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Insider’s Guide to Obamacare’s Special Enrollment Periods

What millions of consumers don't know about qualifying life events can't help them capitalize on the Affordable Care Act's special enrollment periods

Publication of the first edition of healthinsurance.org’s Guide to Obamacare’s Open Enrollment in 2014 was our response to readers’ frequent requests for information about their enrollment options under the Affordable Care Act.

Our guide has helped thousands of readers successfully navigate the Affordable Care Act’s annual open enrollment period and find affordable, quality health insurance – either through the health marketplaces or off-exchange. We’re proud to have been part of the decrease in the national uninsured rate.

We do know, of course, that not everyone eligible for ACA-compliant health coverage bought coverage during the most recent open enrollment period. Some folks may not have enrolled because they somehow missed the enrollment deadlines. Others may have thought coverage was too expensive, or weren’t aware that they were eligible for the ACA’s premium subsidies (which are substantial enough that 6 million uninsured Americans can qualify for free health insurance, due in part to the American Rescue Plan’s enhancement of the ACA’s subsidies). Others simply didn’t have enough information to make a decision.

But depending on the circumstances, people can still enroll in health coverage even after open enrollment has ended, if they experience a qualifying event. This guide will walk you through all the qualifying events and the specific rules for how they trigger special enrollment periods.

Special enrollment periods are normally required in order to buy coverage outside of open enrollment

In a normal year, enrollment outside of the open enrollment window is only available if you experience a qualifying event. It doesn’t matter how healthy you are, or whether you’ve had continuous coverage or how much you’re able to pay – enrollment is simply not available for most of the year without a qualifying event.

And that’s where our Insider’s Guide to Special Enrollment comes in.

Louise Norris, a highly regarded expert on health insurance and author of our first guide, has put together an authoritative overview of special enrollment periods and the qualifying events that trigger those SEPs. [Note that this guide is specific to special enrollment periods in the individual market; the special enrollment period rules that apply to employer-sponsored plans are similar, but not entirely the same.]

During most SEPs, an individual (and dependents) can enroll in any health plan available in the exchange (as discussed later in this guide, some SEPs have restrictions for plan changes that limit people to a plan at the same metal level they already have). And most of the SEPs also apply to health plans available outside the exchange.

As a licensed agent, the author has seen them all – obvious triggers like loss of coverage due to divorce or legal separation, and not-so-obvious triggers such as an increase in income that makes someone newly eligible or newly ineligible for exchange subsidies.

The qualifying events that trigger special enrollment periods in 2022 are mostly the same as they were in 2020 and 2021, although there have been some additional SEPs added (for example, situations involving employer reimbursement of health insurance premiums, people who have off-exchange coverage and then experience an income change that makes them newly eligible for premium subsidies in the exchange, and people with income below 150% of the poverty level). And as has been the case in the past few years, you’ll generally need to be prepared to provide proof of your qualifying event.

In most cases, a special enrollment period is only available if you already had minimum essential coverage before the qualifying event, and there are restrictions that prevent people from using SEPs to upgrade to better coverage during the year. Some of these restrictions and nuances have been added over the years, so the rules aren’t the same as they were in the beginning.

If you’re reading this guide and feel paralyzed in the “off-season” – the 9.5 months outside of open enrollment – don’t despair. It’s possible you already have a qualifying life event. And if you don’t right now, there may be one just around the next corner. If you’re uncertain about your eligibility for a special enrollment period, call (866) 686-8071 to discuss your situation with a licensed insurance professional.

We hope you find this guide useful – and if you do – we hope you’ll share it with someone else who needs the information.

