SECTION

Individuals with coverage

FAQs +

• Should I use all of my advance premium tax credit (APTC) toward my monthly premium, or should I consider saving some of it to receive on my tax return next year?
• I filed my taxes but I still received a "Failure to Reconcile" notice from the IRS. What should I do?
• I buy my health plan directly from the insurance company. Why should I consider shopping for a new plan on the health insurance Marketplace?
• Does my health insurance plan cover abortion care?
• How can I sort through dozens of insurance plans to find the best value plan?
• My family signed up for my employer-sponsored plan, but I'd like to switch them to a more affordable Marketplace plan. My employer's open enrollment period is ending soon. If I switch my family to a Marketplace plan, can I drop them from my employer plan?
• I heard a new rule will let my spouse and children enroll in a Marketplace plan with subsidies if the cost to enroll in my employer’s plan is unaffordable. How do we find out if the new rule applies to our family?
• Can I buy or change private health plan coverage outside of open enrollment?
• I’ve had the same insurance policy since 2013 because the premiums are lower than the new plans that must comply with the Affordable Care Act. My insurer is offering me the option to renew my current policy again. What are the pros and cons of doing that?
• What if I sign up for a plan and change my mind? Can I switch my plan during open enrollment?
• I signed up for a bronze plan with a high deductible during open enrollment. Now, six months later, I need surgery and would rather be in a different plan with a lower deductible. Can I change plans?
• I just got a promotion and no longer qualify for premium tax credits. Can I drop my current plan and buy a new one even though it’s outside the open enrollment period? Can I buy a plan outside the health insurance marketplace?
• I currently have a bronze-level marketplace plan, and am eligible for a special enrollment period. Can I change into a silver-level plan?
• I just learned my primary care doctor is not in the plan’s network. Can I change plans?
• I own my own business and have no employees, what are my options?
• If I switch plans, how do I make sure I can keep my doctor?
• I have an individual insurance policy. Can I drop it during open enrollment and go into the health insurance Marketplace and qualify for premium tax credits?
• If I switch plans, how do I make sure the drug I am taking is covered under the new plan?
• I have Medicare. Can I drop it and go to the health insurance Marketplace?
• I have Marketplace coverage and just had a baby. Can I change plans?
• I got a notice that my Marketplace plan will be cancelled or terminated. What are my options?
• I've been told I should look for a Health Savings Account (HSA) compatible plan on the health insurance Marketplace. What is an HSA-compatible plan and what are the pros and cons of enrolling in one?
• We have a family plan and we also have a Health Savings Account (HSA). My son is 22 and just graduated from college. He’s unemployed so we'd like to keep him on our family plan. Can we still use our HSA to help pay for his medical expenses?
• I received a notice telling me it is open enrollment and time to renew my Marketplace plan. What do I need to do?
• When should I return to the Marketplace to renew my plan and update my eligibility for subsidies?
• I signed up for a Marketplace plan through a special enrollment period in July. Do I still have to renew my plan during the open enrollment period?
• I haven’t had any changes in my income or other family circumstances, and I want to keep my same plan. Why should I return to the Marketplace?
• I like my health plan just the way it is. Will it stay the same in 2024?
• I received a notice from the Marketplace telling me I’m not eligible for automatic renewal with a tax credit. What should I do?
• The notice from my insurer says my plan won’t be offered again. Now what do I do?
• What happens if I don’t return to the Marketplace to update my application?
• I was automatically re-enrolled by the Marketplace and I just got my premium invoice for January. It’s way too high! What do I do?
• I received premium tax credits to help pay for my coverage, but I didn't file a tax return. Will I still be able to get coverage next year and financial assistance?

FAQs +

• I heard a new rule will let my spouse and children enroll in a Marketplace plan with subsidies if the cost to enroll in my employer’s plan is unaffordable. How do we find out if the new rule applies to our family?
• My family signed up for my employer-sponsored plan, but I'd like to switch them to a more affordable Marketplace plan. My employer's open enrollment period is ending soon. If I switch my family to a Marketplace plan, can I drop them from my employer plan?
• My hours at work were cut back, resulting in a temporary loss of income. Can I qualify for premium tax credits?
• I work full time for a large employer (more than 50 full time employees) and I’m married and we have kids. Is my employer required to offer health benefits that cover my spouse and kids?
• I work full time for a large employer (more than 50 full time employees). Is my employer required to offer me health benefits?
• I work part-time for a large employer. Is my employer required to offer me health benefits? What about benefits for my spouse and kids?
• I work for a large employer. My employer has offered me a Health Reimbursement Arrangement (HRA), with money to buy health insurance on my own. What are my options?
• I work for a large employer (more than 50 full time employees) but my hours vary during the year. Does my employer have to offer me health benefits?
• My hours at work were cut and I no longer qualify for my employer’s plan. Do I have to wait until the open enrollment period to sign up for an individual plan?
• I have an offer of employer-sponsored coverage, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I get premium tax credits in the health insurance Marketplace?
• I want to add my spouse and/or children to my employer-sponsored plan but I can’t afford the family premium. Can my spouse buy a more affordable plan on the health insurance Marketplace?
• When can I enroll in my employer plan?
• We just had a baby. Can I add my baby to my family plan?
• We just had a baby. Before that my husband and I were each covered under our own health plans at our own jobs, but now we want the family covered under one policy. Can we all switch to my employer plan now?
• Is my employer required to offer benefits to retirees?
• I will start a new job next month with benefits. Can I enroll right away in my employer plan?
• I work and am eligible for health benefits. Do I have to sign up for my job-based plan or will my employer do that for me?
• My employer’s workplace wellness program increases premiums for employees who don’t participate and/or can’t meet certain targets for healthy behavior. Can I leave my employer-sponsored plan and get Marketplace coverage?
• I have COBRA and it’s too expensive. Can I drop it during open enrollment and enroll in a Marketplace plan instead?
• I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?
• My hours at work were cut back and I no longer qualify for my employer’s health plan. I’ve been offered COBRA but it’s too expensive. Can I shop for coverage and subsidies on the Marketplace instead?
• I thought there was supposed to be a cap on my out-of-pocket costs, but when I look at my plan options, it looks like there is more than one cap, depending on what health care I use. How can that be?
• I thought my employer plan couldn’t have any annual or lifetime limits on benefits but I heard that there are limits in our plan. Is that allowed?
• My employer won’t fill out the form that asks about the affordability of our coverage. I think my job-based plan is unaffordable and I’m not enrolled in it. Can I apply for Marketplace coverage and premium tax credits without that form?
• I’m eligible for health benefits at work, but I didn’t turn in my enrollment papers on time during the company’s open enrollment, so now I’m not covered. Can I get a policy in the Marketplace instead? Can I apply for premium tax credits?
• My large employer offers health benefits to me. My spouse works and has coverage through their job. To figure out whether my coverage is affordable, do I just count my income or do I count my spouse’s salary, as well?
• My employer plan covers only preventive services and a few doctors’ visits each year. I want better coverage. Can I apply for coverage and premium tax credits in the Marketplace?

FAQs +

• I work full time for a small business (fewer than 50 employees). Does my employer have to offer me health benefits?
• I work for a small business. My employer has offered me a Health Reimbursement Arrangement (HRA), with money to buy health insurance on my own. What are my options?
• I have a new Health Reimbursement Arrangement (HRA) from my small employer. Can I use it to enroll in coverage if it is outside of Open Enrollment?
• My hours at work were cut back, resulting in a temporary loss of income. Can I qualify for premium tax credits?
• My family signed up for my employer-sponsored plan, but I'd like to switch them to a more affordable Marketplace plan. My employer's open enrollment period is ending soon. If I switch my family to a Marketplace plan, can I drop them from my employer plan?
• I heard a new rule will let my spouse and children enroll in a Marketplace plan with subsidies if the cost to enroll in my employer’s plan is unaffordable. How do we find out if the new rule applies to our family?
• I have an offer of coverage from my employer, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I get financial help in the health insurance Marketplace?
• My employer just told us we are enrolling in “SHOP” coverage. What is SHOP coverage?
• The company I work for is buying SHOP coverage. Can I choose any plan I want?
• I’ve heard there is a tax credit if my employer buys SHOP coverage. Can I get it?
• When can I enroll in my small employer plan?
• I work for a small business and I smoke. Will my company be charged more because of me?
• I own my own business and have no employees, what are my options?

