Frequently-asked questions by tag
![Is pediatric dental coverage included in exchange plans? photo](https://www.healthinsurance.org/wp-content/uploads/2020/01/pediatric-dental-and-the-aca-400x203.jpg)
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…
![What type of health insurance exchange does my state have? photo](https://www.healthinsurance.org/wp-content/uploads/2020/10/what-type-of-health-exchange-400x203.jpg)
What type of health insurance exchange does my state have?
June 26, 2024 – As of the 2024 plan year, there will be 19 fully state-run health insurance marketplaces (SBMs), three state-based marketplaces that use…
![Should I buy the health plan my college offers? or buy through an ACA exchange? photo](https://www.healthinsurance.org/wp-content/uploads/2020/08/college-health-plan-or-ACA-scaled-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/05/smokers-health-insurance-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2019/12/payment-deadline-health-insurance-premium-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2018/01/husband-wife-esi-exchange-400x203.jpg)
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 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? photo](https://www.healthinsurance.org/wp-content/uploads/2019/12/income-change-affect-premium-subsidy-400x203.jpg)
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?
February 9, 2024 – If you received advance payments of the premium tax credit for health insurance that you purchased last year on HealthCare.gov (or 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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/08/upgrade-aca-coverage-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/04/aca-subsidy-household-income-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/02/exchange-coverage-after-retirement-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2018/02/lifetime-annual-benefit-maximums-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/06/employer-coverage-aca-subsidies-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/10/will-the-affordable-care-act-make-it-easier-to-get-individual-health-insurance-400x203.jpg)
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…
![If I enroll in the exchange, will that coverage take effect immediately? photo](https://www.healthinsurance.org/wp-content/uploads/2020/08/health-coverage-effective-date-400x203.jpg)
If I enroll in the exchange, will that coverage take effect immediately?
January 11, 2024 – If you enroll through your marketplace your coverage effective date mostly depends on whether you're enrolling during open enrollment or a…
![Does every business with 50 or more employees pay a penalty if it doesn’t offer ‘affordable, comprehensive’ insurance? photo](https://www.healthinsurance.org/wp-content/uploads/2018/01/employer-mandate-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/06/child-only-health-policies-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/06/off-exchange-health-insurance-plans-scaled-400x203.jpg)
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…
![If I don’t enroll in a plan by the open enrollment deadline, what are my options? photo](https://www.healthinsurance.org/wp-content/uploads/2020/12/miss-open-enrollment-deadline-1-400x203.jpg)
If I don’t enroll in a plan by the open enrollment deadline, what are my options?
September 18, 2023 – 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…
![I earn too much to qualify for a subsidy. Why should I buy through the exchange? photo](https://www.healthinsurance.org/wp-content/uploads/2020/10/off-exchange-health-plan-400x203.jpg)
I earn too much to qualify for a subsidy. Why should I buy through the exchange?
September 8, 2023 – The American Rescue Plan (ARP), enacted in March 2021, makes health insurance coverage more affordable for millions of people who buy their…
![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? photo](https://www.healthinsurance.org/wp-content/uploads/2018/01/parents-move-to-us-dont-qualify-400x203.jpg)
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…
![Are visits to the chiropractor or physical therapist covered under the Affordable Care Act? photo](https://www.healthinsurance.org/wp-content/uploads/2019/02/aca-health-insurance-chiropractor-400x203.jpg)
Are visits to the chiropractor or physical therapist covered under the Affordable Care Act?
September 5, 2023 – All ACA-compliant individual and small group plans include coverage for physical therapy. Some individual market plans, sold via the health…
![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? photo](https://www.healthinsurance.org/wp-content/uploads/2018/02/insurance-college-student-at-home-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2021/01/husband-wife-file-separately-subsidy-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/11/aca-vision-coverage-400x203.jpg)
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 small businesses use the ACA’s health insurance marketplaces (exchanges)? photo](https://www.healthinsurance.org/wp-content/uploads/2020/08/shop-exchanges-400x203.jpg)
Can small businesses use the ACA’s health insurance marketplaces (exchanges)?
June 29, 2023 – The Affordable Care Act included an enrollment platform called SHOP (Small Business Health Options Program), an exchange where businesses…
![Do Gold exchange plans offer more generous coverage than Bronze or Silver plans? photo](https://www.healthinsurance.org/wp-content/uploads/2016/06/obamcare-gold-silver-bronze-platinum-plans-400x203.jpg)
Do Gold exchange plans offer more generous coverage than Bronze or Silver plans?
June 23, 2023 – All plans (whether Bronze, Silver, Gold or Platinum) must cover the same essential benefits, including free preventive care; they all…
![Can I buy coverage in the exchange that starts January 1 and stop paying for my COBRA insurance at that point? photo](https://www.healthinsurance.org/wp-content/uploads/2017/12/cobra-to-aca-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2016/01/aca-dental-coverage-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2016/08/obamacare-silver-plan-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2019/05/aca-dependent-subsidy-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/02/health-insurance-rate-increases-1-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2018/01/doctor-refusing-aca-coverage-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/05/health-insurance-options-from-employer-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2020/01/tracking-health-insurance-coverage-400x203.jpg)
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? photo](https://www.healthinsurance.org/wp-content/uploads/2019/10/employee-unhappy-with-health-coverage-400x203.jpg)
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…
![If I have access to health insurance, can my husband’s company deny me coverage? photo](https://www.healthinsurance.org/wp-content/uploads/2018/12/spouse-coverage-denied-400x203.jpg)
If I have access to health insurance, can my husband’s company deny me coverage?
January 22, 2021 – 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…