Your ACA Health Insurance Enrollment Checklist
âPeople in their 50s and 60s who may have watched the market before before turning away in horror from how much they would have to pay for a plan should look again,â said Karen Pollitz, senior researcher and expert ACA at the non-partisan Kaiser. Family Foundation Bottom Line: The recently enacted stimulus law increases subsidies to market premiums and, more importantly, says that no one will have to pay more than 8.5% of their income for ACA health insurance.
One thing to note: the more generous grants and the 8.5% income threshold for bonuses are only good for 2021 and 2022. There are proposals in Congress to make these changes permanent, but so far, lawmakers have not acted.
Deciding which health insurance plan is right for your health care needs and your budget can be complicated and daunting. Here’s a checklist of what you need to know about ACA and the information you’ll need right at your fingertips to make your health plan decisions.
Understanding ACA Coverage
All ACA plans are required to cover the same set of essential health benefits, such as hospital services, doctor’s visits, diagnostic tests, emergency room care, and other vital services. All of your pre-existing conditions will be covered.
The plans offered by private insurance companies are organized by categories named for metals. Each category has a different mix of premiums, deductibles, and co-payments to meet different health and financial needs.
- Lowest monthly premiums
- Highest deductibles and quotas
- Plans designed to cover you in the event of serious illness or injury
- Most Popular Package Category
- Moderate monthly premiums
- Moderate deductibles and quotas
- Only plans in this category are eligible for cost-shared grants
- Plans designed to swap a slightly higher monthly premium for more extensive routine healthcare coverage
- High monthly premiums
- Lower deductibles and quotas
- Plans designed for people willing to trade in higher monthly premiums for better coverage of routine care costs.
- Highest monthly premium
- Lowest deductibles and quotas
- Plans designed for those who need a lot of care and are willing to pay a very high premium.
What are ACA Grants?
- Premium tax credit
- This tax credit reduces the monthly premium for those who qualify. The amount to which you are entitled depends on your income. For 2021 and 2022, federal law states that you will never have to pay more than 8.5% of your income for an ACA premium.
- If you qualify for a premium subsidy – or a tax credit – the federal government will pay the amount of the tax credit for which you qualify directly into your health insurance plan and you will pay your portion. Or, you can choose to pay the full premium and take advantage of the tax credit when you file your tax return.
- Cost sharing grant
- If you qualify for a premium tax credit, you may also be eligible for a cost sharing reduction. This will help you pay for reimbursable expenses such as deductibles and co-payments.
- You can only get these savings if you sign up for a Silver plan – and you will get a plan specifically designed for those who qualify for this additional financial aid.
How can I get a grant?
- Your eligibility for a premium tax credit depends on the estimated household income you indicate in your application.
- This health care.gov calculator will let you know if you are eligible for a grant and by how much.
- Be sure to include yourself, your spouse, and anyone else you declare as dependent on your income taxes, even those who don’t need coverage, when you estimate your grant.
Ready to apply? Collect personal information
- Name and date of birth for you, your spouse, your children, other dependents and any other person under the age of 21 who lives with you, even if they do not apply for coverage
- Postal addresses of the persons appearing on your request
- Social security numbers for everyone on your application
- If someone is a lawful permanent resident, you will be asked for information from immigration documents.
- Tax information, including how you file, the dependents you claim, and the income of anyone listed on your claim
- Health coverage. Does anyone in your household have public or private health insurance? You will need their policy numbers.
- Employer information, including whether coverage has been offered to you through your or a family member’s job, and employer contact details for all household members who are employed