This section covers issues for individuals without coverage or offer of coverage and their options, including eligibility for premium tax credits.
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Resource Guide
On Private Health Insurance Coverage & The Health Insurance Marketplace
SECTION
Individuals with no coverage
FAQs +
- Who can buy coverage in the Marketplace?
- How can I sort through dozens of insurance plans to find the best value plan?
- What is the difference between a premium and a deductible? If I want to save the most money possible, should I just pick a plan with the lowest premium?
- I’m eligible for health benefits at work, but I want to see if I can get a better deal in the Marketplace. Can I do that?
- Can I buy a plan in the Marketplace if I don’t have a green card?
- I live in one state, but drive across the border every day to work in a different state. What Marketplace should I use to buy coverage?
- My child goes to college in another state but we want him on our family plan in the health insurance Marketplace. Can we do that?
- My doctor’s office is located in a neighboring state. Will I still be able to see him if I get a plan on the marketplace?
- I own my own business and have no employees, what are my options?
- Is an insurer allowed to ask me about my health history?
- The Marketplace said I must submit additional information to document my eligibility (to buy coverage or to qualify for premium tax credits). They gave me 90 days. I won’t be able to gather the information that quickly. Can I request an extension?
- I missed the deadline for submitting additional documentation to the Marketplace to prove my eligibility (to buy coverage or to qualify for premium tax credits or to receive an exemption). What can I do?
- How do I appeal a Marketplace decision?
- How long will the Marketplace appeal take?
- I received a notice saying there is a data matching issue on my application and the Marketplace needs to verify my income. How should I verify my income?
- What is the public charge rule and how will it impact me?
- Can immigrants enroll in Medicaid or Children’s Health Insurance Program (CHIP) coverage?
- Can immigrants buy health insurance through the health insurance Marketplace?
- Can immigrants get help paying premiums and/or cost-sharing for health insurance in the health insurance Marketplaces?
- Can family members in families with mixed immigration status, where some family members are lawfully present and others are undocumented, enroll in Medicaid or CHIP or receive help buying coverage through the Marketplaces?
- How will an individual’s citizenship and immigration status be checked?
- Will getting health insurance through Medicaid, CHIP, or health insurance Marketplaces affect an individual’s ability to obtain lawful permanent status or citizenship?
- Will applying for health insurance through Medicaid, CHIP, or health insurance Marketplaces put undocumented family members at risk?
- Who is a lawfully present immigrant for health insurance purposes?
- Are individuals granted deferred action under “Deferred Action for Childhood Arrivals” eligible for Medicaid, CHIP, and the health insurance Marketplaces?
- Where can immigrants who cannot enroll in Medicaid or CHIP or get coverage through the Marketplaces get health care or health coverage?
FAQs +
- Can I buy or change private health plan coverage outside of open enrollment?
- Why can’t I buy a plan when I need it? Why do I have to wait for the open enrollment period?
- When can I buy a health plan through the Marketplace?
- When can I enroll in Medicaid?
- Can I buy or change private health plan coverage outside of open enrollment?
- If I buy a plan during open enrollment, when does my coverage start?
- We are a low-income family and need health insurance, but haven’t had any major life changes recently. Can we enroll in a Marketplace plan outside of open enrollment?
- My insurer says I owe past due premiums for coverage and won’t enroll me for new coverage until I pay them. Is this allowed?
- Does pregnancy trigger a special enrollment opportunity to buy or change coverage?
- My income has gone down and I think I may now qualify for premium tax credits in the health insurance Marketplace. Do I have to wait for an open enrollment period before I can enroll?
- My income has gone down and I think I may now qualify for cost-sharing reduction subsidies in the health insurance Marketplace. Do I have to wait for an open enrollment period before I can enroll?
- I am an American Indian. When can I enroll in a Marketplace plan?
- I just got married and my spouse and I want to get Marketplace coverage. Do we qualify for a special enrollment period?
- I’m a seasonal worker and spend 4 months of the year in a different state. Can I get a special enrollment opportunity to sign up for a new plan during the time I’m in that state?
- My husband and I are retired and spend 6 months of the year in Florida. Can we get a special enrollment opportunity to enroll in a new plan when we move to Florida, even though we’ll only be there for half the year?
- I have been diagnosed with a serious health condition and will be obtaining care from an out-of-state hospital. During my course of treatment I’ll be living near the hospital. Can I qualify for a special enrollment period based on this temporary “move”?
- I’m a college student and will be going to an out-of-state university. Can I qualify for a special enrollment period to sign up for a new plan in the state where I’ll be going to school?
- I’m not going to be able to sign up for 2024 coverage during this year’s open enrollment because my home was damaged in a natural disaster. But I’m hoping I’ll be able to return to my home by early next year. Can I sign up for coverage then?
- Due to a natural disaster, I no longer have access to documents I need to verify my eligibility for a special enrollment period, and won’t make the Marketplace’s 30-day deadline to submit them. What should I do?
FAQs +
- Who is eligible for Marketplace premium tax credits?
- I filed my taxes but I still received a "Failure to Reconcile" notice from the IRS. What should I do?
- What information and documentation will I need to provide when applying for coverage on the Marketplace?
- When I projected my income for next year I was determined eligible for Medicaid. When I submitted my application for Medicaid to my state’s Medicaid agency, I was told my income was too high. How do I get enrolled in coverage?
- The Marketplace is saying that it cannot verify my identity. What does this mean and how do I enroll in coverage?
- I filed my tax return, but did not reconcile my premium tax credit using Form 8962. Will I be re-enrolled with premium tax credits this year?
- When are you not eligible for premium tax credits?
- I’m married. I work full-time for a large employer that offers me health benefits, but won’t cover spouses. Is that allowed? Can my spouse apply for coverage and subsidies in the Marketplace?
- I’m offered health benefits at work, but they’re not very good. I understand I may be eligible for Marketplace subsidies if my job-based plan doesn't meet a "minimum value" standard. What does that mean?
- My employer’s health plan doesn’t cover brand-name drugs, only generics. Does that mean it doesn’t have minimum value? Can I shop for better coverage and subsidies on the Marketplace?
- My employer’s plan is grandfathered so it doesn’t cover preventive services. Can I shop for better coverage in the Marketplace if my job-based plan is grandfathered?
- If I’m eligible for other coverage but haven’t enrolled in it yet, can I qualify for premium tax credits in the Marketplace?
- My kids are eligible for the Children’s Health Insurance Program (CHIP). Can I enroll them in our Marketplace health plan and get premium tax credits for them instead?
- I understand eligibility for premium tax credits is based on our household income. Who counts as being in my household?
- I’m eligible for COBRA but haven’t elected it yet. Does that affect my eligibility for Marketplace subsidies?
- How much can I earn and qualify for premium tax credits in the Marketplace?
- Is the value of my house counted in determining my eligibility for premium tax credits in the Marketplace?
- My income is below the federal poverty level and my state has not elected to expand Medicaid eligibility. Can I qualify for premium tax credits?
- I don’t usually file taxes because I’m not required to. Will that affect my eligibility for premium tax credits?
- I have a Marketplace plan and am receiving premium tax credits. I am now pregnant. Since I’m eligible for pregnancy-related Medicaid coverage, am I required to drop my Marketplace plan and lose my financial assistance?
- I earn enough to qualify for premium tax credits, but I’m concerned my income may drop later this year to less than 100 percent of poverty. If that happens, will I have to pay back the premium tax credits I get?
- What income is counted in determining my eligibility for premium tax credits?
- I get Social Security benefits and don’t make enough to pay federal income taxes on them. Do I count my tax-free Social Security benefits when I apply for premium tax credits?
- I’m divorced and receive child support payments from my ex-husband. Do I count that in determining eligibility for subsidies?
- My income is very low, but I just inherited $10,000 from my aunt. Will that affect my eligibility for subsidies?
- I’m currently collecting workers compensation benefits. Are those counted in determining my eligibility for subsidies?
- I have a college scholarship that covers my tuition and fees. Do I count that as income in determining my eligibility for subsidies?
- My wife and I have a teenager who has a part-time job. Do we count her income as part of our household income when we apply for Marketplace subsidies?
- I’m married but estranged from my spouse. We file taxes separately. Am I eligible for premium tax credits?
- I’m in a common law marriage—what should I indicate as my marital status on my application for premium tax credits?
- I’m 62 and already collecting Social Security. Are my Social Security benefits counted in determining my eligibility for subsidies in the Marketplace?
- I’m a retired veteran collecting VA pension benefits. Are those benefits counted in determining my eligibility for subsidies in the Marketplace?
- My partner and I live together but are unmarried. Is our combined household income what we should report?
- I’m raising my grandchild and claim her as a tax dependent. If I apply for Marketplace subsidies, will we be considered one household?
- We are a married, same-sex couple. When we apply for Marketplace subsidies, will the Marketplace consider us a married household?
- My partner and I are unmarried and we have two children. How do we count our household size and income when we apply for subsidies in the Marketplace? Can we buy one policy to cover the whole family?
- My 20-year-old daughter has a son. She’s a full-time student and I support both of them financially. Which one of us – me or my daughter – should claim my grandson as our dependent?
- We claim my 22-year-old son, a full-time college student, as a dependent. He just got married. Can we continue to claim him as a dependent?
- My 23-year-old daughter lives with us but pays rent and helps buy groceries. Can we include her as a dependent?
- My mother lives on her own. She earns about $3,000 a year from Social Security and my husband and I pay her rent and help buy groceries. Can we claim her as a dependent?
- I can’t afford to pay much for deductibles and co-pays. Is there help for me in the Marketplace for cost-sharing?
- If I use my premium subsidy for a bronze plan, I can save even more money on the premium. Can I also get my cost-sharing reduction through a bronze plan?
FAQs +
- Can I get premium tax credits for health plans sold outside of the Marketplace?
- When I projected my income for next year I was determined eligible for Medicaid. When I submitted my application for Medicaid to my state’s Medicaid agency, I was told my income was too high. How do I get enrolled in coverage?
- Can I use the premium tax credit to reduce the cost of any Marketplace health plan?
- Can I use a premium tax credit and cost-sharing reductions for a separate dental plan?
- Should I claim a premium tax credit in advance or at the end of the year or some of both?
- How do I apply for premium tax credits?
- I’m using a web-broker’s website to enroll into Marketplace coverage, and the system is prompting me to enter my financial information, is this allowed?
- What happens if we want different plans for different family members?
- I’ve picked the plan I want. Now do I send my premium to the Marketplace?
- I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?
- Can I pay my health insurance premium with a credit card, debit card, money order, or cash?
- What happens to a young adult who applies for premium tax credits the first year he or she is not a tax dependent, and so he or she hasn’t filed a return in prior years?
- Can my brother (or my church) pay my portion of the monthly health insurance premium for me?
- What happens if I’m late with a monthly health insurance premium payment?
- I’m behind on my payments and trying to catch up, but meanwhile I got sick and so had to make more health care claims. Does my health plan have to pay them?
- I receive premium tax credits, but I still can’t afford my premium. I’ve missed four payments in a row. Can the insurer cancel my coverage?
- How do I project my household size/income for next year if I’m pregnant now? I’m married and this pregnancy will be our first child. We want to find subsidized coverage in the Marketplace.
- I’m married now but expect to get divorced this year. What should I indicate as my marital status when I apply for coverage?
- What if I don’t know what my income will be next year?
- My income is uneven during the year. Some months I earn very little, other months I earn more. I think my annual income will be low enough to qualify for subsidies next year, but I’m not sure. What if I’m wrong?
- If it turns out my annual income was lower than I estimated so I could have enrolled in Medicaid, do I have to pay back the premium tax credit?
- How often during the year can I adjust my premium tax credit amount? What documentation is required to make an adjustment? How long after I request the adjustment will it take effect?
- I never filed an income tax return before. Can I claim a premium tax credit?