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Table of Contents

Insider’s Guide to Obamacare’s Special Enrollment Periods
1 Qualifying events and why we need them
2 Who doesn’t need a special enrollment period?
3 Involuntary loss of coverage is a qualifying event
4 How your ‘big move’ can trigger an SEP
5 Divorce, death, or legal separation: SEP is optional
6 A change in subsidy eligibility changes your options
7 Citizenship or lawful immigrant status can deliver coverage
8 An SEP if your employer plan doesn’t measure up
9 Non-calendar-year renewal as a qualifying event
10 Leaving the coverage gap? This SEP’s for you.
11 Proving you deserve a special enrollment period
12 An SEP for your growing family
13 Exceptional circumstances for special enrollment
14 An SEP if you have a QSEHRA or ICHRA
15 An SEP if your income doesn’t exceed 150% of the federal poverty level

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Allen D Blume
Allen D Blume
2 years ago

My wife and I have recently relocated from Minnesota to North Dakota and are looking for a “best value” Medicare supplemental insurance provider. We have been drawing Medicare benefits for several years, and we have a UCare Classic ™ supplemental package that provides for very good quality coverage – extensive medical care and biannual dental prophylaxis – but it will expire 30 days from our formal declaration of residency in North Dakota.
What are our insurability options? Are there rated/ranked packages available from major underwriters (Specifically Blue Cross & Blue Shield, but others comparable to UCare) and where would we find these rankings? Are there insurance providers who cover more than biannual dental cleanings?
Finally, where could I obtain side-by-side pricing and service comparisons for companies operating in North Dakota?
Thank you for your assistance,
Allen D. Blume
240 7th St. NE
Valley City, ND 58072
(703) 399-4884 C
[email protected]

Louise Norris
Louise Norris
2 years ago
Reply to  Allen D Blume

Allen,
I believe the plan you have is actually a Medicare Advantage plan, as opposed to a Medicare Supplement (Medigap) plan. Since your coverage under the plan you have now is ending, you’ll have the option to select a new Medicare Advantage plan, or to switch to Original Medicare plus a Medicare Supplement plan that’s offered in North Dakota .
Most Medicare Advantage plans include prescription drug coverage and dental coverage, although the specifics will vary by plan. If you opt for Original Medicare plus a Medigap plan instead, you’ll want to purchase a separate Part D plan in order to have prescription drug coverage.
Medicare Advantage plans and Part D plans are rated on a five-star rating system. Medigap plans do not have a star-rating system, but the plans are standardized, with letter designations for names. So a plan with the same letter name will offer the same benefits, regardless of which insurer offers it (pricing and how the rates change over time will vary from one insurer to another).
You can use Medicare’s plan finder tool to see what’s available in your new area: https://www.medicare.gov/plan-compare/#/?lang=en
Our Medicare site will also likely be useful to you: https://www.medicareresources.org/medicare-benefits/ It has extensive resources about Medicare Advantage, Medigap, Medicare Part D, and a summary page for North Dakota: https://www.healthinsurance.org/north-dakota-medicare/
We also recommend that you reach out to the North Dakota State Health Insurance Counseling Program – they can answer questions you have about Medicare plans that are available in North Dakota: https://www.shiptacenter.org/about-medicare/regional-ship-location/north-dakota

stephen
stephen
2 years ago

we have moved out of the country for a year, so i want to cancel my policy. when I return, is that considered a qualifying event that allows me to reinstate coverage?

Louise Norris
Louise Norris
2 years ago
Reply to  stephen

Yes, that would trigger a special enrollment period. This is explained in more detail in this section of the guide: https://www.healthinsurance.org/special-enrollment-guide/how-your-big-move-can-trigger-an-sep/
In most cases, a move only triggers a special enrollment period if you already had minimum essential coverage prior to the move. But there’s an exception for people moving to the US (or back to the US) from abroad. So when you return to the US, you’ll be able to select a new plan, even if it’s outside of open enrollment. Be aware, however, that you may have a gap between when you actually arrive in the US and when your new policy can take effect, so you’ll probably need to maintain travel insurance for a little while when you first come back.

Elaine Miller
Elaine Miller
2 years ago

I am planning early retirement in January of 2021. I believe I have the option of Cobra for 18 months. If this is the case, my Cobra will run out end of June 2022. Would that be considered a qualifying event? On the other hand could I sign up for “Obamacare” during open enrollment in Dec 2021, but have coverage take effect in July 2022?

