There’s still time to get health insurance through the public exchange

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Anyone without health insurance is about two weeks away from getting coverage in 2023 on the public marketplace — and subsidies could make it easier.

Open enrollment for the state health care exchange continues through Jan. 15, which will come into force on February 1. (If your region has its own exchange, the registration deadline may be different.) After the registration window closes, you are usually required to have a qualifying life event – that is, the birth of a child or marriage – to be granted a special registration period.

Most people enrolled in the marketplace — 13 million out of 14.5 million by 2022 — qualify for government subsidies (technically tax credits) to help pay premiums. Four out of five consumers will be able to get plans by 2023 for $10 or less a month after accounting for those tax credits, according to the Centers for Medicare & Medicaid Services.

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Some people may qualify for cost-sharing assistance, such as deductibles and copays in certain programs, depending on their income.

For the most part, people who get insurance through a federal (or state) exchange are self-employed or don’t have access to workplace insurance, or they don’t qualify for Medicare or Medicaid.

As of Dec. 15, about 11.5 million people had chosen a plan in the marketplace, according to CMS.

Tax bills are high now

Grants are still more generous than before the pandemic. Temporary funding increases set for 2021 and 2022 were extended through 2025 in the Fiscal Retrenchment Act, which became law in August.

This means there is no income limit to qualify for the subsidy, and the amount anyone pays in premiums is limited to 8.5% of their income as calculated by the exchange. Before the reforms, assistance was generally only available to households with incomes from 100% to 400% of the federal poverty level.

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Market subsidy eligibility is based on factors including income, age and the second most expensive “silver” plan in your area (which may or may not be the plan you enroll in).

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For the income portion of the decision, you will need to estimate it in 2023 during the registration process.

Giving a good rating is important

Note that it is important to give a good estimate.

If you end up with a higher annual income than you reported when you signed up, it may mean that you are not eligible for as much aid as you are getting. And any excess will need to be accounted for at tax time in 2024 – which could reduce your refund or increase the amount of tax you owe.

“You don’t want a nasty surprise when you do your taxes next year,” says Cynthia Cox, director of the Kaiser Family Foundation’s Affordable Care Act program.

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Similarly, if you are entitled to more than you received, the difference can increase your refund or reduce the amount of tax you owe.

At any time during the year you can adjust your income estimate or notice any important life changes (for example, the birth of a child, marriage, etc.) that may affect the amount of subsidies you are entitled to receive.

Falling behind on premiums can mean going down

Be aware that if you do not pay your premiums (or part of them), you will face cancellations and unpaid claims.

For subsidized enrollees, payments are usually reduced after three months if premiums are not withheld. For those who pay full premiums because they are not eligible for the subsidy, there is a grace period of about a month before cancellation, depending on the country.

If you end up uninsured, you cannot re-enroll in the marketplace unless you qualify for a special enrollment period.


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