COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, federal legislation that allows you – if you work for an employer group of 20 or more employees – to continue to purchase health insurance for up to 18 months if you lose your job or your employer-sponsored coverage otherwise ends. (Coverage can continue for up to 36 months in some situations.)| healthinsurance.org
Find definitions for the most frequently searched health insurance terms, including definitions related to Affordable Care Act (Obamacare) coverage benefits, costs and eligibility.| healthinsurance.org
Under the Inflation Reduction Act (IRA), the enhanced subsidies that are in effect in 2022 (as a result of the American Rescue Plan) will continue to be in effect through 2025.| healthinsurance.org
Twelve of the states that expanded Medicaid under the ACA have trigger laws that would quickly end or potentially scale back Medicaid expansion if the share of federal funding for Medicaid expansion drops.| healthinsurance.org
States continue to realize the impact of Medicaid – and incentives to expand. Here's what's happening in states that aren't yet on board.| healthinsurance.org
A health insurance premium is the amount – typically billed monthly – that policyholders pay for health coverage. Policyholders must pay their premiums each month regardless of whether they visit a doctor or use any other healthcare service.| healthinsurance.org
Medicaid for children plays a vital role in covering kids in the U.S., but many families may not be aware of the state and federal guidelines that make their children eligible for coverage.| healthinsurance.org
Reinsurance is essentially insurance for insurance companies. Just like individuals count on their insurance company to cover a portion of their medical bills if and when they have a claim, reinsurance programs pay a portion of the insurer's bills when enrollees have high-cost claims.| healthinsurance.org
Learn about the ACA health insurance Marketplace in Georgia for 2025. Discover available plans, eligibility requirements, enrollment dates, and how to apply for coverage.| healthinsurance.org
Worried about losing coverage due to Medicaid redeterminations and renewals? Determine your eligibility, see options and find a new health insurance plan.| healthinsurance.org
The Inflation Reduction Act would extend ARP's health insurance subsidy enhancements – helping millions eligible for ACA marketplace subsidies.| healthinsurance.org
When it comes to obtaining health insurance for the self employed, consumers have several coverage options to consider, including ACA Marketplace individual and family health insurance, COBRA continuation of group coverage, Medicaid, insurance through a spouse’s health plan, and short-term health insurance.| healthinsurance.org
Find affordable health insurance for individuals and families, including subsidized ACA marketplace plans. Compare plans. Get a free quote.| healthinsurance.org
Enhanced Direct Enrollment (EDE) is a service that allows approved entities to enroll consumers in Marketplace qualified health plans (QHPs), with income-based subsidies if they’re subsidy eligible, without the enrollee needing to visit the HealthCare.gov website.| healthinsurance.org
Nine states have state-funded health insurance subsidy programs that make coverage even more affordable than it would be with federal subsidies alone.| healthinsurance.org
If you have a health plan in the individual market, on-exchange or off-exchange, you can probably just let it renew for the coming year without doing anything during open enrollment. But this is generally not in your best interest.| healthinsurance.org
State health insurance Marketplaces – or exchanges – vary in terms of enrollment platforms, carrier availability, rates and more. Learn more about your Marketplace.| healthinsurance.org
Balance billing occurs when providers bill a patient for the difference between the amount they charge and the amount that the patient's insurance approves. The negotiated rate that insurers pay providers is almost always less than the provider's "retail price." Depending on the circumstances, out-of-network providers can bill the patient for the difference, or balance; this is called balance billing. Federal rules protect patients from "surprise" balance billing as of 2022.| healthinsurance.org
Minnesota, New York, and Oregon have implemented a Basic Health Program – a coverage for people ineligible for Medicaid and with incomes up to 200% of FPL (250% in New York), and for legal immigrants who aren't eligible for Medicaid because of the five-year waiting period.| healthinsurance.org
A self-insured health plan (also known as a self-funded health plan) is coverage offered by an employer or association in which the employer (or association) takes on the risk involved with providing coverage, instead of purchasing coverage from an insurance company.| healthinsurance.org