Louise Norris
2 years ago
Reply to  Elaine Miller

Yes, the expiration of your COBRA coverage will count as a qualifying event and will trigger a special enrollment period. (and no, you can’t enroll during open enrollment in late 2021 and have the coverage effective date delayed until July 2022, so utilizing the special enrollment period is your best bet).
The qualifying event in this case is loss of other coverage, as explained here: https://www.healthinsurance.org/special-enrollment-guide/involuntary-loss-of-coverage-is-a-qualifying-event/ If you enroll in the two months prior to the end of your COBRA coverage, you’ll be able to have seamless coverage, with your new plan taking effect July 1. You can also enroll in the 60 days after your COBRA ends, but then you’d have a gap in coverage.

Clare Rockenhaus
Clare Rockenhaus
1 year ago

My daughter, 24 years old, is unemployed as of 10-31-20. She had health insurance through her job that is now gone. She went on her dad’s workplace plan, but he is retiring 1-1-21. He will use COBRA but it’s too expensive to also cover our daughter. Can she apply for a marketplace plan during open enrollment for a start date of coverage 1-1-21? We live in Kansas, which has not expanded Medicaid. She is looking for a job, and should be able to find something that makes at least minimum wage.

Louise Norris
Louise Norris
1 year ago

Yes, she can enroll during open enrollment for a plan that starts 1/1/21. In order to qualify for a premium tax credit (premium subsidy), she’s going to need to have a 2021 income of at least $12,760 (assuming she files her taxes as a household of one). If she can get a job that pays at least that much, she’ll be eligible for substantial subsidies that will cover a good deal of the premium cost for a plan purchased through the exchange. If she ends up getting a job during 2021 that provides health benefits, she’ll be able to cancel her marketplace plan at that point.

Jason
Jason
1 year ago

Hi Louise, first of all the phone number listed at the bottom of your article doesn’t seem to be working. My wife of 3 years is finally immigrating to the U.S. When I signed up for health insurance through my (new) job a few months ago, I was told that marriage is a qualifying event but immigration isn’t. This makes no sense to me, as I was unable to add my wife to my policy at that time due to her not having a social security number. Now that she’ll be getting one in the near future, that must qualify her to be added to my insurance, right? I’m looking for something concrete to go to my employer with because I don’t believe they will let me do anything before the next open enrollment if I can’t tell them exactly why they should. Thank you for the article.

Last edited 1 year ago by Jason
Louise Norris
Editor
1 year ago
Reply to  Jason

Congratulations on your wife’s immigration. Unfortunately, your employer may be correct here. Gaining lawfully present immigration status is a qualifying event for enrolling in a plan through the health insurance marketplace: https://www.healthinsurance.org/special-enrollment-guide/citizenship-status-can-deliver-coverage/

But it’s not listed as one of the qualifying events that trigger a special enrollment period for an employer-sponsored plan, as those follow somewhat different rules: https://www.law.cornell.edu/cfr/text/29/2590.701-6#a_2

For comparison, the qualifying events for individual/marketplace coverage do include gaining lawfully present immigration status: https://www.law.cornell.edu/cfr/text/45/155.420 (see section (d)(3), which refers to the fact that a lawfully present immigration status is necessary in order to enroll in the exchange, and that newly gaining that status is a qualifying event).

So your wife would be able to enroll in a plan through the marketplace until your group’s open enrollment period. At that point, you’d be able to add her to your group plan if you choose to do so (note that she would not be eligible for a subsidy in the marketplace if she’s eligible to be covered under your group plan and the coverage they provide is comprehensive and considered affordable for you, even if she isn’t enrolled in the group plan).

Jason
Jason
1 year ago
Reply to  Louise Norris

Thank you!

