Health Insurance Marketplace (Affordable Care Act) Coverage
Who is Eligible?
In general Pre-Medicare retirees are eligible for this coverage. You are not eligible to enroll in a health care plan through the Health Insurance Marketplace if you have health insurance through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage.
When Should You Apply?
The open enrollment period for 2020 coverage is November 1, 2019 to January 31, 2020. If you are seeking coverage effective January 1, 2020, you must enroll by December 15, 2019.
Special Enrollment Period (SEP)
If your benefits are terminated you will have a Special Enrollment Period. The Special Enrollment Period will allow you to obtain coverage through the Health Insurance Marketplace during the 60-day period following the qualifying life event. For example, if you lose your WESTMORELAND EMPLOYER PLAN coverage on December 31, 2019, you will have until March 1, 2020 to enroll in a health care plan through the Health Insurance Marketplace.
What Will It Cost to Pay For Coverage?
There are different types of insurance plans available on the Health Insurance Marketplace at the Bronze, Silver, Gold, and Platinum levels. Actual premiums will vary across plans and regions. Plans and prices for all types of plans available in 2020 will be available to preview on the healthcare.gov website.
Is There Financial Assistance to Help Me Pay Premiums?
Yes. Depending on your household income you may qualify for premium tax credits and cost-sharing subsidies.
Premium Tax Credit
If your previous benefits are terminated completely, you may be eligible to receive a premium tax credit if your household income falls within a certain range of the Federal poverty level.
For 2019 that income will be:
- $12,140 (100%) up to $48,560 (400%) for one individual
- $16,460 (100%) up to $65,840 (400%) for a family of two
- $20,780 (100%) up to $83,120 (400%) for a family of three
- $25,100 (100%) up to $100,400 (400%) for a family of four
Cost-sharing subsidies work by reducing an individual’s or a family’s out-of-pocket cost for health care services, such as deductibles, copayments, and coinsurance. Cost-sharing subsidies may only be applied toward a Silver plan. If you qualify for a premium tax credit and have household income from 100% to 250% of the Federal poverty level, you may be eligible for cost-sharing subsidies. The amount of the subsidy depends on your household income and is automatically applied when you enroll in a Silver plan and is paid directly to the insurance company by the federal government.
How Do You Enroll?
There are 4 ways to apply for coverage through the Health Insurance Marketplace. You can:
- Apply online at www.healthcare.gov and select your state to get started.
- Apply by phone: Call 1-800-318-2596 (TTY:1-855-889-4325). The Marketplace Call Center is open 24 hours a day, 7 days a week.
- Apply in person: Speak to trained people in your community like Navigators, assisters, agents, and brokers. Go to https://localhelp.healthcare.gov and enter your zip code to see a list of groups and people near you.
- Apply by mail: Complete a paper application and mail it in. To get an application call the Marketplace Call Center number above.