Medicaid expansion extended eligibility to adults up to age 64 with incomes up to 138% of the federal poverty level. Washington, DC and 40 states have expanded Medicaid.| healthinsurance.org
Grandmothered plans are individual and small-group health plans that took effect after the ACA was signed into law in 2010, but before the exchanges opened for business in 2013. (In some states, grandmothered plans include plans that were issued as late as the end of 2013.)| healthinsurance.org
Grandfathered plans are health plans that were already in effect as of March 23, 2010, when the Affordable Care Act was signed into law. In the individual market, they are plans that already covered the policyholder as of that date, and in the employer-sponsored market, they are plans that the employer had already implemented as of that date, and has continuously offered ever since, with at least one covered employee at all times.| healthinsurance.org
Cost-sharing refers to the fact you – as a health insurance policy holder – and your health insurance company share in the cost of your covered health care services.| healthinsurance.org
The Affordable Care Act requires nearly all health plans to cover a wide range of free preventive health services including wide-ranging preventive care for everyone, preventive care for women and children, and vaccines for children and adults.| healthinsurance.org
In recent weeks, we’ve seen news reports of Marketplace enrollees’ coverage being switched without their knowledge. Here's what consumers need to know.| healthinsurance.org
A proposed federal rule issued this week would, if finalized, bring wide-ranging changes for the Affordable Care Act’s health insurance Marketplace, including a shorter open enrollment period in all states.| healthinsurance.org
What will happen to Marketplace health insurance subsidy availability and size when the subsidy enhancements instituted under the American Rescue Plan sunset after 2025?| healthinsurance.org
The type of managed care your health plan falls under affects your healthcare costs and plan benefits – including access to medical providers.| healthinsurance.org
Starting Nov. 1, 2024, Georgia residents will use a state-run health insurance enrollment platform, Georgia Access, to shop for and enroll in Marketplace health coverage for 2025. Here’s a look at the changes that consumers can expect.| healthinsurance.org
Obamacare's annual open enrollment runs until January 15 in most states. Here's why you might want to enroll by December 15 anyway.| healthinsurance.org
During the open enrollment period for 2024 health coverage, more than 21.4 million people enrolled in private qualified health plans (QHPs) through the Marketplaces (exchanges) nationwide. This was a 31% increase over the previous record high set in 2023, when 16.4 million people enrolled in Marketplace QHPs.| healthinsurance.org
If you’re in a relationship deemed a domestic partnership, access to your domestic partner’s health insurance, or their access to yours, depends on where you live and your health plan’s rules.| healthinsurance.org
Starting in November, DACA health insurance options will include exchange enrollment and eligibility for income-based premium subsidies. The federal government estimates that 100,000 people will be newly eligible for Marketplace coverage under the rule.| healthinsurance.org
When a new Commander in Chief takes office and their party also controls both chambers of Congress, how quickly can they make changes to health policy? Can policy changes happen on “Day One” of a new administration?| healthinsurance.org
Open enrollment for 2025 ACA (Affordable Care Act)-compliant health insurance is just around the corner. Let’s take a look at the various changes that consumers should be aware of this fall.| healthinsurance.org
For women in the US, health insurance has come a very long way in the last decade, thanks in large part to the dramatic improvements and consumer protections brought about by Obamacare. This is particularly true in the individual market, where previous reforms and mandates had rarely applied.| healthinsurance.org
In addition to the Platinum, Gold, Silver and Bronze individual health insurance plans, the ACA allows catastrophic plans for people under age 30, or for those 30 and older who qualify for a hardship exemption from having to maintain health insurance coverage or pay a penalty. But subsidies cannot be used to purchase these plans, so enrollment is very low.| healthinsurance.org
The federal poverty level (FPL) - also referred to as the federal poverty guidelines – is used to determine eligibility for Medicaid and CHIP, and for premium subsidies and cost-sharing reductions in the health insurance marketplace.| healthinsurance.org
The U.S. Department of Health and Human Services has finalized a special enrollment period in states that use HealthCare.gov, granting year-round enrollment in ACA-compliant health insurance if an applicant’s household income does not exceed 150% of the federal poverty level and if the applicant is eligible for a premium tax credit.| healthinsurance.org