Marilyn Corbin
Marilyn Corbin
1 year ago

Thanks for this information. My son recently graduated from college and his health plan has now expired. He hasn’t found a job yet, so we need to get him on a plan. He’s an Idaho resident and we are in CA. I am a member of a healthshare ministry, which has been okay for me, but I don’t know if it’s a good choice for him, as he has a pre-existing condition .My husband is not working and has benefits through the VA. My son will still be considered a dependent on our 2021 tax return, so our entire household income will be considered in calculations, making YHI health plans unaffordable for him. Any ideas?

Louise Norris
Editor
1 year ago
Reply to  Marilyn Corbin

Has he obtained quotes for plans available through YHI, and if so, did he look at the Catastrophic plans? Those are very similar to Bronze plans (but they provide three office visits with copays before the deductible is met), but less expensive in terms of monthly premiums if the person isn’t subsidy-eligible.

If he wants to enroll in a plan through YHI, he’ll need to sign up within 60 days of his prior coverage ending. Otherwise, he’ll need to wait for open enrollment, which starts November 1. I assume he won’t be your tax dependent in 2022? In that case, he’ll be able to sign up for his own coverage through YHI during the open enrollment period. If he still has little to no income at that point, he’d likely qualify for Medicaid, since Idaho has expanded Medicaid eligibility for adults under the ACA. If it looks like he’ll earn more than $17,775 in 2022 (but still need to obtain his own health insurance), he’ll be able to enroll in a plan with a subsidy.

CL Caudle
CL Caudle
10 months ago

I just realized that the income limits were higher for 2021 (no cap) for subsidies. I purchased a BCBS policy in NC not through the market place. Is it too late for me to take advantage of a subsidy for 2021?

Louise Norris
Editor
10 months ago
Reply to  CL Caudle

Unfortunately, yes. There’s no way to go back and claim the premium tax credit if your coverage was purchased outside the marketplace. You might be able to transition to a marketplace plan for December, if you’ve got a qualifying life event at this point. But that would only give you the subsidy for the month of December.

The good news is that the income cap has also been eliminated for 2022. So you can enroll in a marketplace plan now, with coverage effective January 1, and you’ll be able to claim the premium tax credit for 2022.

james kachline
james kachline
7 months ago

Louise, you wrote me last year the following (*see below), and I have further questions:

Once I compute my monthly payment, when I sign up for an exchange policy starting June 1, 2022, will I pay the full monthly premium… then when I do our tax return for 2022 (in early 2023), will I get a credit back (for any amount paid by me over the cap amount) at that time through my tax return? In May, 2022, when we would likely sign up for the new exchange coverage for the remainder of the year, I could only guess what my wife’s and my total income for 2022 will be, in order to multiply that amount by 8.5% (ARP’s cap %), so how does the monthly premium payment or later credit/rebate actually work?

Also, when my COBRA coverage for (myself and wife) expires on May 31, 2022, I assume this is an event that allows us to sign up under “special enrollment period”. Also, would we then have 60 days to sign up from that date (with coverage retroactive to June 1, 2022)?

Thank you so much for your response.

*”They will look at your entire income for 2022 to determine your subsidy eligibility. But then your premium subsidies will be calculated on a monthly basis, and applied from June through December.

So for example, let’s say your total household income in 2022 is $80,000. That’s above 400% of the poverty level for a household of two, so the ARP’s 8.5% of income cap would apply for 2022. That would mean that your required contribution for the whole year would be 8.5% of $80,000, which works out to $6,800. But then they divide that by 12 to determine your required monthly contribution, which would be $567.

So each month, from June through December, they’d expect you to pay $567/month in premiums for the benchmark plan (second-lowest-cost Silver plan). Let’s say, for example, that the benchmark plan’s full price for your household would be $1,200/month. You’d then qualify for a subsidy equal to $633/month. You could apply that subsidy amount to any available metal-level plan, which means you’d pay less than $567/month if you pick a cheaper plan, but more if you pick a more expensive plan.

