10 Essential ACA Benefits
ACA Plan Types
Understanding the Affordable Care Act
How the Insurance Exchanges Work
Income Requirements for ACA
How Does the ACA Affect Insurance Premiums?
Government Subsidy Overview

Legends and Families

Health care is changing but what does it mean for you? Find out how the healthcare laws affect you and learn more about obtaining health insurance on your own.

2018 Open Enrollment Period

November 1, 2017 - January 31, 2018

The Government Open Enrollment period is no longer open. To enroll in a qualified insurance plan before the marketplace reopens on 11/01/2017 you must have experienced a qualifying life event.

Are you eligible for financial assistance?

You have many health coverage options available. Use our Coverage Calculator to get your personalized coverage roadmap.

Coverage Calculator »

Get Educated

Take control of your health coverage by learning everything you need to know about healthcare laws and the government subsidy program.

Learn More »

Key Facts

You may qualify for government subsidies to reduce the cost of individual insurance.

show more

Depending on what your estimated income is for the year, you may qualify for a government subsidy, which may decrease your monthly premium if you buy your own insurance through the state or government Marketplace. To see if you qualify, check out our Coverage Calculator.

Individuals under the age of 26 may remain on their parents' health plan.

show more

Under the Affordable Care Act, a child can stay on his or her parent's health plan, or be added back onto it, until he or she reaches the age of 26. If you're under the age of 26, being added to your parent's health plan might be an affordable option.

Individuals under age 30 are eligible to purchase less expensive catastrophic plans.

show more

Catastrophic health plans are a cost effective alternative to traditional insurance coverage and they meet the insurance mandate for people under the age of 30. Catastrophic health plans feature lower monthly premiums have higher deductibles and only emphasize coverage for hospitalization or serious illness.

If you're uninsured for more than 3 consecutive months, you could face tax penalties.

show more

The ACA requires that nearly everyone purchase health insurance or face potential financial penalties. The 2016 tax penalty for going without coverage is 2.5% of your income or $695 per adult and $347.50 per child. You’ll pay the higher of the amounts. In future years, the fee is adjusted for inflation.

Enrollment isn't guaranteed year-round, but affordable short-term options are available.

show more

The only time individuals can enroll in new public health insurance is during the government open enrollment period. There are some exceptions if you have a "qualifying life event," (like a permanent move, marriage or birth of a child) which would make you eligible for a special enrollment period. Individuals locked-out until the next open enrollment period may be eligible to purchase short-term insurance to obtain some protection against unexpected medical costs, however they could still be subject to the financial penalties for failure to have health insurance coverage.

Have More Questions?

Below are our lists of available resources that can help guide you through this process. We also have a thorough knowledge base of FAQ's available.

FAQ's

When can I enroll in new coverage?

If you are seeking individual coverage through the Government or State Exchanges you may only enroll in new coverage during the Government Open Enrollment Period. You can only enroll in coverage outside of that time period if you have a qualifying life event . Events that are considered acceptable qualifying life events (QLE) include:

  • permanently moving to a new state
  • job loss
  • family changes (marriage, divorce, birth of a child)
  • loss of existing health coverage because of a job loss or job change
  • loss of eligibility for Medicaid or CHIP
  • expiration of your COBRA benefits
If you have had a QLE you typically have 60 days after the event occurs to enroll and you may need to provide documentation to prove that the QLE occurred.

Do I have to obtain health insurance coverage?

Yes. One of the elements of the Affordable Care Act was the Individual Mandate which requires that nearly everyone purchase health insurance or be subject to a penalty. There are some exceptions to the individual mandate for people who are incarcerated, Medicaid recipients and a few others. Additionally, keep in mind that you will have to prove you're covered. After you enroll, you'll get a form from your insurance company that says you have the minimum coverage. You'll need to submit that new form with your government tax return .

How do the Government subsidies work?

Government subsidies are available to help individuals with the cost of purchasing health insurance coverage through a marketplace. To qualify for a subsidy your income must be between 100% and 400% of the government poverty level. Subsidies are paid directly to the insurers to help lower premium costs. However, subsidies are structured so that the most qualifying individuals or families will have to pay towards their premiums will range from 2.0% to 9.5% of their income.

What types of plans are offered on the exchanges?

All plans offered through the exchanges must provide minimum essential benefits and provide certain preventive services. The four types of plans available on the public exchanges are referred to as "metallic plans" because they are named after four types of metals:

  • Bronze - pays for 60% of all covered costs
  • Silver - pays for 70% of all covered costs
  • Gold - pays for 80% of all covered costs
  • Platinum - pays for 90% of all covered costs

What are the essential benefits that exchange offered plans must cover?

Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

What preventive services do the exchange offered plans need to provide?

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance.

  • Abdominal Aortic Aneurysm
  • Alcohol Misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal Cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users

Will I be covered if I purchase a plan outside of the exchanges?

Yes. However, plans purchased outside of the state and government exchanges are not eligible for government subsidies.

How do I know if I am eligible for Medicaid?

Although Medicaid is financed by the federal government it is a state sponsored program which means you need to meet your states eligibility requirements in order to qualify. Generally, you should qualify for Medicaid if your household income is less than 100% of the Government Poverty Level . Many states have expanded coverage to include everyone earning up to 133% of the Government Poverty Level. You can find out if you qualify using our Coverage Calculator.

Do I Qualify for a Subsidy?

Find out if you qualify for a Government insurance exchange subsidy by completing our simple questionnaire with our coverage calculator.