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 qualifying health coverage; through a job or another person’s job, divorce, Medicaid or CHIP, Medicare, or coverage under you parent’s health plan due to you turning 26 and loss coverage (You may report the loss of coverage up to 60 days before or after).
- Got married, had a baby, adopted a baby, or gained a dependent due to child support or court order (you have 60 days to enroll after these life events).
- Moved to a new ZIP code, county, or state (only if you had prior health coverage for one or more days in the 60 days prior to your move).
- Newly eligible for Marketplace coverage because you’ve become a citizen, national, or lawfully present individual.
- Newly eligible for Marketplace coverage after being released from incarceration.
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 2021 federal poverty level (FPL) income numbers are below:
- $12,880 for individuals
- $17,420 for a family of 2
- $21,960 for a family of 3
- $26,500 for a family of 4
- $31,040 for a family of 5
- $35,580 for a family of 6
- $40,120 for a family of 7
- $44,660 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.
400% is the maximum amount of income a family can have before they no longer qualify for subsidies. If a family makes more than 400% fpl, they can still enroll in the health Insurance Marketplace. But not eligible for tax subsides.
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
Pediatric Associates
4420 Kimbell Drive
Wichita Falls, Texas 76302
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)