FAQs +

• I have retiree coverage from my former employer, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I drop my retiree plan and get financial help in the health insurance marketplace?
• Does my retiree coverage have to comply with the Affordable Care Act?
• My spouse is covered under my plan at work. If I retire and sign up for my retiree plan, will my husband be eligible to buy a plan on the Marketplace?
• I’m 63 and about to retire. I’ll be offered a retiree health plan. Can I look for better coverage and subsidies in the Marketplace instead?
• My spouse is an early retiree with affordable retiree health benefits from his former employer, but I’m not eligible to be on his plan. Can I apply for coverage and subsidies in the Marketplace?
• I’m 63 and my husband is 65 and on Medicare. I'd like to apply for premium tax credits for Marketplace coverage. Can we count my husband’s premiums for Medicare, his supplemental, and Part D against my required contribution for Marketplace coverage?

FAQs +

• What is a student health plan?
• My daughter is a college student with a student health plan but she will be continuing school online while living at home. Her health plan does not cover any providers in our area. How can she get access to care while she is living at home?
• Does a student health plan count as minimum essential coverage?
• Does a student health plan have to cover essential health benefits?
• Does my student health plan have to cover contraceptives?
• I’m a part-time student. Does my college have to let me enroll in the student health plan?
• I’m eligible for a student health plan but haven’t signed up yet. Do I have to enroll in that plan or can I apply for coverage and subsidies in the Marketplace?
• I’m enrolled in student health coverage now, but I think I can get a better deal in the Marketplace. Can I drop student health plan coverage and go to the Marketplace instead?
• I’m about to turn 19 and I’m covered under my parent’s health plan as a dependent. How long can I stay covered as a dependent?
• I’m going to a college that offers a student health plan. Can I stay covered as a dependent on my parent’s policy or do I have to take the student health coverage?
• I just got a job that offers health benefits, but my parent’s policy is better and less expensive to me. Can I stay on my parent’s policy?
• I’m a college student enrolled in my college’s student health plan. Can I drop it and go to the health insurance Marketplace?
• I’m 24 and I used to be covered as a dependent on my parent’s policy through an employer. I dropped off last year when I found other coverage, but now I’ve lost that other coverage and want to get back on my parent’s policy. Can I do that?
• Do my parents have to claim me as a tax dependent for me to be on their health plan to age 26?
• I’m 25 years old and eligible for coverage as a dependent under my parent’s employer plan. If I apply for my own Marketplace plan with premium tax credits, will the Marketplace consider the coverage available to me under my parent’s plan?
• Do I have to live in my parent’s home to be covered as a dependent under their policy?
• I’m covered under my parent’s policy but I’m moving to another state. Can I remain covered as a dependent?
• My spouse and I want to cover our 25-year-old child on our Marketplace plan and apply for premium tax credits. We don’t claim her as a dependent, she doesn’t live with us, and she has a job. Do we have to count our child's income as part of our income?
• Can I be covered under my parent’s plan if I’m married?
• I’m under age 26, covered on my parent’s plan as a dependent, and I’m getting married. Does my parent’s plan have to cover my spouse?
• I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?
• I’m covered on my parent’s policy now, but my 26th birthday is next summer, and I won’t be eligible for dependent coverage any longer. Should I apply for Marketplace health plans and subsidies now, during open enrollment?
• My parents have Marketplace coverage, but don’t qualify for subsidies. I’m 24 and qualify on my own. My parents don’t claim me as a tax dependent. Can I be covered under their Marketplace policy and apply my premium tax credit to their premium?