Subsidies for Young Adults Under the Affordable Care Act (ACA)

Eligibility for Medicaid Expansion

The Affordable Care Act (ACA) expanded Medicaid eligibility to adults under the age of 26 with incomes below 138% of the federal poverty level (FPL). In North Carolina, this means that adults under 26 can apply for Medicaid if their income is below $18,754 per year.

The 22-year-old in the situation you described may be eligible for Medicaid expansion if they meet the income requirement and are not employed. However, they should be aware that Medicaid is a government-funded program with limited benefits compared to private health insurance.

Subsidies for Marketplace Health Insurance

If the 22-year-old does not qualify for Medicaid expansion, they may be eligible for subsidies to help pay for health insurance purchased through the Health Insurance Marketplace. Subsidies are available to adults with incomes between 138% and 400% of the FPL.

The amount of the subsidy depends on the applicant’s income, family size, and the cost of health insurance plans in their area. Depending on their income, the 22-year-old may be able to receive a subsidy that covers a significant portion of their health insurance premium.

Qualifying Event for Enrollment

Losing health insurance coverage is a qualifying event that allows individuals to enroll in health insurance outside of the annual Open Enrollment Period. This means that the 22-year-old can enroll in health insurance through the Marketplace once their parents’ coverage ends, even if it is not during the Open Enrollment Period.

Next Steps

The 22-year-old should apply for Medicaid expansion and Marketplace subsidies to determine their eligibility. They can apply online at HealthCare.gov or by calling the Marketplace’s toll-free number (1-800-318-2596).

If they are not eligible for Medicaid expansion or Marketplace subsidies, they should consider purchasing health insurance directly from a health insurance company. It is important to compare plans and premiums to find the best option for their needs and budget.

Licensed health insurance agents can assist the 22-year-old with understanding their options and enrolling in health insurance. They can provide personalized guidance and help them navigate the complex world of health insurance.