Those are all just hypothetical numbers to illustrate this – your own amounts will be based on your own income and the cost of the benchmark plan in your area. Please let us know if any of this is still unclear.”

james kachline
james kachline
7 months ago

I now see part of my question answered below re: COBRA expiration. It appears that expiration is a qualifying event for special enrollment period, and that we should sign up sometime within the 60 days prior to COBRA expiration date (May 31, 2022), in order to prevent a gap in our coverage (new coverage to start June 1, 2022)… correct? Thank you for response to this and remaining questions in post below.

Louise Norris
Editor
7 months ago
Reply to  james kachline

James,

As you’ve already noted, the new marketplace plan would not be retroactive. So it’s important to sign up in the 60 days prior to June 1, so that the new plan takes effect June 1. You would still have a 60-day special enrollment period that runs through June and July, but coverage would take effect the first of the month after you enroll, meaning you’d have a gap in coverage if you do that.

In terms of premiums and the premium tax credit: You can choose to pay full price and claim any tax credit for which you’re eligible when you file your 2022 tax return. Or you can make a best-guess estimate of what your income will be, and the marketplace will base your subsidy (if applicable) on that income projection (depending on the circumstances, they may want you to provide proof of the income projection you make). You’ll still have to reconcile the premium tax credit on your 2022 tax return either way. If you underestimated your income (and thus got a larger advance premium tax credit than you should have), you’ll pay back the excess on your tax return. But if you overestimated your income (and thus got a smaller advance premium tax credit than you should have), you’ll get the additional amount from the IRS when you file your taxes.

terra
terra
7 months ago

My dad has moved from Canada, he is 75 and has been retired for 10 years and is only using their health system from BC. would this qualify as a Special Enrollment? He can eventually get on Medicare B, but it won’t be activated until July so will be without insurance for several months.

Louise Norris
Editor
6 months ago
Reply to  terra

Here’s an article where we’ve discussed this sort of situation in more detail: https://www.medicareresources.org/faqs/can-recent-immigrants-to-the-united-states-get-health-coverage-if-theyre-over-65/
If your dad has recently arrived in the US (within the last 60 days), he’s eligible for a special enrollment period during which he can enroll in a health insurance plan through the exchange/marketplace in the state where he’s living. This is true as long as he’s not eligible for premium-free Medicare Part A (presumably he does not have 10 years of work history in the US, and is thus not eligible for premium-free Part A?)

Stella
Stella
4 months ago

My husband cancelled my health insurance prior to the qualifying event (divorce) obviously without documentation. I spoke with his employer’s benefits department, which initially told me that without the divorce decree (because we are not “legally” separated, as we live in NC and never had it filed with the court) that my health insurance would be reinstated. The Benefit’s representative is now telling me that my husband has to reinstate my health insurance and inform HR that he made a mistake. I was also told that COBRA would be sending me information, but I do not have a qualifying event (divorce), so how can they offer me continuation of benefits?? I am at a lost for what to do, as this change has been done mid-year and without proper documentation. Husband is saying that HR processed the health insurance cancellation so he isn’t going to talk with them. I am now uninsured and I cannot get anyone to help with this matter. Any advise?

Louise Norris
Editor
4 months ago
Reply to  Stella

If you’re still eligible to be on his plan (ie, there has been no divorce or legal separation), I would advise that you call the HR department again and keep trying to get someone who can help you sort it out, either by reinstating your coverage or getting COBRA paperwork to you. But if they can’t help you and your husband is unwilling to discuss this with his HR department, you might need to obtain your own health insurance.

You’ll qualify for a special enrollment period to buy a plan in the NC marketplace, even though it’s mid-year. You’ll just need to show that your previous coverage has been cancelled within the last 60 days (or is soon to be cancelled) and that will trigger the special enrollment period. Here’s more about the special enrollment period due to loss of coverage: https://www.healthinsurance.org/special-enrollment-guide/involuntary-loss-of-coverage-is-a-qualifying-event/

If you’re going to be divorced before the end of the year, you’ll be filing your 2022 tax return as single (or head of household, depending on the circumstances). So you’ll want to keep that in mind if you’re applying for premium tax credits (subsidies) in the marketplace, as that’s based on the income you’ll report for the whole year when you file your tax return.

