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11 Things You Need to Know About ACA Enrollment

How to choose a health insurance plan

Health Insurance Marketplace

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Healthcare.gov is where the majority of Americans in the individual market will shop for a health insurance plan.

En español | 1. Who should apply?

The Affordable Care Act (ACA) Health Insurance Marketplace is the place where people who do not have health care coverage through their job or a government program, such as Medicare or Medicaid, purchase health insurance. 



2. Where to apply

The best place to start is at healthcare.gov. That’s where the majority of Americans in the individual market will shop for a plan. But 11 states and the District of Columbia have their own marketplaces: California, Colorado, Connecticut, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington. To access your marketplace, go to healthcare.gov, click on Get Coverage and you will be asked to select your state. You will then be directed to click on your state marketplace or to click on Continue to access the federal site.

Note: Healthcare.gov will be offline for maintenance on Sundays during open enrollment between 12 a.m. and 12 p.m. The only exception is Dec. 10. 

You can also call the Marketplace Call Center at 800-318-2596 and apply over the phone. It accepts calls seven days a week, 24 hours a day.

Or you can apply in person. Many nonprofit and community organizations have trained people, known as navigators, to help you apply for coverage. You can go to localhelp.healthcare.gov, plug in your zip code and a list of nearby navigators will pop up.

3. When to apply

The marketplace open enrollment begins on Nov. 1, 2017, and for most Americans will end on Dec. 15, 2017. Eight states and the District of Columbia have extended the open enrollment deadline:

California – Jan. 31, 2018

Colorado – Jan. 12, 2018

Connecticut – Dec. 22, 2017

District of Columbia – Jan. 31, 2018

Massachusetts – Jan. 23, 2018

Minnesota – Jan. 14, 2018

New York – Jan. 31, 2018

Rhode Island – Dec. 31, 2017

Washington – Jan. 15, 2018

4. What do the plans cost?

The cost depends on your income. About 85 percent of the more than 10 million people who already have insurance through the marketplace receive a federal subsidy to help them pay the monthly premiums. In general, you may be eligible for a subsidy if, for example, you are single and your 2018 income falls between $12,060 and $48,240; or if you are a family of three and you have a household income between $20,420 and $81,680. You can choose to use the subsidy to lower your premium or you can pay the full premium and deduct the subsidy from your federal income taxes.

In addition, about 60 percent of marketplace enrollees qualify for assistance that defrays the cost of deductibles and copays. To be eligible, individual income in 2018 must be between $12,060 and $31,050, for example; 2018 income for a family of three must be between $20,420 and $51,050. To determine whether you will qualify, use the subsidy calculator at healthcare.gov/lower-costs.

5. I’ve heard premiums are going to be higher than last year. Is that true?

Yes. Most insurance companies have raised the premiums for 2018, given the uncertainty surrounding whether the federal government will reimburse insurers for the subsidies for lower-income people. 

However, if you qualify for a subsidy, you likely won’t be affected by the premium increases. Under the ACA, the subsidies increases in proportion to the rate increases.

But if you earn too much to qualify for federal financial assistance, you are apt to find your premium has increased. The amount of increase will vary widely by state and by plan. You can find out how much your premium is going up at healthcare.gov.

6. How do I prove my eligibility for the subsidy?

You’ll need to provide detailed information on the application, including:

  • Birth dates and home addresses for all individuals who will be applying for coverage under the plan
  • Social Security numbers, name of employer and income information for every member of your household, even if they aren’t all applying for coverage
  • Estimated household income for 2018
  • Policy number and plan ID of your current insurance plan
  • Any letter or document your current plan has provided regarding renewal

7. How do I find a plan?

Go to healthcare.gov/see-plans/. You’ll be asked for personal details such as where you live, your age, gender and some health-related questions, such as “do you smoke?”  You will then be directed to a screen that will list all the plans available in your county.

8. What are the different types of plans?

The marketplace plans fall into four categories:

  • Bronze – Lowest monthly premium, highest out-of-pocket cost, very high deductibles. 
  • Silver – The most popular plan. Moderate premiums, moderate out-of-pocket costs, deductibles are lower than Bronze plan.
  • Gold – High monthly premiums, lower out-of-pocket costs, low deductibles.
  • Platinum – Highest monthly premiums, lowest out-of-pocket costs, very low deductibles.

There is also a catastrophic plan, which includes all the benefits required by the ACA, including free preventive care.  These plans carry low monthly premiums and very high deductibles. But they are only available to individuals under the age of 30 and to those who get an exemption from the marketplace because, for example, they cannot afford coverage any other way.

You can find out more about the various types of plans at healthcare.gov/choose-a-plan/plans-categories.

9. What if I’m already enrolled in a marketplace plan?

If you don’t do anything by Dec. 15, 2017 — or when open enrollment ends in your state — you will be automatically renewed in your current plan. If your plan is no longer available, the marketplace will enroll you in the most similar plan.

10. Does it pay to shop around for a plan? 

Yes, as there have been many changes in the 2018 plans. Many insurers have left the marketplace. In addition, if you are currently enrolled, your doctor may leave the plan’s network in 2018. Premiums also vary from year to year. 

11. What happens if I don’t buy insurance?

The ACA requires that nearly all Americans have health insurance. There are some exceptions: You can apply for a hardship exemption if, for example, you have filed for bankruptcy, cannot find affordable coverage or had a death in the family.

If you don’t get an exemption, you’ll have to pay a penalty — 2.5 percent of your modified adjusted gross income or $695 per adult, whichever is higher, and $347.50 for each child under 18.

Beginning with the 2018 tax-filing season, the IRS will not process any tax return that does not disclose whether the filer has health insurance coverage or an exemption.

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