Health Insurance Marketplace
Open Enrollment for 2022 Coverage is over.
You can now enroll in a Health Insurance Marketplace plan ONLY if you have a life event that qualifies you for a Special Enrollment Period.
You may qualify for a Special Enrollment Period if you experience one of these situations:
- Loss of Minimum Essential Coverage (MEC).
- Loses employer coverage due to, for
― Loss of a job
― Voluntarily quitting a job
― Reduction in work hours that causes
loss of eligibility for employer plan.
- Discontinuation of employer plan
- Loses eligibility for Medicaid or CHIP
- COBRA coverage expires
- Non-group plan is canceled
- Loses eligibility for student health plan that
is MEC (Minimum Essential Coverage)
- Loses coverage due to a divorce or legal
- Loses coverage because no longer a
- Loses eligibility for coverage under a
- Loses coverage due to a death of another
person in the family
- Current QHP is decertified
- No longer living, working, or residing in the
area of the plan
- Must pay full cost of COBRA coverage due
to termination of employer contributions to
Notes: “Loss of MEC” does not include voluntarily
dropping coverage or termination by insurer due to
the enrollee’s nonpayment of premiums.
- Loses employer coverage due to, for
- Loss of pregnancy-related coverage
- Loss of Medicaid for the medically needy
- End of non-calendar year plan
- Birth, adoption, placement for adoption or foster care, or court order
- Death of enrollee or a dependent
- Divorce or legal separation
- Other situations may apply.
A new policy in 2022 allows people with low incomes to enroll in a marketplace plan at any time during the year.
What is the new SEP for low-income people? People who are eligible for an advance premium tax credit (APTC) and have a projected income at or below 150% Federal Poverty Line (FPL) ($20,385 for a household of one and $41,625 for a family of four in 2023) are now eligible for a new SEP on the federal marketplace that allows them to enroll in a plan in any month during the year, without having to experience a qualifying life event.
In August 2022, Congress enacted the Inflation Reduction Act, which extends these enhanced marketplace subsidies and expanded eligibility for premium tax credits for an additional three years, through the end of the 2025 coverage year. As a result, the low-income special enrollment period for people with income at or below 150% FPL remains in place in states that use HealthCare.gov.
If you are enrolling in Marketplace coverage for the first time, you may need to submit documents to prove you qualify for this Special Enrollment Period.
Who is eligible to enroll in health coverage through the Marketplace?
- Must live in the United States
- Must be a U.S. citizen or national (or be lawfully present)
- Cannot be incarcerated
How is the Federal Poverty Level used to determine eligibility for certain programs and eligibility?
Every year a measure of income is issued by the Department of Health and Human Services. Those federal poverty levels are used to determine eligibility for certain programs and eligibility, including savings on Marketplace health insurance, Medicaid and CHIP coverage.
The 2023 federal poverty level (FPL) income numbers are below:
- $13,590 for individuals
- $18,310 for a family of 2
- $23,030 for a family of 3
- $27,750 for a family of 4
- $32,470 for a family of 5
- $37,190 for a family of 6
- $41,910 for a family of 7
- $46,630 for a family of 8
How are federal poverty levels used to determine eligibility for reduced-cost health coverage?
- Income above 400% FPL: If your income is above 400% FPL, you may now qualify for premium tax credits that lower your monthly premium for a 2021 Marketplace health insurance plan.
- Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
- Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
- Income below 100% FPL: If your income falls below 100% FPL, you probably won’t qualify for savings on a Marketplace health insurance plan or for income-based Medicaid.
At 100% poverty level you can start to receive subsides for lower premium cost and lower cost sharing. Income below poverty will most likely not receive subsidies.
The premium tax credit is available to individuals and families with incomes at or above the federal poverty level who purchase coverage in the health insurance marketplace in their state. Through the end of the 2025 coverage year, there is no maximum income limit for the premium tax credit. People whose benchmark premium costs more than 8.5% of household income qualify for a premium tax credit if they meet other eligibility criteria.
If you have other health coverage: Medicare Part A, B or C, Medicaid,CHIP, any job-based plan, and individual health plan, COBRA, retiree coverage, TRICARE, VA, or some other kind of health coverage you may not be eligible for subsidies.
Does Community Healthcare Center offer resources to help research Marketplace plans and enrollment assistance in those plans?
Yes! Community Healthcare Center (CHC) has Certified Application Counselors that offer free and unbiased assistance and enrollment. CHC staff can assist you with researching the right plan for you and your family, and they can help you enroll for coverage during open enrollment.
All assistance and enrollment services are free and unbiased.
Call (940)766-6306 today to schedule an appointment with one of Community Healthcare Center’s Certified Application Counselors.
Se habla español.
Certified Application Counselors offices are located at:
Community Healthcare Center
200 Martin Luther King Jr. Blvd
Wichita Falls, Texas 76301
You can also apply online with the Health Insurance Marketplace at healthcare.gov or by calling 1-800-318-2596.
CLICK HERE to view and/or download the Authorization/Privacy Notice form regarding receiving free and unbiased assistance and enrollment with Certified Application Counselors at Community Healthcare Center. (Spanish version CLICK HERE)