ACA Frequently Asked Questions

Open enrollment for 2023 federal marketplace health coverage is from November 1, 2022-January 15, 2023. States that have their own exchanges may have different end dates (see What is a State Exchange in this FAQ). If you’d like help enrolling in a plan and live in a state served by the Health Insurance Marketplace (healthcare.gov), call American Exchange at 1.888.995.1674. We can help at no cost to you.

Some states that run their own exchanges may have different time frames. We can help you enroll in plans through state exchanges in:

• California
• Idaho
• Maryland
• Nevada
• New Jersey
• New York

Some states run their own health exchanges. They do not use the healthcare.gov platform to enroll their residents in health plans, so you enroll with the state.

American Exchange is licensed to enroll people through the state exchange if you live in:

• California
• Idaho
• Maryland
• Nevada
• New Jersey
• New York

American Exchange can’t help you enroll if you live in one of the following states. We’ve provided links to the state exchange websites where you can get more information and enroll. Just click on the link for your state.

State Exchange Websites

Colorado

Connecticut

District of Columbia

Kentucky

Maine

Massachusetts

Minnesota

New Mexico

Pennsylvania

Rhode Island

Vermont

Washington

To get health insurance through the Affordable Care Act (ACA) marketplace, you must:

• Live in the United States (US)
• Be a US citizen, national, or be lawfully present. (See I am an immigrant. Am I eligible? for more information).
• Not be serving a term in prison or jail.

More people than ever are eligible for financial savings. The Centers for Medicare & Medicaid Services (CMS) says that 4 out of 5 people will be able to find a plan for $10 or less per month.

To see if you qualify for an ACA plan and the savings you are eligible for, call American Exchange at 888.995.1674.

The cost varies by the type of plan you buy and your household income. For individuals with income up to 150% FPL, the required contribution is zero, while at an income of 400% FPL or above, the required contribution is 8.5% of household income.

The ACA marketplace offers help paying for premiums and out-of-pocket costs, like copays and deductibles, based on your income. Premium tax credits lower your monthly payments for your plan. Cost sharing subsidies lower your out-of-pocket cost when you go to the doctor or have a hospital stay.

Plans are split into 4 groups to make it easier for you to compare plans and understand costs. Bronze plans usually have the lowest monthly premiums, but they have the highest deductibles and other cost sharing. American Exchange created a guide to help you understand the different metal groups. Click here to download Understanding ACA Metal Plans.  

Call American Exchange at 1.888.995.1674. to see if you qualify for premium tax credits.

It depends on how much everyone in your household earns each year. Based on your household income, you could qualify for a premium tax credit. This credit will lower or completely pay for your monthly premium costs. See Who is eligible for a premium tax credit? for more information.

You must meet the following criteria to be eligible to get help paying your monthly premiums:

• Your household income must be at least equal to the Federal Poverty Level (FPL).
  • If your household income is below 150% FPL, you will pay $0 for your monthly premium.
• You are not eligible for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or other public programs.
• You are a US citizen or have proof of legal residency.
  • Lawfully present immigrants whose household income is below 100% FPL can also be eligible for tax subsidies if they meet all other eligibility requirements.
• You do not have access to affordable coverage through an employer (including a family member’s employer). See If I don’t sign up for health insurance from my job, can I get an advanced premium tax credit (APTC) through an ACA plan? for more information.
• You file taxes jointly, if you are married.

Yes, if:

• You are eligible for a premium tax credit.
• Your household income is between 100%-250% of the FPL.
• You enroll in a silver plan.

The Kaiser Family Foundation created a Health Insurance Marketplace Calculator to help you estimate what you will pay for an ACA health plan. You will need to enter information about your age, household income, zip code, and family size to see if you qualify for help paying your monthly premium or out-of-pocket costs.

You need a lot of information about you and your household to enroll in an ACA marketplace plan. We’ve created a checklist to help you gather the information you need before you enroll. Click here to download the ACA Enrollment Checklist.

To get a quote for coverage, you can estimate your household income. You may be required to provide proof of income once you are enrolled.

Health insurance is confusing. We created a list of terms so you can better understand health insurance and pick the right plan for you and your family. Click here to download Health Insurance Terms.

The marketplace health plans are split into 4 groups to make it easier for you to compare plans and understand costs. American Exchange created a guide to help you understand the different metal groups. Click here to download Understanding ACA Metal Plans.

You must submit all required documents within 90 days of the date you enroll:

• If you don’t provide proof of income, you may lose your tax credit, but you will still be enrolled in your health insurance plan.
• If you don’t provide proof of citizenship, you will lose your plan.
• If you don’t provide immigration status, you will lose your plan.

