Health Insurance FAQs

Am I required to have health insurance coverage?

The federal government now requires that most individuals purchase health insurance. Those who don’t may be subject to a tax penalty.

When can I enroll in “ObamaCare” health insurance coverage?

Open Enrollment for health insurance coverage in a Marketplace plan starts November 1, with January 1 being the first date your coverage can start. Open Enrollment ends on December 15. If you do not enroll by December 15, you cannot enroll in a health insurance plan for that year unless you qualify for a Special Enrollment Period following certain life events.

What are copayment plans?

Copayment plans offer a fixed copayment (or copay) for things like office visits and prescriptions. While you’ll know what you’re going to pay with copay plans, they come at a higher monthly premium cost. These plans are ideal for someone who wants predictable costs and doesn’t mind paying more in premiums.

What are deductible and coinsurance plans?

Deductible and coinsurance plans have lower premiums than copayment plans. If you don’t expect a lot of medical expenses and want to save money on premiums, these may be the plans for you. For these plans, you pay the full cost of your medical expenses until you meet your deductible. (A deductible is the amount a person pays for health care before your insurance starts to pay.) Then you pay a coinsurance percentage, sharing the cost with the insurance company until you reach your out-of-pocket limit. After that, the insurance company pays all covered costs. Some plans are also Health Savings Account (HSA) eligible which means an HSA can be used to pay for certain medical expenses.

What is my modified adjusted gross income (MAGI)?

Modified adjusted gross income (MAGI) includes your adjusted gross income and any tax-exempt foreign income, tax-exempt Social Security benefits, and tax-exempt interest. Supplemental Security Income is excluded from your MAGI.

Do my spouse and I have to file taxes jointly to get Marketplace savings?

If you are married, you must file a joint federal tax return for the year you want coverage in order to qualify for premium tax credits. If you file separately, you can enroll in a Marketplace plan together but can’t get premium tax credits. If you are living apart but are not legally separated or divorced, you must file a joint income tax return to qualify for premium tax credits. If you are legally separated or divorced you do not need to file jointly in order to receive premium tax credits.

If I don’t have a source of income, can I still qualify for premium tax credits?

You must make at least 100% of the Federal Poverty Level (FPL) in order to qualify for premium tax credits. If your MAGI is less than 100% of the FPL then you may qualify for Medicaid depending on state rules and regulations. If your income is between 100% and 250% of the FPL you may be eligible for both premium tax credits and cost-sharing reductions with a Silver Level Health Insurance plan. If your income is between 250% and 400% of the FPL you are eligible for premium tax credits only. You are ineligible for any federal tax credits if your income is below 100% or above 400% of the FPL.

How do I apply for a subsidy or qualify for lower costs on health insurance?

When you buy health insurance coverage in the Marketplace, you may be able to get a subsidy or premium tax credit that lowers your monthly premium. This will depend on your household size and income. Our health agents can help you learn if you qualify and assist you with the application process.

I own a small business with less than 50 employees. Am I required to offer health insurance to my employees?

If you have 50 or fewer employees, the health care law does not require you to offer health insurance. However, you can purchase insurance through the Small Business Health Options Program (SHOP). Please contact one of our health agents for more information.

I am turning 65 on my next birthday. When should I get my Medicare card so I can sign up for a Medicare supplement policy?

If you are receiving Social Security benefits, you will automatically be enrolled in Medicare and your Medicare card should be mailed to you 3 months before your 65th birthday, then you can sign up for Medicare supplement. If you are not receiving Social Security benefits (because you are still working, for example) you will need to sign up for Part A and Part B.