Marketplace Health Insurance
Health Insurance Plans for You and Your Family, with Tax Credits
If you can answer “yes” to the 2 below questions, choosing an ACA (Affordable Care Act) health insurance plan with instant tax credits to lower the premium costs through the Marketplace is usually your best choice:
Q1
Will the annual income on your 2022 tax return fall under these income thresholds corresponding to the number of people in your family?
approximately $86,000 for family of 1
approximately $170,000 for family of 2
approximately $215,000 for family of 3
approximately $260,000 for family of 4
approximately $305,000 for family of 5
approximately $310,000 for family of 6
Q2
DURING the time period you need this individual health insurance coverage…
Will you NOT have access to an employer-sponsored health insurance plan through work?
And…
Will your spouse (if married) NOT have access to an employer-sponsored health insurance plan through work?
If you have answered “yes” to both questions, you are on the right page. Continue below. If you answered “no” to either question, the better information page for you is “Individual Health Insurance Options.”
We Help Individuals and Families With These Health Insurance Plans (And More)
Here are the two details to understand about the benefits of a Marketplace health insurance plan…
When your income is under the threshold, and you don’t have available employer-sponsored coverage, you will receive one or both of two big benefits of a Marketplace health insurance plan:
Advanced Premium Tax Credits (APTCs)
In “plain speak” you may receive instant tax credits to help lower the monthly premium cost.
The Affordable Care Act provides APTCs to individuals and families that help lower the monthly cost of health insurance. APTC's or "tax credits" are figured in a formula that analyzes the covered person(s) ages, family size, zip code, and income.
The tax credit is calculated at time of enrollment or renewal, and reported to the health insurer. The insurer will only charge you the remaining premium cost. Just to be clear, here is an example:
-Family of 4, Calculated Tax Credit: $575.00
-Monthly Premium Cost of Chosen Plan: $875.00
-Family Pays $300.00 Monthly to Insurer (875 - 575)
We can easily determine your tax credit based on these factors, so you can compare based on cost.
Cost Sharing Reductions (CSRs)
In “plan speak” you may receive an enhanced Silver Level plan with much lower copays and deductible.
The A.C.A. also provides for Cost Sharing Reductions for some individuals and families who receive the Advanced Premium Tax Credit.
Cost sharing reductions, or "CSR's" are a something much simpler than the confusing name implies. If you receive the CSR then the policy you choose (it must be a Silver level benefit plan) is "enhanced." By enhanced… the policy's copays, deductible and out of pocket maximum are lowered! That means you pay less out of your pocket when you use medical services. Here’s a quick example:
-Doctor's Office Copay: $5 instead $20
-Deductible: $700 instead of the usual $4,500
-Out of Pocket Max.: $2,100 instead of $8,700
If you are feeling overwhelmed already, no worries! Chip can help.
The Affordable Care Act has brought in some great benefits, but the selection and enrollment process for coverage, in the ACA built format, is kind of a confusing mess! See below how Chip can help you through the process, doing most of the work along the way:
You Request a Free Quote
Begin the free process of working with Chip by requesting a quote (see the bottom of this page). Chip will receive your information, calculate your tax credit, and research plans suitable to your needs. He’ll then compile all the info into an initial email he will send to you ASAP.
Recommendations, and Questions Answered
You can review all the information in your own time, then follow up with Chip with your questions. You can have a conversation via email, phone, text, Zoom / Facetime, or an in-person meeting at his office, your home, or at a local coffee shop.
Enrollment in the ACA Marketplace
The healthcare.gov Marketplace site can feel like a puzzle to solve. Chip can enroll you in the plan you choose, then work to follow up with any requested items from the Marketplace, such as proof or prior coverage or income. He’ll then work to ensure your ID cards and policy arrive.
You can enroll in ACA health insurance through the Marketplace throughout the year.
Because only the annual enrollment period (AEP) is publicized many people mistakenly think you can only enroll in your own health insurance plan at the beginning of each year. Not true! Read below to understand the two enrollment periods.
Annual Enrollment Period (AEP)
Between November 1st and December 15th anyone can enroll in an individual or family health insurance plan, to begin on January 1st of the new year.
This open enrollment period is open to everyone, and you do not need a set reason to enroll.
Special Enrollment Periods (SEPs)
You may also enroll yourself and your family in a health insurance plan at any time throughout the year, if you qualify with a SEP, or special enrollment period. Those are:
You or your spouse have lost employer-sponsored health insurance (usually because of a job change), or your COBRA coverage ended.
Your 26th birthday means you have lost coverage on your parent’s plan.
You have moved to a new zip code; in a new county, or to a new state.
You are recently married. Or, you are recently separated, or divorced.
You lost eligibility in Medicaid, or lost eligibility in a plan your spouse covers you under, or that you choose, as the plan is ending.
You gained access to an individual coverage HRA or a QSEHRA.
You had a baby, adopted a child, or placed a child for foster care.
And a few other reasons. Check with Chip to confirm.
Two important notes to understand:
-You must enroll in a health insurance plan within 60 days of the date of your SEP.
-You may have to prove the SEP reason. For example, if you lost employer-sponsored health insurance, the Marketplace may ask for a COBRA letter or other proof.
Chip Millard is a member of Healthcare.gov's "Champions Circle."
A distinction awarded by Healthcare.gov to health insurance agents and brokers who go above and beyond to increase access to health insurance (helping local people understand their benefits and costs options, and helping them enroll) in their communities.
Three Recent Marketplace Health Insurance Plans We Helped Clients With:
Below are 3 success storied we have found on the Marketplace in helping our customers obtain their own health insurance plan:
A 26 Year Old Student Needs His Own Health Insurance Plan
Joseph, a grad school student in Chapel Hill, has been on his mother’s health insurance through her employer.
At 26 dependent coverage ends on your birthday. So Joseph needed his own plan. We reviewed his part-time income, and determined the tax credit.
He qualified for a tax credit, and the CSR, and pays $43.18 monthly for a low copay, low deductible plan.
A Family of 5 Moves Off of Work-Based Health Insurance
A family of 5 in Durham experienced a SEP when one spouse went to part-time work to be at home with the couple’s 3 children. Employer-sponsored health insurance is not available at the other spouse’s job.
We determined the tax credit (as the couple’s income was well under the threshold for a family of 5), and found they could choose a copay style plan for the family, all at $310.55 total premium cost per month.
A Retired Couple Needs a Plan Before Medicare Eligibility
A couple in their early 60’s recently moved to Pittsboro to live close to their adult children, after retiring from jobs in Pennsylvania. They have two SEPs, moving to a new state, and ending work coverage.
They are currently at a lower income bracket between full-time work and taking a larger retirement income at age 65, so their tax credit pays the entire monthly premium cost! They will pay $0.00 for a H.S.A. plan.
Free Personalized Quote and Information
Complete the form below and Chip will send you an email with recommended quotes of insurance (including detailed ideas of premium costs and benefits). All in a conversational, “plain speak” explanation of the details Chip is known for (see our reviews on the home page). You can review the information, then follow up with your questions via email, phone call, text, or Zoom / Facetime.
Note: Privacy is something we take seriously, and keeping the information you shared private is of utmost importance to us. We do not share any information with third parties. The minimum of information is shared with an insurance company to put together a detailed free quote and illustration for you.