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Your ACA Health Insurance Enrollment Checklist

Guide to understanding costs, coverage, subsidies and how to sign up for a plan

Healthcare.gov website home page
HealthCare.gov

If you need health insurance and aren’t covered through your job or your spouse’s plan, or you’ve retired but are younger than 65 and not yet eligible for Medicare, it’s time to consider signing up for a plan under the Affordable Care Act (ACA).

Under the Inflation Reduction Act, the expansion of the ACA marketplace subsidies, first included in the 2021 American Rescue Plan, has been extended through 2025. This provision not only increases the ACA marketplace premium subsidies, making individual health insurance more affordable, but it also states that no one will have to pay more than 8.5 percent of their income for ACA health insurance. 

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If you are already enrolled in a marketplace plan, it would be a good idea to review your coverage during the ACA's annual open enrollment period, which runs from Nov. 1, 2022 until January 15, 2023 for the federal marketplace and most state exchanges. Some states have a longer open enrollment period so best to check with your state to see when your deadline is for making changes.

Deciding what health insurance plan works for your health care needs and your budget can be complicated and daunting. Here’s a checklist of what you need to know about the ACA and what information you’ll need at your fingertips as you make your health plan decisions.

Understanding ACA coverage

All ACA plans are required to cover the same set of essential health benefits, such as hospital services, doctor visits, diagnostic tests, emergency room care and other vital services. All your preexisting conditions will be covered. The plans available through private insurance companies are organized by categories named for metals. Each category has a different combination of premiums, deductible and copays to meet varying health and financial needs.

Bronze

  • Lowest monthly premiums
  • Highest deductibles and copays
  • Plans designed to cover you in case of serious sickness or injury

Silver

  • Most popular plan category
  • Moderate monthly premiums
  • Moderate deductibles and copays
  • Only plans in this category are eligible for cost-sharing subsidies
  • Plans designed to trade a slightly higher monthly premium for more coverage of routine health care

Gold

  • High monthly premiums
  • Lower deductibles and copays
  • Plans designed for people willing to trade higher monthly premiums for more coverage of routine care costs

How to Apply for ACA Health Coverage

Click here for the federal ACA marketplace or learn about your state exchange if you live in one of these 18 locations:

Platinum

  • Highest monthly premium
  • Lowest deductibles and copays
  • Plans designed for those who need a lot of care and are willing to pay a very high premium

What are ACA subsidies?

Premium tax credit

  • This tax credit lowers the monthly premium for those who qualify. How much you qualify for depends on your income. For 2021 and 2022, federal law says you will never have to pay more than 8.5% of your income for an ACA premium.

  • If you qualify for a premium subsidy — or tax credit — the federal government will pay the amount of the tax credit you qualify for directly to your health plan and you'll pay your portion. Or, you can elect to pay the full premium and take the tax credit when you file your income taxes.

Cost-sharing subsidy

  • If you qualify for a premium tax credit you may also be eligible for a cost-sharing reduction. This will help you pay for such out-of-pocket costs as deductibles and copays.

  • You can get these savings only if you enroll in a silver plan — and you'll get a plan designed specifically for those who qualify for this additional financial assistance.

How do I qualify for a subsidy?

  • Whether you qualify for a premium tax credit depends on the estimated household income you put on your application.

  • This healthcare.gov calculator will let you know whether you are eligible for a subsidy and how much.

  • Make sure to include yourself, your spouse and anyone else you claim as a dependent on your income taxes, even those who don't need coverage, when you estimate your subsidy.
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Ready to apply? Gather personal information

  • Name and date of birth for you, your spouse, children, other dependents and anyone else under 21 who lives with you, even if they are not applying for coverage.

  • Mailing addresses for those on your application.

  • Social Security numbers for everyone listed on your application.

  • If anyone is a legal permanent resident, you'll be asked for information from immigration documents.

  • Tax information, including how you file, any dependents you claim and income of anyone on your application.

  • Health coverage. Does anyone in your household have public or private health insurance? You'll need their policy numbers.

  • Employer information, including whether you were offered coverage through your job or that of a family member, and employer contact information for all household members who are employed.
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How and when to apply

  • Go to healthcare.gov or the exchange in your state exchange to fill out an application.

  • Your coverage takes effect the first of the month after you apply. For example, if you apply by April 30, your coverage starts May 1. But if you apply May 10 you'll have to wait until June 1 for the coverage to kick in.

  • If you have a life-changing event such as the loss of job-related health insurance or loss of insurance through your spouse, you may apply at any time during the year.

What if I need help with my application?

Healthcare.gov has a web page that allows you to put in your zip code and find insurance agents, brokers or local organizations that provide assistance.

Editor's Note: This story, originally published June 10, 2022, has been updated to reflect new information.

Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.

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AARP Membership — $12 for your first year when you sign up for Automatic Renewal

Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine.