Act Now to Secure Health Insurance Through the Public Exchange and Receive Financial Assistance for Premiums

Individuals who do not have health insurance have a limited amount of time to obtain coverage for the year 2023 through the public marketplace. Financial assistance may be available to make the cost of the insurance more manageable.

The federal health care exchange has an open enrollment period that ends on January 15th, with coverage beginning on February 1st. If your state has its own exchange, the last day to enroll may be different. After the enrollment window closes, you would usually need to experience a significant life event, such as having a baby or getting married, to be given a special enrollment period.

The majority of individuals enrolled in the marketplace, which is estimated to be 13 million out of 14.5 million in 2022, are eligible for federal subsidies, also known as tax credits, to help cover their premiums. The Centers for Medicare & Medicaid Services has reported that 4 out of 5 customers will be able to find plans for $10 or less per month after taking into account the tax credits.

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Depending on their income, certain individuals may be able to receive assistance with cost sharing, including deductibles and copays on certain plans.

Generally, individuals who obtain insurance through the federal (or their state's) exchange are either self-employed or do not have access to employer-provided insurance, or they do not meet the requirements for Medicare or Medicaid.

As of December 15th, the Centers for Medicare and Medicaid Services (CMS) reported that approximately 11.5 million individuals had chosen a plan through the health insurance marketplace.

The Inflation Reduction Act, which was passed into law in August, has extended the temporarily expanded subsidies that were put in place for 2021 and 2022 through 2025. These subsidies are now more generous than they were prior to the pandemic.

Subsidies are now available to anyone, regardless of their income, and the amount they pay for premiums is limited to 8.5% of their income as determined by the exchange. Previously, assistance was only available to households with income ranging from 100% to 400% of the federal poverty level.

The subsidies you can receive from the marketplace are determined by a variety of factors, such as your income, age, and the second-cheapest "silver" plan available in your region (which may or may not be the plan you choose).When signing up, you will need to calculate an estimated income for the year 2023.

It is essential to provide an accurate estimation.

If your yearly income is higher than what you initially reported when you enrolled, it could mean that you are not eligible for the same amount of aid that you are currently receiving. This discrepancy will need to be addressed when you file your taxes in 2024, which could lead to a smaller refund or a higher tax bill.

Cynthia Cox, director for the Kaiser Family Foundation’s Affordable Care Act program, warned that one should be aware of potential tax surprises when filing the following year.

If you are eligible for more than you received, the difference will either increase your refund or reduce the amount of taxes you owe.

At any time during the year, you can modify your estimated income or indicate any significant life changes (e.g. having a baby, getting married, etc.) that could influence the amount of subsidies you are eligible for.

It is important to remember that if you do not make your payments for your insurance premiums (or your portion of them), your coverage could be terminated and any claims you make may not be honored.

Those who receive subsidies for their health insurance coverage will usually have their plan terminated after three months if they fail to pay their premiums. For those who pay the full amount without subsidies, the grace period for payment is usually around one month, depending on the state.

If you find yourself without health insurance, you will not be able to sign up for coverage through the marketplace unless you meet the criteria for a special enrollment period.