Affordable Care Act: Understanding Options for Your Mom’s Health Insurance

The rising cost of healthcare can be a major concern, especially for those who need regular medical care. Navigating the Affordable Care Act (ACA) to find the right health insurance plan can be challenging, but it’s essential to ensure that your loved ones have the coverage they need.

In this blog, we’ll explore a recent post from a user who was seeking health insurance options for their mother. Through this example, we’ll provide insights into ACA-related topics:

Determining Household Income for ACA Eligibility

The ACA’s eligibility requirements for Medicaid and subsidized health insurance plans consider household income. In the case of the post, the user’s income was mistakenly included in their parents’ household income, which could have affected their mother’s eligibility for subsidies.

Household income includes:

The income of the tax filer and their spouse
The income of their dependents

Important note: Adult children who live with their parents and earn a substantial income may not be considered dependents, which means their income should not be included in the household income.

Exploring COBRA Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides individuals with the option to continue their employer-sponsored health insurance after they lose coverage due to a qualifying event, such as retirement. COBRA coverage typically lasts for 18 to 36 months.

Benefits of COBRA:

Coverage is the same as the employer’s active employees
No medical underwriting is required

Drawbacks of COBRA:

High premiums (full cost is paid by the individual)
Limited coverage duration

Medicaid Eligibility for Seniors

Individuals aged 65 and older may qualify for Medicare, a federal health insurance program. However, seniors who have limited income and resources may also qualify for Medicaid, which provides health insurance coverage to low-income individuals and families.

Eligibility requirements for Medicaid:

Age: 65 or older
Income: Below the Medicaid income limit, which varies by state
Assets: Below the Medicaid asset limit, which also varies by state

Subsidized Health Insurance Plans on the Marketplace

The ACA’s Marketplace is a federally facilitated health insurance exchange where individuals and families can shop for affordable health insurance plans. Subsidies are available to low- and moderate-income individuals and families to help them pay for premiums and other costs.

To qualify for subsidies:

Household income must be below certain income thresholds
Citizenship or legal residency status is required

Next Steps: Seeking Professional Guidance

Navigating the ACA and exploring health insurance options can be complex. It’s always advisable to seek guidance from a licensed health insurance agent who can assess your specific situation, provide personalized recommendations, and assist you in enrolling in a plan that meets your needs.