Frequently Asked Questions

Read about the most commonly asked questions.

It’s basically an online store for health insurance. In the marketplace, we can shop and compare plans from different insurance companies.
You may be able to enroll in Medicaid coverage at no cost if you meet certain income qualifications.
If you underestimate your income and receive too much financial assistance, you may have to pay some of it back. If you make more than 400% of the Federal Poverty Level and should not have qualified for a subsidy, you will need to pay it all back. If you overestimate your income and don’t receive enough assistance, you will be credited the difference at tax time.

If you already enrolled for coverage and want to change to a different plan, you may only do so during the annual open enrollment period, unless you have a qualifying event. Experiencing a qualifying event makes you eligible for a special enrollment period (SEP). Qualifying events can include:

  • Change in income
  • Getting married
  • Having a baby
  • Getting divorced
  • Death in the family
  • Moving to a new city or state

You are eligible to stay on your parents’ plan as a dependent until you turn 26 years old. 

The ACA requires insurance companies to increase coverage levels. It also requires them to cover everyone, including people who are very ill and would normally have been turned down for coverage. In order to do this, insurance companies must then pass some of their increased costs onto their customers.
  • Obamacare requires all health insurance plans to cover pre-existing conditions.
  • We can’t be denied coverage due to our health status.
  • All plans must cover preventive care.
  • Plans must cover children’s vision and dental care.
  • There are new limits to the maximum deductible and out-of-pocket costs.
You may qualify for a subsidy if you do not have any other insurance plan available to you—either through your employer or a public insurance plan like Medicaid—and your income is between 138% and 400% of the Federal Poverty Level.
Only naturalized citizens and lawfully present immigrants are eligible to receive a subsidy or Medicaid. Undocumented immigrants are not required to have health insurance and do not qualify for a subsidy.

One of the provisions of Obamacare is to classify health insurance plans under a Metallic Level System. The metallic level of a plan makes is easier for us to compare plans with similar levels of coverage and make informed choices. There are 4 different metallic levels :

  • Bronze – covers 60% of expected medical expenses
  • Silver – covers 70% of expected medical expenses
  • Gold – covers 80% of expected medical expenses
  • Platinum – covers 90% of medical expenses

The bronze plans are typically the least expensive and the platinum plans are the most expensive.

In order to qualify for lower health care costs :

  • You cannot have coverage available through your employer or your spouse’s employer.
  • You must not be eligible for public insurance like Medicare or Medicaid.
  • Your income must be between 138% and 400% of the federal poverty level.
Not everyone can afford it. For this reason the government offers financial assistance, called a subsidy. These subsidies can help lower your health care costs and/or allow you to pay a discounted monthly rate for your coverage.

Most of us are now legally required to have health insurance or pay a fine. There are some exceptions to this rule. If you fall into any of the following categories, you are not legally required to have health insurance:

  • You belong to a Native American tribe.
  • You can’t afford the lowest priced plan available to you.
  • Your annual income is lower than is required to file a tax return.
  • You’re not a US citizen.
  • Health insurance is against your religious beliefs.
  • You belong to a health care sharing ministry.
  • You’re currently in prison.
Obamacare is not a health insurance plan—it’s a law called the Affordable Care Act. This law requires all of us to have health insurance or pay the fine.
Many health plans have a fixed dollar amount that you must pay for your medical services each year before your insurance benefits kick in. Some plans may have services that are covered before your deductible is met—such as office visits or prescription drugs. Usually a co-pay will apply for these types of services.