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Understanding the Affordable Care Act

The Affordable Care Act, referred to as the ACA, is a comprehensive healthcare reform law that was enacted in March of 2010. Its purpose is to increase health insurance coverage for those not covered by insurance and to allow reforms within the health insurance market.

Sounds simple enough, right?

Sure, but like most laws and federal programs, questions arise quickly and can leave many of us feeling overwhelmed and unsure how, or if we’re even eligible, to take advantage of the Affordable Care Act.

Your FSB team has your back and put together a quick guide to help you understand the ins and outs of the Affordable Care Act.

First things first

What is the Affordable Care Act?

The Affordable Care Act or ACA was enacted with 3 goals in mind:

  • Make affordable health insurance more widely available
  • Expand the Medicaid program so all adults with income below 138% of the federal poverty level would be covered
  • Support new medical care delivery methods that function with the purpose to lower the cost of health care

How can I tell if I’m eligible for the ACA?

There are baseline criteria used to determine whether or not you are eligible for the ACA. The requirements are as follows:

  1. You currently reside in the United States.
  2. You are a legal resident or citizen of the United States.
  3. You are not currently imprisoned.
  4. Your income is no more than 400% (or 500% as of 2021 and 2022) of the federal poverty line.

How do you know if you are within qualifying distance of the FPL?

The income number to be considered at the federal poverty level is dependent on your household’s family size. The income numbers for 2022 are displayed below.

Family size 2022 income numbers
Individuals $13,590
Family of 2 $18,310
Family of 3 $23,030
Family of 4 $27,750
Family of 5 $32,470
Family of 6 $37,190
Family of 7 $41,910
Family of 8 $46,630
Family of 9+ Add $4,720 for each additional person

 

The federal poverty level income numbers are higher in Hawaii and Alaska. If interested in seeing those numbers, check out the HHS poverty guidelines for 2022.

Understanding the ACA open enrollment period

Now that we have gone over what the ACA is and how you know if you qualify for it, we are going to talk about the open enrollment period.

It is important to make sure you have all the information you need as we approach the next few months leading up to open enrollment.

What is the ACA open enrollment period?

The ACA enrollment period is a specific time of year that people can buy health insurance. It is important to note that each state may have a different period, so you must make sure you have the correct dates for your specific state. If you are someone who receives health insurance from your employer, you also may have a different period to make health insurance decisions.

When does the ACA open enrollment period start?

In most states, the open enrollment period for the upcoming year starts November 1, 2022 and ends January 15, 2023.

However, some states have their own ACA exchanges with different date ranges.

Can I enroll in health insurance outside of the enrollment period?

If you happen to miss your state’s enrollment period, you may qualify for a Special Enrollment Period (SEP).

You may qualify for SEP if you have experienced a life event listed below:

  • The loss of health insurance through your job
  • Household changes such as divorce, marriage, death in the family, or having a baby
  • A change in your home address

If your specific life event was not listed above, here is a much more detailed list of life events that can qualify you for SEP.

It is also possible for you to enroll at any time of the year if you

  • Qualify for MassHealth
  • Qualify for a ConnectorCare Plan through the Health Connector when you didn’t in the past, or if this is your first time applying
  • Apply for dental insurance
  • Are you a member of a federally recognized tribe or an Alaska Native shareholder

If you have any questions about the ACA and whether or not you qualify, Franklin Savings Bank is here to help you!

As we approach November 1st, when the enrollment period starts in many states, it is important to have all the information you need to make sure you get the best and most affordable health care for you and your family.

Contact us to set up an appointment today!

 

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