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Your ACA Health Insurance Enrollment Checklist

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

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Courtesy HealthCare.gov/Getty Images

En español | If you've lost your health insurance during the pandemic or have just been unable to pay for coverage in the past, it's time to take another look at the Affordable Care Act (ACA). And you don't have to wait for the law's annual open enrollment. Even people who already have a marketplace plan might want to take a look and see if they can get a better deal under the new rules. The federal exchange allows that and so do many of the states.

COVID-19 concerns led the federal government and the states that operate their own health insurance exchanges to open up these marketplaces for a special enrollment period that lasts until Aug. 15, 2021. (Annual open enrollment typically starts Nov. 1.) And the American Rescue Plan, signed into law in March, made changes in the way the ACA works that experts say will make it much more affordable and makes these plans worth a new look.


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"People in their 50s and 60s who may have looked at the marketplace before and then turned away in horror at how much they would have to pay for a plan should look again,” says Karen Pollitz, senior fellow and ACA expert at the nonpartisan Kaiser Family Foundation. The bottom line: The recently enacted stimulus law increases marketplace premium subsidies and, most importantly, says that no one will have to pay more than 8.5 percent of their income for ACA health insurance.

One thing to note: The more generous subsidies and 8.5 percent income threshold for premiums are good only for 2021 and 2022. There are proposals in Congress to make these changes permanent, but so far lawmakers have not acted.

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.
       
  • 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 percent 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.

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

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 15 locations:

How and when to apply

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

  • The current special enrollment period lasts until Aug. 15.

  • 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.

  • The usual ACA open enrollment period begins Nov. 1 and ends Dec. 15.

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.

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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