More health insurance carriers are entering ACA's exchanges for 2022. Here's why you should pay attention to new health plans in your exchange.| healthinsurance.org
If your employer-sponsored insurance becomes unaffordable or stops providing minimum value, the change may make you eligible for a special enrollment period.| healthinsurance.org
As of the 2025 plan year, there will be 20 fully state-run health insurance marketplaces (SBMs), three state-based marketplaces that use the federal platform (SBM-FP), and 28 fully federally run marketplaces. Three of the SBMs had an SBM-FP model in 2021, but transitioned to their own enrollment platforms as of the 2022 plan year. Virginia joined them in the fall of 2023, and Georgia will also be running its own exchange platform by the fall of 2024. Illinois has enacted legislation to creat...| healthinsurance.org
Health insurance coverage for IVF and other fertility treatments varies from one state to another and from one health plan to another.| healthinsurance.org
A health insurance deductible is the amount an individual must pay for healthcare expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts.| healthinsurance.org
Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage.| healthinsurance.org
If you're like the vast majority of consumers, you may be hearing about CSRs for the first time and wondering why these subsidies are so important, and whether they actually affect your own coverage. Here's what you need to know:| healthinsurance.org
An out-of-pocket maximum is a predetermined, limited amount of money that an individual must pay before an insurance company or (self-insured employer) will pay 100% of an individual's covered, in-network health care expenses.| healthinsurance.org
The monthly premiums you pay in order to have coverage are not included in out-of-pocket costs. Out-of-pocket costs are only incurred if and when you need medical care, whereas premiums have to be paid every month, regardless of whether you need medical care or not.| healthinsurance.org
An off-exchange plan is a health insurance policy that is purchased directly from an insurance company or through an agent or broker, outside of the official ACA-created health insurance exchange.| healthinsurance.org
Under the Affordable Care Act, individual and small-group health plans that are not grandfathered must cover items and services in 10 health benefit categories.| healthinsurance.org
A cost-sharing reduction (CSR) is a provision of the Affordable Care Act that reduces out-of-pocket costs for eligible enrollees who select Silver health insurance plans in the marketplace. CSRs – often referred to as cost-sharing subsidies – reduce enrollees' cost-sharing by lowering a health plan's out-of-pocket maximum, and increasing the actuarial value (AV) of the plan.| healthinsurance.org
There are two different meanings for the term benchmark plan – and both have to do with the Affordable Care Act: Benchmark plan is the term used to describe the second-lowest-cost Silver plan (SLCSP) available in the exchange/Marketplace, and it’s also the term for the plan that each state designates as the standard for essential health benefits (EHBs).| healthinsurance.org
Follow the national dialogue about health reform through blog posts from respected authorities on individual health insurance and health reform.| healthinsurance.org
Outside of the ACA's open enrollment period, you can only sign up for ACA-compliant health coverage if you qualify for a special enrollment period.| healthinsurance.org
As of 2023, the IRS has fixed the ACA's "family glitch." The family glitch previously made millions of Americans ineligible for premium subsidies in the exchange, even though their cost for employer-sponsored family health coverage was unaffordable. This disproportionately affected lower-income families.| healthinsurance.org
Immigrants can enroll in ACA-compliant individual health insurance just like any other lawfully present U.S. resident. Lawfully present immigrants are eligible for premium subsidies.| healthinsurance.org
According to Kaiser Family Foundation data, there are about 1.9 million people in the coverage gap across nine states (this does not include North Carolina, as Medicaid expansion will take effect there in late 2023). They aren't eligible for Medicaid, nor are they eligible for premium subsidies in the exchange.| healthinsurance.org
Learn who’s eligible to enroll in Texas' Medicaid program, how to apply, the status of Medicaid expansion and the effects of Medicaid disenrollment.| healthinsurance.org
Our ACA health insurance subsidy calculator estimates your premium subsidy based on your income, age and household size.| healthinsurance.org
Need more info about Medicaid in your state? Get updated information on the current status of Medicaid expansion, along with general information about each state’s program.| healthinsurance.org