You must submit documents that show a yearly income amount that closely matches the yearly income amount you entered on your application. If others live with you, you will have to show proof of income for them as well.

Make sure you submit a copy of your proof of income (keep the original document) to keep your health coverage.

Tip: If you have a different job than you had last year, submit recent pay stubs from your new job instead of last year’s tax return or W2.

Learn more about proof of income documents.

The documents you must submit to the marketplace to prove your citizenship include a U.S. passport, Certificate of Naturalization (N-550/N-570), or a Certificate of Citizenship (N-560/N-561). Make sure you submit a copy of your proof of citizenship (keep the original document) before the deadline to keep your health coverage.

Get a complete list of documents to submit as proof of citizenship.

There are many documents you can submit to prove your immigration status, including a Permanent Resident Card, “Green Card” (I-551), Reentry Permit (I-327), or a Refugee Travel Document (I-571). Make sure you submit a copy of your proof of immigration status (not the original document) before the deadline to keep your health coverage.

Get a complete list of documents to submit as proof of immigration status.

Lawfully present immigrants are eligible for ACA health plans. The marketplace does not directly provide any benefits for undocumented immigrants.

Here is a list of eligible immigrant statuses to see if you are eligible for an ACA marketplace plan.

1. Save your document as a PDF (.pdf) file. American Exchange does not accept any other file format.
2. Click upload documents or copy and paste the following link into your browser: https://www.americanexchange.com/upload-pdf/. 
3. Click on the state or program you are in. If you aren’t in a program, click All Other Programs.
4. Click the down arrow on the right under Document Type to select the type of document you are uploading.
5. Click Choose File to find the document on your computer that you want to upload.
   • Repeat this step to upload more than 1 document.
6. For the “Email” field, enter your Case Manager’s email address for an American Exchange agent to reach out about the documentation.
7. Click Submit.

You should choose male or female based on the sex listed or you think is listed on your birth certificate regardless of what pronoun you identify with. The reason is that health plans cover different services for women than they do men. Maternity care is one example.

Yes. If you entered a valid email address when you enrolled, you will get an email from the Health Insurance Marketplace®. You will also get a marketplace eligibility report.

Your insurance company will also send information about your plan, and will mail an insurance card for you and anyone covered by your plan to use when you go to the doctor.

Yes. American Exchange’s licensed, ACA-certified enrollment team can find the right ADAP approved plan to fit your needs. Call 1.888.995.1674. We can also enroll your eligible family member in a marketplace plan.

It is very important to enter this information correctly. If the frequency and amount don’t match what you actually earn, your advance premium tax credit (APTC) will be wrong. That will affect your monthly premium payment amount. You could also have a problem when reconciling the APTC on your taxes. 

Here’s how to answer the questions.

1. From the Pay Frequency drop-down menu, pick weekly, two weeks, or monthly, depending on how often you get paid. If you are using a W-2 form, pick annual.

2. In the Pay Amount field, put in the gross income you earned during the time period you selected in the Pay Frequency drop down. Gross income is the amount you earned before taxes were taken out.

No, you are not eligible for advance premium tax credits (APTC). To qualify for premium assistance, a household must have an income of at least 100% of the federal poverty level in a state that did not expand Medicaid. If you live in a state that expanded Medicaid, your income must be above 138% of the federal poverty level. 

Click here to see if you qualify for Medicaid and to access your state’s Medicaid and Children’s Health Insurance Programs (CHIP) website. 

If you don’t qualify for Medicaid, you can enroll in a marketplace plan, but you will have to pay the monthly premium costs yourself.

No, you are not eligible for advance premium tax credits (APTC). If you are eligible for Ryan White or AIDS Drug Assistance Program (ADAP), you would be eligible for financial assistance to cover the total cost of your monthly premium payments.

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• Microsoft Edge
• Mozilla Firefox
• Google Chrome
• Apple Safari (for the iPhone).

Make sure that the browser accepts cookies and that you clear your cache. If you are using a work or public computer, ask someone or check with the company’s policies and procedures before making any changes to the browser.

Maybe. You can get advanced premium tax credits (APTCs) for the 2022 plan year when your household income is above 400% of the federal poverty level (FPL) if your health insurance premium is more than 8.5% of your household income.

If you select no, you will not qualify for advanced premium tax credits (APTC) to lower your  monthly premium payment.

You must answer this question truthfully. Each year, you have to reconcile:

• The amount of APTC paid to the health plan to lower your monthly premium
• The APTC you qualified for based on your income.

Any difference between the two amounts will affect your tax return. Learn more about reconciling premium tax credits.

No. You will not be eligible for APTC or other cost-sharing reductions if you are married and file taxes separately from your spouse. You can still enroll in a marketplace plan, but you will have to pay the full premium costs yourself.

