"Affordable Care Act"?

Financial Help 

We'll get you help based on your income if your qualify. Based on your yearly income and household size, you may qualify for financial help in the form of subsidies: Premium tax credits, cost sharing reduction, and both Medicaid and CHIP. We find what you qualify for and help you get it. 

  • Advanced Premium Tax Credit: A type of subsidy that reduces your monthly payment (or premium) as soon as your coverage begins. For example, if your premium is $200, and you qualify for a $180 a month premium tax credit, you will pay $20 a month for your insurance plan. The amount of your premium tax credit is based on your estimated yearly income, your family size, and how much health insurance costs in your area.

  • Affordable Care Act: The comprehensive health care reform law enacted in March 2010. Also known as the ACA and Obamacare.

  • CHIP (Children’s Health Insurance Program): CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP can cover parents and pregnant women. Each state offers CHIP coverage, and has its own rules about who qualifies for CHIP. There’s no limited enrollment period for CHIP. If you qualify, your coverage can begin immediately, any time of year.

  • Comprehensive Coverage: The health insurance plans offered through the Health Insurance Marketplace must include a basic set of benefits, including doctor visits, hospitalizations, maternity care, emergency room care, prescriptions, and more.

  • Cost Sharing Reduction (CSR): Cost Sharing Reduction is a type of subsidy that provides a discount that lowers the amount you have to pay for any out-of-pocket costs like deductibles, coinsurance, and copayments. This is based on your estimated yearly income, your family size, and how much health insurance costs in your area.

  • Federal Poverty Line (FPL): The Federal Poverty Line is a measure of income issued every year by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage. 
    How federal poverty levels are used to determine eligibility for reduced-cost health coverage: 

    • Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.

    • Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.

    • Income below 100% FPL: If your income falls below 100% FPL and your state hasn't expanded Medicaid coverage, you won't qualify for either income-based Medicaid or savings on a Marketplace health insurance plan. You may still qualify for Medicaid under your state's current rules.

  • Financial assistance or Savings: There may be ways for those with low or middle incomes to get help paying for their health insurance by signing up for a plan through the Health Insurance Marketplace. If you qualify for financial assistance, the government will pay a portion of your health insurance premiums directly to your health insurance company every month. This will lower the amount of money you have to pay for your health insurance premium every month.

  • Health insurance: Health insurance is a way to help you pay for your health care. It is a contract with an insurer that says they will help pay for your doctor visits if you get sick or injured. Having quality health insurance is coverage that helps you stay healthy, protects your wallet, and gives you peace of mind.

  • Health insurance requirement or Individual mandate: As part of the new health care law, most Americans will need to have health insurance. If you do not have health insurance, you may have to pay a fine. You won’t have to pay a fine if you have a very low income and coverage is unaffordable for you, or for other reasons including your religious beliefs. You can also apply for a waiver asking not to pay a fine if you aren’t automatically exempt.

  • Health Insurance Marketplace (Exchange): The Health Insurance Marketplace (sometimes called an Exchange) is a new way to compare and purchase health insurance plans. Every state will have a Health Insurance Marketplace, though each state’s Marketplace will look different. But the important thing is that all plans available through the Marketplace will cover the care that you need. You will be able to choose from a selection of insurers and plans in easy-to-understand language, so you can compare the different types of coverage that are available to you.

  • Medicaid: Medicaid is a state and federal program that provides health coverage if you have a very low income and limited resources. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include low-income adults, their children, and people with certain disabilities. There’s no limited enrollment period for Medicaid. If you qualify, your coverage can begin immediately, any time of year.

  • Open Enrollment Period: The period of time when you can sign up for health coverage through the Health Insurance Marketplace. The next open enrollment period is from November 1, 2016 to January 31, 2017.

  • Pre-existing conditions: A current or past medical condition, illness, or disability that — before the health reform law was passed — could cause a person to be denied or charged more for their health coverage. Beginning in 2014, people can no longer be turned down or charged more for their health coverage because of pre-existing conditions.

  • Qualifying life event: A change in your life that can qualify you for a special enrollment period to enroll in a health insurance plan. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby).

  • Special enrollment period: The next open enrollment period for the Health Insurance Marketplace is November 1st, 2016 through January 31st, 2017. Outside of this window, someone may qualify for a special enrollment period. This period lasts until 60 days after a qualifying life event, such as a job loss, birth, or divorce.

  • Subsidy: A subsidy is financial assistance that helps you pay for your health insurance. There are two kinds of subsidies available from the federal government for marketplace health insurance plan: Advanced premium tax credits and Cost Sharing Reduction. The goal of these subsidies is to make health insurance more affordable for households with annual incomes below the federal poverty levels specified by the law.