How To Qualify for Health Insurance

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If you live in the US, you already know how important health insurance is. Without it, you can expect to pay thousands (if not tens of thousands) every time you need to go to the hospital. A simple ride from your home to the ambulance usually costs more than $1,200! However, insurance itself can get rather expensive, and not everyone might have the means to purchase a plan. Luckily, under the ACA (Affordable Care Act), low-cost and even free insurance plans are available for the general population. There are restrictions on who can benefit from these plans, and the qualifying process might be a bit confusing. That is why this article will cover all about how you can qualify for health insurance.

What is a “Qualifying coverage”

Before we go into how to qualify for health insurance, it is important to know what qualifying coverage exactly means. It refers to any health insurance plan that provides “minimum essential coverage”, as defined by the ACA. This is your Medicare, CHIP (Children’s Health Insurance Program), Veterans Administration coverage, etc.

a small black chair made of wires in a white room
Qualifying coverage represents minimum essential health coverage.

The important thing to note about qualifying coverage is that it does not include any benefits for a specific illness or limited need. For example, you may not get dental coverage under qualifying coverage, as dental plans are considered to be limited-coverage plans. Furthermore, qualifying coverage needs not to be fully compliant with the ACA, weird as it sounds. While any new health plans have to comply with the regulations, grandmothered/grandfathered plans in the small group/individual markets do not have to comply with most of the provisions.

Most of the time, you will be able to qualify for coverage based on your income level. That being said, every state also has its own qualification rules. The qualifying process in itself can be quite confusing, in fact. Let’s “demystify” it!

How can you qualify for health insurance?

All of the insurance plans covered by the ACA have something called “Open Enrollment Periods”. They usually run from November to January, though the specific dates vary from one year to another. For the year 2022/2023, open enrollment started on November 1 and is slated to end on January 15. For the most part, this is the only time when you can acquire a new health plan or make changes to your existing one. Qualifying for the open enrollment period requires your family to meet a certain income threshold, which is different in every state. Even if you don’t qualify based on income, there is still a possibility that you can qualify in other ways.

What can you do during the open enrollment period?

During the open enrollment period, you can either purchase coverage or make changes to an existing one. Here are some of the activities that are available to you:

  • Choosing a plan for the first time
  • Making changes to existing plans
  • Re-enrolling
  • Choosing a new plan to replace your current one
person signing a document
Open enrollment is the only time when you can make changes to your health insurance plan.

There is also the possibility of making similar changes year-round in special cases. These changes vary by the marketplace but usually include moving to another state, getting married or divorced, childbirth/adding a dependent, and losing other coverage options.

The two exceptions to these rules are Medicaid and CHIP. They do not have Open Enrollment Periods, and you can apply for them at any time of the year. It is possible that you know these two by another name (Med Quest in Hawaii, SoonerCare in Oklahoma, etc.). If you want to apply for Medicaid, you can do so either by going through the marketplace or by visiting your state Medicaid agency directly.

Qualifying for Medicaid and CHIP

To qualify for either of these plans, you will need to fill out an application through the HIM (Health Insurance Marketplace). To do so, you will need to navigate to your state’s marketplace page. The easiest way to do so is to try and create an account on healthcare.gov. You will get to choose your state, and the website will either prompt you to create an account, or it will provide you with the link to the correct health marketplace for your state.

Once there, you will need to fill out a small form where you will state how many people live in your household and your estimated household income.

Estimating your expected household income

This is arguably the “hardest” part of qualifying for health insurance. You will need to, to the best of your ability, predict what your income level is going to be throughout the year. Needless to say, this can be quite challenging, especially in families that do not have steady jobs.

money, calculator, notepad representing how to qualify for health insurance
You may need to do some calculations.

There are two important things to know here. First,  your marketplace savings are based on your expected income, not your last year’s income. Second, you need to calculate the income for the entire family. This means yourself, your spouse, and anyone who you plan to claim as a tax dependent. Even if the other members of your family do not need health coverage through the marketplace, you will still need to include their income in the calculations.

With that in mind, there are three steps to estimate income in order to qualify for health insurance:

  1. Start with your household’s AGI (Adjusted Gross Income). You can use your most recent federal tax return to find the appropriate number.
  2. Add any of the following kinds of income, provided you have them: Tax-exempt interest, tax-exempt foreign income, and tax-exempt Social Security benefits. Note that this also includes tier 1 railroad retirement benefits. Do NOT include SSI (Supplemental Security Income).
  3. Lastly, you will want to adjust the estimate to account for any expected changes. These changes include raises, changes in employment, investment income, changes to your dependents, and anything else that may impact your income in the following year.

Final advice

Even if you do qualify for health insurance, there’s a chance that the plan that you qualify for does not meet your needs. If that happens to be the case, you may want to explore other options. The best thing to do is get in touch with ACME Health Life Agency, and we will provide you with the best insurance plans that match your needs and your finances.

Why choose us:

Quick and simple process

Most affordable plans

All available options in one place

Helpful guidance

What others say about us:

5.0

I was very pleased with the service I received from ACME. The agent went over all the plans at my disposal, explained everything patiently, and helped me pick the best solutions. I would recommend them to anyone.

Alicia Montgomery