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Affordable Care Act for Individuals

The Affordable Care Act

The Affordable Care Act (ACA) is a federal law that helps uninsured people get affordable health insurance. It affects how much you’ll pay for insurance and the quality of health insurance that is offered by private insurance companies in the health insurance marketplace.

Higher Standards for Insurance Companies

Health insurance companies must:

  • insure people with pre-existing health conditions,

  • Cover essential health benefits,

  • Offer free preventive health care, and

  • Allow children under age 26 to stay on their parents’ health insurance plan.

Cost of Insurance

Under the ACA, the cost of your health insurance premium is based on your income, not on what the insurance company wants to charge. Most people who enroll under the ACA qualify for tax credits that reduce the cost of their insurance premiums. Cost sharing subsidies lower out-of- pocket costs for Silver plans bought through the Health Insurance Marketplace. If you don’t qualify for these, you may qualify for Medicaid.

Type of Plans

  • Bronze - The lowest cost plan. 60% of medical costs paid by the insurance company; you pay the remaining 40%.

  • Silver - 70% of medical costs paid by the insurance company; you pay the remaining 30%

  • Gold - 80% of medical costs paid by the insurance company; you pay the remaining 20%.

  • Platinum -The most expensive plan. 90% of medical costs are paid by the insurance company, 10% paid by you.

Do I have to enroll?

Yes, unless you already have health insurance through Medicaid, Medicare, your employment, or an individual insurance plan. Some people who are uninsured are still exempt from the ACA. They include people whose incomes fall below the threshold for filing federal income taxes or if enrollment would cause undue financial hardship; people who qualify for religious exemptions; people in jail or prison and native Americans who are members of tribes.

What happens if I don’t enroll?

You’ll still be responsible for paying 100% of your medical expenses AND you’ll be charged a fine when you file your income taxes. The amount of the fine depends on your income and increases every year that you remain uninsured.

What happens if I don’t pay the fee?

Unpaid fees will roll over to the next tax year, with interest charges. The IRS can also deduct the fee from your income tax refund. But the IRS can’t garnish your wages to satisfy the fee.

How do I enroll?

Enrollment is through the Health Insurance Marketplace during the open enrollment period. You can enroll online or with a paper application by going to www.healthcare.gov or calling 800-318-2596. In central Texas, Insure Central Texas provides one-on- one help with enrollment at several drop-in sites. For locations, dates and hours, call 2-1- 1- or go here: www.foundcom.org/get-financially-stable/insure-central-texas.


When can I enroll?

“Open enrollment” is for a specific period of time that varies from year to year. It usually begins in the fall and closes early the in the following year. If you don’t enroll during the open enrollment, period, you’ll have to wait until the next enrollment period. You can qualify for Special Enrollment (outside the enrollment period) if you have experienced a “significant life event” such as marriage, birth of a child, or loss of your current insurance.