ACA Eligibility Verification: What You Need to Know
If you’ve ever wondered how the government verifies your eligibility for employer-sponsored health insurance coverage, you’re not alone. Many people have questions about how the Affordable Care Act (ACA) works, and one of the most common is how the government ensures that people who are eligible for employer coverage don’t receive subsidies for health insurance through the Health Insurance Marketplace.
What is the ACA?
The ACA, also known as Obamacare, is a comprehensive health care reform law enacted in 2010. One of the main goals of the ACA is to expand access to affordable health insurance coverage for all Americans. To achieve this goal, the ACA created the Health Insurance Marketplace, where individuals and families can shop for and compare health insurance plans from private insurers.
Who is Eligible for Subsidies?
Subsidies are financial assistance provided by the government to help people afford health insurance coverage through the Health Insurance Marketplace. To be eligible for subsidies, you must meet certain criteria, including:
You must be a U.S. citizen or legal resident.
You must not be eligible for affordable employer-sponsored health insurance coverage.
Your income must be within certain limits.
How is Employer Coverage Verified?
The government verifies your eligibility for employer coverage through a variety of methods, including:
Employer reporting: Employers are required to report to the IRS whether they offer health insurance coverage to their employees.
1095-C forms: Employers are also required to provide employees with a 1095-C form, which shows the type of health insurance coverage offered and the cost of the coverage.
Income verification: The government compares your income to the cost of the employer-sponsored coverage to determine if the coverage is affordable.
Self-attestation: When you apply for subsidies through the Health Insurance Marketplace, you must attest that you are not eligible for affordable employer-sponsored coverage.
What Happens if You Are Ineligible for Subsidies?
If you are determined to be ineligible for subsidies, you will have to repay any subsidies that you received. You may also be subject to a penalty for fraud.
What Should You Do if You Are Unsure of Your Eligibility?
If you are unsure of your eligibility for subsidies, you should contact a licensed health insurance agent or visit HealthCare.gov to get help determining your eligibility. You can also call the Health Insurance Marketplace at 1-800-318-2596.
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