Stella
Stella
4 months ago
Reply to  Louise Norris

Thank you for your response! I will reach out to his employer’s benefits department again. I still do not understand how he could cancel without documentation to support the qualifying event (divorce). Isn’t the prevention of such an issue the responsibility of the HR department? Instead they are putting blame on the employee while also making it MY responsibility to request reinstatement from that employee (my husband). I trusted that my health insurance coverage was secure until the final divorce decree was granted. Where are the laws to prevent such situations from occurring? Anyway, thank you for your time and your assistance!

Brian Estwick
Brian Estwick
3 months ago

I have been on my wife’s work related health insurance for many years. She is retiring and I will not be 65 until two months after she retires. She can’t delay her retirement because she has a defined benefit pension plan impacted by rising interest rates. Does this qualify me for a special enrollment period for ACA? Can I get ACA for less than a year so that I can transition to Medicare when I turn 65? Thank you!

Louise Norris
Editor
3 months ago
Reply to  Brian Estwick

Brian,
Yes, if you lose your coverage when she retires, that will make you eligible for a special enrollment period during which you could enroll in a plan through the marketplace in your state. Here’s more about the special enrollment period due to loss of other coverage: https://www.healthinsurance.org/special-enrollment-guide/involuntary-loss-of-coverage-is-a-qualifying-event/

And yes, you would be able to cancel that plan when you transition to Medicare. Here’s more about that: https://www.medicareresources.org/medicare-eligibility-and-enrollment/moving-from-obamacare-to-medicare/ (Plans purchased in the marketplace are always month-to-month; any enrollee always has the option to cancel their coverage anytime, for any reason. So it’s not like employer-sponsored health coverage in that regard.)

One other option you might want to look into is COBRA. If COBRA is available, you have a 60-day window when you can elect the COBRA continuation of the group health coverage. If you elect COBRA at any time during that window, your coverage is retroactive to the date it would otherwise have ended, so you have seamless coverage. But if you don’t elect COBRA, it just never takes effect.

Medicare starts the first of the month you turn 65 (as long as you enroll in the three months before that). So depending on the specifics of exactly when your Medicare will start, you may or may not have a short enough gap to be safely covered by that 60-day COBRA election window.

Franklin P
Franklin P
2 months ago

Dear Louise or any experts here,

I am looking for some insights on behalf of my Permanent Resident parents (87 and 76 year olds). The have been permanent residents for 10+ years, but had been going back and forth between the US and Asia until my sister moved into the US recently. While they are healthy, my sister and I are obviously concern if they don’t have any health insurance living in the US. They never worked in the US and have not decided whether to reside with my sister in CA or with me in NJ, so if one state is better than the other, it would certainly help them decide! I understand that because they never worked here, they will probably have to purchase health insurance.

Any thoughts/advice on all the available options is greatly appreciated.

Thank you.

Louise Norris
Editor
2 months ago
Reply to  Franklin P

Franklin,

Yes, they will need to purchase coverage, as they would not be eligible for premium-free Medicare Part A without a work history in the US (and for all enrollees, Medicare Part B has a premium). Here’s more on health insurance for immigrants: https://www.healthinsurance.org/obamacare/how-immigrants-are-getting-health-coverage/ And here’s more info about coverage for immigrants who are over 65: https://www.medicareresources.org/faqs/can-recent-immigrants-to-the-united-states-get-health-coverage-if-theyre-over-65/

If they want to purchase private health insurance, they may be eligible for subsidies to offset the cost of a plan purchased in the marketplace/exchange. In California, the marketplace is Covered California. In New Jersey, it’s GetCoveredNJ. Both are state-run exchanges, and both provide additional state-funded subsidies in addition to the federal premium subsidies, depending on a person’s income (California’s state-funded subsidies have been paused through the end of 2022 due to the American Rescue Plan’s additional federal subsidies, but the California budget calls for them to be reinstated in 2023 if the federal ARP subsidies are not extended).