Plans and costs change each year. In October or November, healthcare.gov will send you a letter to tell you how your plan will change next year. You will also get a letter from your health plan telling you about the changes in costs.

You should look at all your options before renewing the plan you have. The monthly premium could have gone up, making it too expensive for you. If you don’t make changes during open enrollment, you will have to stay in that plan for the rest of the year, unless you had a life changing event that qualified you for a special enrollment period.

Learn more about life-changing events that qualify you for an Affordable Care Act special enrollment period (SEP). 

It depends. As long as the job-based plan meets minimum value standards and is considered affordable, you would not be eligible for a tax credit.

Your employer’s plan meets the minimum value standard if both of these are true:

• It pays at least 60% of the total costs of medical services for a standard population.
• The benefits offered include substantial coverage of doctor and inpatient hospital services.

Most job-based plans do meet the minimum value standard. Ask your employer or look at the Statement of Benefits and Coverage from your employer.

If you’re unemployed you may be able to get an Affordable Care Act (ACA) health insurance plan. Savings is based on your income, which includes unemployment compensation, and household size. You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

If you have just left your job for any reason and lost your job-based health coverage, you qualify for a Special Enrollment Period. This means you can enroll in a Marketplace insurance plan any time of year. You usually have 60 days from the day you lose your coverage to enroll.

Learn more about ACA special enrollment periods.

Your household is the number of people you claim on your taxes, even if they are not applying for health insurance. It’s important to answer this correctly because the number of people in your household affects where you fall on the Federal Poverty Level (FPL) scale. Include:

• Yourself
• Your spouse if you are married
• All dependents you claim on your taxes.

Learn more about household size.

Call American Exchange immediately at 1.888.995.1674, so we can find out what actions need to be taken to avoid any gaps in your coverage or having your plan cancelled.

If you had Marketplace coverage at any time during the year, you’ll use your Form 1095-A to “reconcile” your 2021 premium tax credits when you file your taxes. Click here for information on how to use your 1095-A Form. 

If you got excess advance payments of the premium tax credit (APTC) for 2021, you’ll have to report the excess APTC on your 2021 tax return or file Form 8962, Premium Tax Credit.

American Exchange can get your 1095-A Form for you if we enrolled you in a marketplace plan. If we did not enroll you, we can try to access the form, but we may not be able to. Call us at 888.995.1674 or email enroll@americanexchange.com.

If you want to access the form yourself, visit accessing and using Form 1095-A.

American Exchange can get your 1095-A Form for you if we enrolled you in a marketplace plan. If we did not enroll you, we can try to access the form, but we may not be able to. Call us at 888.995.1674 or email enroll@americanexchange.com.

If you want to access the form yourself, visit accessing and using Form 1095-A.

American can make income and other account changes for you. It is important that you let us make any account changes, so you do not lose coverage.

Call us at 888.995.1674 to update your information.

You can find your ACA health plan marketplace ID on the Eligibility Results Letter you received from the Health Insurance Marketplace. American Exchange can also find it for you. Call us at 1.888.995.1674.

A binder payment is the first payment you make to an insurance company to purchase the health plan you enrolled in. The binder payment covers the cost of your first month’s premium.

The binder payment is due 30 days after you enroll in the plan. The insurance company you bought your plan from will send you a bill with the due date. Make sure to submit your payment by the date on the bill.

Learn more about premium and binder payments.

A premium payment is the amount you pay each month to stay enrolled in your health plan. The premium is usually due the first of each month. Your health plan will send you a bill each month. Make sure you pay the premium by the due date each month to keep your health insurance.

Here is an example of how binder and premium payments work:

• Mary enrolled in a health plan on November 15
• Mary’s coverage starts on January 1
• Mary’s binder payment is $100.00
• Mary must pay the insurance company $100 by December 14 to be enrolled in the plan
• Mary’s monthly premium is $100
• To stay enrolled in the plan, Mary must pay $100 to the insurance company by the first day of each month beginning February 1

If you do not pay the full binder amount you owe no later than 30 days after you enrolled in a plan, the insurance company will cancel your policy.

Example: Carlos paid the binder payment during the grace period

• Carlos enrolled in a health plan December 1
• His coverage started on January 1
• Carlos’ binder payment of $50 was due to the insurance company on January 1, but he never paid it
• Carlos’ plan was terminated by the insurance company on January 30. He had no health insurance coverage at all, and will have to pay for any healthcare services she received in January

A grace period is the window of time you have to pay your premium payment if you are paying after the due date on the bill. The grace period is shorter for people who don’t get tax credits.

See the following questions and answers in this FAQ for more information: 

• What is the grace period if I do not get tax credits? 
• What is the grace period if I do get tax credits?
• Am I still covered by my health insurance during grace periods?

