About Insuring Your Health
KHN contributing columnist Michelle Andrews writes the series聽, which explores health care coverage and costs.
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Q: How does someone qualify to enroll in a marketplace? Are the rules the same in every state?
A: Almost anyone can shop for health insurance through the online state marketplaces, sometimes called exchanges, that will open in October. The only real exception is immigrants who are in this country illegally. They can’t buy coverage on the exchanges under any circumstances. That’s true whether your state is running its own exchange or letting the federal government do so.
Even though practically anyone can shop for coverage on a state exchange, only certain people will qualify for subsidies to make coverage more affordable there. Subsidies will be available to people with incomes up to 400 percent of the federal poverty level. That’s about $46,000 for one person or $94,000 for a family of four.
Subsidies will only be available to people who don’t have good coverage available elsewhere. So if you’re eligible for Medicare or Medicaid, you can’t get subsidies on the exchanges. Likewise, if your employer offers good coverage you won’t qualify for subsidies. Good coverage in this case means a plan that doesn’t cost more than 9 1/2 percent of your income and pays at least 60 percent of your covered medical expenses. If your employer plan comes up short in either of those areas, you could qualify for subsidized coverage on an exchange.
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