My advice would be to use the plan browsing tools on the CoveredCA and GetCoveredNJ websites, to get an idea of what plans are available in each area and how much they would cost after accounting for your parents’ income. A local broker can be of assistance as well, and you won’t pay anything for their services (you can use the “find local assistance” or similar tool on the marketplace website to find brokers who are certified by the marketplace).

Franklin P
Franklin P
2 months ago
Reply to  Louise Norris

Thank you very much, Louise. I will read the links and follow your advise, while also waiting for Nov 1 to see what is available in the marketplace.

Laura
Laura
1 month ago

Dear Louise, I recently got health coverage through my state’s marketplace as a special enrollment because I retired from teaching and my health coverage ended as of July 31st. I called and got advice from a counselor from the marketplace who advised that I should put my new income in the paperwork which is considerably less than what my teaching salary was. So basically I made much more from January – June that I am now making in retirement. After reading many of your responses to people, it seems that the advice I was given may be wrong. My higher salary fit the higher bills I had to pay at the time so it isn’t like I have “excess” money for the second half of the year where my, income is less. The premium tax credit I got using my current retirement monthly income fits what I am able to afford now. Based on what I read that you said to others, It seems like I should have estimated what my average income was for both my old teaching job and my new retirement so the annual income (which the site automatically calculated based on my what I put in for my monthly income) to get the correct premium tax credit. I am just trying to handle my business correctly. Is the worst that would happen that I would just have to pay back lots when I file my taxes? Do I need to update my income and include my “old” income, or could I also just change the amount of the subsidy I accept and pay more now out of pocket knowing that I may need to reconcile some of this at tax time? In 2023, my income factors will be quite steady so I am not concerned about planning ahead. It is just what is happening right now for August through December. Thank you so much for your input and allowing questions via this forum.

Louise Norris
Editor
1 month ago
Reply to  Laura

Laura,
It’s true that the premium tax credit reconciliation (on your tax return next spring) is going to be based on your total income for 2022. Here’s how income is calculated under the ACA: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/
Changing your income with the marketplace or manually adjusting your premium tax credit for the remainder of the year might be a good idea, as that will reduce or eliminate the amount you have to repay when you file your taxes. But it would also depend on whether you’re expecting a tax refund for this year. If so, the excess premium tax credits would just be subtracted from your refund, which might be an easier way to handle it.

Ivonne
Ivonne
12 days ago

I hope this post is still monitored. As we are nearing the Open Enrollment time in 2022 for coverage in 2023 I wanted to know where is the best place to start. I am looking for my partner who is uninsured currently, 54 male, in Florida. Do we go to an insurance broker office, or is online the best way? It is overwhelming to even get a quote online, and when you give your email and phone details they bother you aggressively. I currently don’t have the option to get him insured in my policy, we aren’t married, but he cannot be without any coverage as this is a financial risk for us married or unmarried.

Louise Norris
Editor
12 days ago
Reply to  Ivonne

Ivonne,
You’re right that it’s too risky for him to continue to go without health insurance. And it’s also true that searching for health insurance online can be overwhelming and result in a lot of marketing calls.
In Florida, the exchange/marketplace (where income-based subsidies are available) is HealthCare.gov. They have a “find local help” tool that can show you the exchange-certified brokers and navigators in your area: https://localhelp.healthcare.gov/ If you enter your zip code, it will show you the agents and enrollment assisters in your area who have completed the exchange’s training and can help your partner figure out the best plan to meet his needs. There’s no charge for their services; the cost of the coverage is the same regardless of whether you enroll on your own or have assistance.
For now, the 2023 plan details and prices are not yet available; that info will be public by late October. But you should be able to get an appointment set up with a broker or enrollment assister who will be able to help you sort through all of the available options once the details are available.

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