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Do I Qualify for Obamacare?

Whether they’re currently insured or uninsured, a lot of people want to know if they qualify for Obamacare health insurance coverage. But what does it mean to “qualify” for Obamacare?

Obamacare is a nickname for the Affordable Care Act, which was signed into law in 2010. Obamacare is not a single health insurance plan, but a complicated law that makes it easier for many people to purchase health insurance coverage on their own or sign up for Medicaid. It also made it possible for many of those who buy their own coverage to get government help paying for their monthly premiums.

Qualifying for Obamacare may involve any of these, so let’s look at each in turn.

Who qualifies for Obamacare health insurance?

Since major provisions of the Affordable Care Act came into effect in 2014, all new major medical health insurance plans are now “Obamacare” plans. Generally speaking, if you don’t get health insurance through an employer, you may qualify for health insurance under Obamacare.

More specifically, you may be eligible to buy Obamacare-compliant health insurance coverage for yourself or your family if you meet the following criteria:

  • You do not have health coverage through your employer or someone else’s employer
  • You earn too much money to qualify for Medicaid
  • You live in the United States and are:
    • A US citizen
    • A US national
    • Otherwise legally present in the US
  • You are not currently incarcerated

You should know, however, that this doesn’t mean you can get Obamacare coverage right now. Obamacare creates specific, limited enrollment opportunities that can vary depending on your personal circumstances. Outside of these enrollment opportunities you generally cannot sign up for Obamacare coverage on your own (though you may be able to enroll in Medicaid).

Do I qualify for Obamacare health insurance right now?

Generally speaking, you can only sign up for health insurance under Obamacare during the yearly open enrollment period that the law created. However, if you experienced certain major life changes (known as “qualifying life events” under the law), you may also be able to purchase Obamacare at other times of the year.

The annual Obamacare open enrollment period:

The annual nationwide Obamacare open enrollment period usually starts in the fall and runs into the early part of the next year. Though the dates are subject to change, the nationwide open enrollment period for 2017 health insurance plans is scheduled to begin November 1, 2016 and to end on January 31, 2017. During this time, any qualified person can enroll in an Obamacare plan and apply for subsidies (more on that later).

Special enrollment periods under Obamacare:

If you experience a qualifying life event, you may trigger a special enrollment period for yourself or your family, even outside the nationwide open enrollment period. Typically, you have a 60 day window after the date of your qualifying life event to sign up for coverage.

Qualifying life events that can trigger a special enrollment periods under Obamacare include the following:

  • Loss of coverage – If you lost your health insurance for any of the following reasons, you may be eligible for a special enrollment period:
    • You lost health coverage through your employer or someone else’s employer
    • Your COBRA coverage expired
    • You turned 26 and are no longer able receive insurance through your parents’ plan
    • You lost your health coverage as the result of a divorce
    • You no longer qualify for Medicaid or CHIP
  • Changes in your family size – If you had any of the following changes to your family size, you may be eligible for a special enrollment period:
    • You got married
    • You had a baby, adopted a child or gained a new dependent
  • Other reasons – If you had any of the following situations, you may qualify for a special enrollment period:
    • You moved permanently to a new coverage area that your old plan does not serve
    • You obtained an eligible immigration status
    • You were released from incarceration

Do I qualify for an Obamacare subsidy?

The Obamacare law allows some people with qualifying incomes to get a government subsidy in the form of a “premium tax credit.” These subsidies help make Obamacare health insurance coverage more affordable by paying a part of your monthly premium on your behalf.

You may qualify for a subsidy if you meet the following criteria:

  • You are not eligible for coverage through your employer or through someone else’s employer
  • Your taxable income is between 100% and 400% of the federal poverty level for your area; for example:
    • If you are a single person with no children, your taxable income can be no more than about $47,000 per year (in 2016)
    • If you are a married couple with one child, your taxable income can be no more than about $81,000 per year (in 2016)

How do Obamacare subsidies work?

Obamacare subsidies work on a sliding scale, and they make sure your monthly premiums are a fixed percentage of your annual income. Generally speaking, if you qualify for subsidies you will pay somewhere between 2% and 9.5% of your income toward your health insurance premiums, no more.

Remember, however, that your eligibility for subsidies is based on your estimated income for the year in which your coverage is in effect, not the prior year. That means, if you earn more than expected during the year, you may need to pay back some or all of the subsidy dollars you received. This reconciliation takes place when you file your federal tax return.

Who qualifies for Medicaid under Obamacare?

The Affordable Care Act sought to expand the federal Medicaid program by making it easier to qualify for Medicaid. States that accepted additional Medicaid dollars under Obamacare loosened the old eligibility requirements for Medicaid, meaning that more low-income individuals and families could enroll. However, a number of states refused the additional Medicaid dollars offered them under Obamacare, and eligibility requirements can vary depending on where you live.

To learn more, contact your state Medicaid office, your state’s government-run health insurance exchange, or a licensed health insurance agent.