
For more information about the basic levels of coverage, visit here.
You may qualify for a Special Enrollment Period (SEP) if you or anyone in your household in the past 60 days experiences:
Changes in household size
- Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.
- Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward.
- Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.
- Died. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.
Changes in residence
Household moves that qualify you for a Special Enrollment Period:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or United States territory
- If you’re a student, moving to or from the place you attend school
- If you’re a seasonal worker, moving to or from the place you both live and work
- Moving to or from a shelter or other transitional housing
Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period.
Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.
Loss of health coverage
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days. Coverage losses that may qualify you for a Special Enrollment Period include:
- Losing job-based coverage
- Losing individual health coverage for a plan or policy bought yourself
- Losing eligibility for Medicaid or CHIP
- Losing eligibility for Medicare
- Losing coverage through a family member
More qualifying changes
Other life circumstances that may qualify you for a Special Enrollment Period, include:
- Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
- Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
- Leaving incarceration
- Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member
If your health care premium is more than 9.5% of your gross income, you may choose what your employer offers or shop for insurance through the marketplace.
You can save money in the Health Insurance Marketplace 3 ways. All of them depend on your income and family size.
- You may be able to lower costs on your monthly premiums when you enroll in a private health insurance plan. These plans all cover essential health benefits and pre-existing conditions.
- You may qualify for lower out-of-pocket costs for co-payments, co-insurance, and deductibles.
- You or your child may get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Some states have expanded Medicaid eligibility, so you may qualify even if you have been turned down for Medicaid in the past.
If you completed an application over the phone or through the Marketplace website, www.healthcare.gov, you should know the results of your eligibility determination instantly.
Regardless, once you know the results of your eligibility determination you are ready to compare prices for different health insurance plans in order to find out which one best meets your needs.
You can appeal the following kinds of Marketplace decisions:
- Whether you’re eligible to buy a Marketplace plan
- Whether you can enroll in a Marketplace plan outside the regular open enrollment period
- Whether you’re eligible for lower costs based on your income
- The amount of savings for which you are eligible
- Whether you’re eligible for Medicaid or the Louisiana Children’s Health Insurance Program (LACHIP)
- Whether you are eligible for an exemption from the individual responsibility requirement for tax years before 2019
Note: Some states have their own individual health insurance mandate, requiring you to have qualifying health coverage or pay a fee with your state taxes for the 2019 plan year. If you live in a state that requires you to have health coverage and you don’t have coverage (or an exemption):
- You’ll be charged a fee when you file your 2019 state taxes.
- You won’t owe a fee on your federal tax return.
To find this year’s fee, click here.
If you only had coverage for part of 2018, your penalty will be prorated for the months that you did not have coverage. You will not pay a penalty for months that you had health coverage. You are considered covered in a given month if you had health coverage for at least one day in that month.
Some individuals will be exempt from the penalty. Exemptions can be found here.