State health insurance Marketplaces – or exchanges – vary in terms of enrollment platforms, carrier availability, rates and more. Learn more about your Marketplace.| healthinsurance.org
ACA-compliant coverage is only available for purchase during the annual open enrollment period, but a special enrollment period allows people to sign up for coverage outside of that annual window. In most cases, this requires a qualifying life event.| healthinsurance.org
See if you're eligible for the Affordable Care Act's premium tax credits (premium subsidies), how subsidies are calculated, and why they are more robust in 2023.| healthinsurance.org
While the Affordable Care Act's premium subsidies help pay the cost of the health insurance itself, cost-sharing subsidies help to reduce out-of-pocket spending for eligible enrollees when they select Silver plans. The Trump administration eliminated federal funding for cost-sharing reductions, but the benefits are still available to eligible enrollees. And because the cost of cost-sharing reductions has been added to premiums, premium subsidies are much larger than they were prior to 2018.| healthinsurance.org
Federal penalties for being uninsured no longer apply since 2019, but some states are implementing their own coverage mandates. Find more info here.| healthinsurance.org
Learn how a new federal rule has expanded the ACA’s nondiscrimination provision, and how it might protect LGBTQI+ communities seeking healthcare and health coverage| healthinsurance.org
When it comes to selecting a health insurance plan, the premium is the most important factor for many shoppers – especially those who are currently healthy. But price shouldn't be the only factor upon which you base your selection, even if your primary concern is financial.| healthinsurance.org
Under the Affordable Care Act, eligibility for Medicaid, premium subsidies, and cost-sharing reductions is based on modified adjusted gross income (MAGI). But the calculation for that is specific to the ACA – it's not the same as the MAGI that's used for other tax purposes| healthinsurance.org
The Affordable Care Act standardized individual health insurance policies by creating a “metal” ranking for individual/family and small-group policies, based on their actuarial value (the percentage of costs that the plan pays across a standard population).| healthinsurance.org
A list of the open enrollment deadlines for enrollment in 2025 ACA-compliant health insurance in every state. Open enrollment runs from November 1 to January 15 in most states, but some state-run exchanges have different schedules.| healthinsurance.org
From 2015 through 2021, the IRS did make an annual change — usually quite small — to the percentage of income that you have to pay for self-purchased (individual/family) health coverage. But there’s a lot more to it than just the percentage of income that the IRS says you have to pay for the benchmark plan.| healthinsurance.org
All plans (whether Bronze, Silver, Gold or Platinum) must cover the same essential benefits, including free preventive care; they all provide comprehensive coverage. But plans with the lowest premiums (Bronze, and to a lesser extent, Silver) require you to pay a larger share of your health costs. This means that your co-pays and deductibles will be higher, and your maximum out-of-pocket will generally be higher as well.| healthinsurance.org
Nathan Wilkes is a Colorado father who came face-to-face with the realities of lifetime maximum benefits on health insurance policies before the ACA eliminated them. His family exhausted their benefits on a private policy as well as CoverColorado, the state's high risk pool. Both policies had $1 million lifetime maximums, and Nathan's son Thomas has severe hemophilia that can cost that much in a year.| healthinsurance.org
Learn how the Affordable Care Act (Obamacare) improved health coverage and made it more affordable through income-based subsidies.| healthinsurance.org
The ACA's subsidy cliff has been temporarily eliminated (through 2025), saving some health insurance buyers thousands of dollars per year.| healthinsurance.org
The Affordable Care Act’s open enrollment period is the annual window during which individuals and families can compare the various health plans that are available and select the one that will best fit their needs for the coming year.| healthinsurance.org
Short-term health insurance plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage. Learn more about short-term plan availability in your state.| healthinsurance.org
Louise Norris has been writing about health insurance and health care reform since 2006 and has as written dozens of opinions and educational pieces about the Affordable Care Act. She's the author of our annually updated guide to ACA open enrollment and our companion guide to special enrollment – both loaded with tips designed to help consumers select the right ACA-compliant coverage and spend less time doing it.| healthinsurance.org