If you do not accept or are not eligible for advance premium tax credits (APTCs), the grace period is 31 days after your premium is due. The marketplace and your insurance company will send you notices about the amount you owe and provide the due date payment must be received for you to stay enrolled in the health plan.

Example: The premium grace period for Anthony, who is not eligible for tax credits:

• Anthony enrolled in a health plan December 1 and paid the $100 binder payment before it was due
• His health coverage started on January 1
• Anthony paid his $100 monthly premium to the insurance company for February and March
• He did not pay the $100 premium payment to the insurance company on April 1
• Anthony had a 31 day grace period – until May 2 – to pay the premium payment before his plan was terminated for nonpayment
• He paid the $100 premium for April on April 26
• Anthony still had insurance coverage during the month of April and will continue to be covered as long as he pays his $100 premium each month

If you get tax credits, your grace period is 90 days after your monthly premium is due. When you make a payment, you must pay the full premium amount due to keep your plan. The marketplace and your insurance company will send you notices about the amount you owe and tell you the due date payment must be received for you to stay enrolled in the health plan.

Example: The premium grace period for Mika, who is eligible for tax credits:

• Mika enrolled in a health plan December 1 and paid the $100 binder payment before it was due
• Mika’s coverage started on January 1
• Mika paid the $100 monthly premium to the insurance company for February and March
• Mika did not pay the $100 premium payment to the insurance company for April or May
• Mika had a 31 day grace period from May 1- until July 3 – to pay the premium payments for April, May, and June before the plan was terminated for nonpayment
• Mika paid the $100 premium for April, May, and June (a total of $300) on June 30
• Mika was still enrolled in the health plan

No. If you do not pay your binder or premium payments, you are not covered until you make full payment for all that you owe. Your coverage will be suspended. That means if you go to a doctor, the insurance company will not cover the cost of the care you receive until you pay what you owe to the health plan.

Many providers will not treat you for non-emergency care when your insurance is suspended.  Once you pay the full amount you owe the health plan, you will be covered for care received during the grace period. The provider will have to resubmit the claim to receive payment.

If you do not pay the binder or premium payments and your plan is canceled, you will have to pay for the treatment you received during the grace period. If payment is an issue, you will have to work out a payment plan with your healthcare provider.

Yes. American Exchange’s licensed, ACA-certified enrollment team can find the right ADAP approved plan to fit your needs. Call 1.888.995.1674. We can also enroll your eligible family member in a marketplace plan.

Yes. American Exchange’s licensed, ACA-certified enrollment team can find the right ADAP approved plan to fit your needs. Call 1.888.995.1674. We can also enroll your eligible family member in a marketplace plan.

Yes. American Exchange’s licensed, ACA-certified enrollment team can find the right ADAP approved plan to fit your needs. Call 1.888.995.1674. We can also enroll your eligible family member in a marketplace plan.

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Make sure that the browser accepts cookies and that you clear your cache. If you are using a work or public computer, ask someone or check with the company’s policies and procedures before making any changes to the browser.

The Treasury Department released a new rule to fix the family glitch that prevented many working families from getting subsidies through Affordable Care Act (ACA) health plans. Before the rule change, employees qualified for an ACA subsidy only if the cost of their job-based coverage was considered unaffordable based on an IRS-determined threshold. But the IRS looked only at how affordable it was for the worker to pay for insurance, not the cost of covering the entire family.

The new rule requires covering the cost of the family to be used to determine if job-based insurance is affordable. That means that workers are eligible for ACA subsidies if their share of the premium for their job-based coverage is more than 9.12% of their expected 2023 income.

Not every family will save money by switching from job-based to marketplace coverage, so you need to weigh the benefits and costs. You need to look at all of the following:

• What covering you under your job-based plan will cost.
• What covering you and your entire family under your job-based plan will cost.
• What covering your entire family under an ACA plan will cost if you qualify for subsidies to reduce your costs.

You may find it more affordable to keep your job-based coverage and enroll your family in an ACA health plan.

American Exchange’s health benefit experts can help you decide what health coverage makes sense for both you and  your family. Call us at 888.995.1674.

Yes. If your household income is below 150% of the federal poverty level (FPL), you are eligible to enroll in an ACA health plan any time during the year. This is considered a life changing event that qualifies you for a special enrollment period (SEP). You may even qualify for a $0 premium ACA health plan.

The following table shows the FPL for 2023 marketplace coverage based on the number of people in your household. If at any time during the year your income dips below 150% for your entire household, you qualify for a special enrollment period.

Table. Federal Poverty Level (FPL) Chart for ACA Coverage Year 2023