Frequently Asked Questions

What is the Affordable Care Act (ACA)?
What is a Navigator?
Will I have to pay a penalty?
What is a tax credit?
What is a cost-sharing reduction?
What is Minimum Essential Coverage?
When can I sign up for health coverage?
What is a Special Enrollment Period?
What is a Premium?
What is a Deductible?
What do I do after I enroll in a Marketplace plan?
What do I need to bring with me to an appointment?

What is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA) is the comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 by President Barak Obama and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name "Affordable Care Act" is used to refer to the final, amended version of the law. The ACA hopes to increase the quality and affordability of health coverage, decrease the amount of individuals without health insurance and reduce the costs of healthcare for individuals and the government.


What is a Navigator?

A navigator is an individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.


Will I have to pay a penalty?

The law requires that you obtain Minimum Essential Coverage (MEC) or face a penalty. If you don’t have health insurance in 2016, you’ll pay 2.5% of your income or $695 per adult (354 per child) that is uninsured, whichever is higher.


What is a tax credit?

A tax credit is the amount of money the government gives you to use to lower your monthly insurance payment when you enroll in a plan through the Health Insurance Marketplace. Your tax credit is based on the income estimate and household information you put on your Marketplace application.


What is a cost-sharing reduction?

A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You also have a lower out-of-pocket maximum. You can get these savings if your income is below a certain level, and only if you choose a health plan from the Silver plan category.


What is Minimum Essential Coverage?

Minimum Essential Coverage or MEC is any health insurance that meets the Affordable Care Act requirement for having coverage. If you have minimum essential coverage, you don’t have to pay the fee for being uninsured.

Examples of minimum essential coverage include:

  • Health Insurance Marketplace plans
  • Job-based plans
  • Most individual plans bought outside the Marketplace
  • Plans sold through the Small Business Health Insurance Program (SHOP) Marketplace
  • Medicare
  • Medicaid
  • The Children's Health Insurance Program (CHIP)
  • TRICARE
  • COBRA

When can I sign up for health coverage?

For the marketplace, Open Enrollment for 2016 health coverage ended January 31, 2016. If you didn’t enroll by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period. The Open Enrollment Period for 2017 is November 1, 2016 — January 31, 2017. Medicaid and CHIP have year round enrollment.


What is a Special Enrollment Period?

Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period. You qualify if you have certain life events, like getting married, having a baby, or losing other health coverage.


What is a Premium?

A premium is the monthly amount that must be paid for your health insurance or plan. It is not included in your deductible, your copayment, or your co-insurance. If you don’t pay your premium, you could lose your coverage.


What is a Deductible?

A premium is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.


What do I do after I enroll in a Marketplace plan?

PAY YOUR PREMIUM
In 7-14 days you will receive an invoice and a welcome packet. You must pay your premium for your insurance to be active. Your health insurance company could end your coverage if you fall behind in paying your monthly health insurance premium. If you fall behind on your health insurance payments contact your health insurance provider immediately. 
UPLOAD INCOME VERIFICATION DOCUMENTS
In about 30 days the Health Insurance Marketplace may send you a letter requesting that you upload documents to your marketplace account in order to verify you income. Your navigator will be able to help you upload the documents.
 
REPORT ANY CHANGES IN INCOME OR HOUSEHOLD
It is important that any changes in your income, household size, or address be reported to the marketplace immediately. Any changes may affect your monthly premium and tax credit amount.

What do I need to bring with me to an appointment?

  • Information about your household. Figure out who's applying for coverage before you start your application
  • Information about everyone applying for coverage including Social Security Numbers and Birthdates
  • Document information for legal immigrants.
  • Employer and income information for every member of your household (for example, from pay stubs or W-2 forms—Wage and Tax Statements).
  • Your best estimate of what your yearly household income will be