- If I’ve not filed taxes in a prior year, how will the Marketplace determine my income?
- What is a mini-med (or limited benefit) plan? What are the risks and benefits of buying one?
- How much are the cost-sharing subsidies?
- If I underestimate my income and end up earning more than 250 percent of the federal poverty level next year, will I have to pay back the cost-sharing subsidies?
FAQs +
- What health plans are offered through the Marketplace?
- What’s the most I would have to repay the IRS?
- What is the difference between a premium and a deductible? If I want to save the most money possible, should I just pick a plan with the lowest premium?
- I heard Marketplace plans have to cover certain health benefits referred to as essential. What are essential health benefits?
- Will my Marketplace health plan cover dental benefits?
- Will covered benefits under all Marketplace plans be the same? How can I compare?
- I notice Marketplace plans are labeled “bronze,” “silver,” “gold,” and “platinum.” What does that mean?
- I’m seeing some gold plans with cheaper premiums than silver plans. Aren’t gold plans supposed to be more expensive?
- How can I find out if my doctor is in a health plan’s network?
- How can I find out if a health plan covers the prescription drugs that I take?
- What is a discount medical plan? What are the risks and benefits of buying one?
- Is dental coverage an essential health benefit?
- An agent offered me a policy that pays $100 per day when I’m in the hospital. It’s called a “fixed indemnity plan.” What are the risks and benefits of buying one?
- I’m buying coverage on the Marketplace for my family. I notice many health plans don’t cover pediatric dental care, but there are also stand-alone dental plans for sale. Is that allowed?
- Is an insurer allowed to ask me about my health history?
- I am interested in making sure my plan includes a provider who is culturally competent. Do provider networks list the race/ethnicity of the provider or their experience with certain communities?
- It looks like pediatric dental benefits are only offered through stand-alone plans in my state Marketplace. Will my premium tax credit be increased to cover the cost of the stand-alone dental plan?
- Most of my doctors are in-network but not all. Can I get care out-of-network?
- What is a Catastrophic Health Plan?
- I see there are bronze plans that are really affordable. Is that the best plan for me?
- Who can buy a Catastrophic Plan?
- If I qualify for a premium tax credit, can I use that to reduce my cost of a Catastrophic Plan?
- Can I be charged more if I have a pre-existing condition?
- Can I be charged more because of my age?
- I’m 59, my wife is 55, and our kids are 24, 17, 15, and 13. What age premium will we be charged for health insurance in the Marketplace?
- What does it mean to “use tobacco?” I’m pretty sure my teenager has smoked at least a couple of times. Do I have to pay a higher rate because of her?
- I smoke cigarettes and I buy my own health insurance. Can I be charged more because I smoke?
- If I qualify for premium tax credits and I smoke, will those tax credits cover the tobacco surcharge on my premium?
- What happens if I don’t disclose to an insurance company that I use tobacco?
- What happens if I take up smoking after I bought the policy?
- I use e-cigarettes (i.e., vape). Is that considered tobacco use and do I have to report that I use tobacco when I sign up for coverage?
FAQs +
- If I buy an individual health plan outside the health insurance Marketplace, is my coverage going to be the same as it would be inside the 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?
- Why should I buy a plan on the health insurance Marketplace?
- When can I buy coverage outside the health insurance Marketplace?
- What are health care sharing ministries? What are the risks and benefits of signing up for one?
- 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?
- Even with subsidies, I cannot afford plans that are available on HealthCare.gov, but I have heard there are other options available. What are they?
- I received a call/mailer selling me new coverage that is much cheaper than what is available on HealthCare.gov. How do I assess my options?
- Is an insurer allowed to ask me about my health history?
FAQs +
- I’m uninsured. Am I required to get coverage?
- I heard that the mandate to have health insurance no longer applies. Is that correct?
- If there’s no longer an individual mandate penalty, why should I get coverage?
- I am looking for coverage. Where should I buy it?
- What is “minimum essential coverage” and why do I need it?
- What’s the penalty if I don’t have coverage?
- I live overseas. Do I still have to comply with the individual mandate?