The ACA Coverage Gap: What to Do When You’re in the Middle

The Affordable Care Act (ACA) has provided health insurance coverage to millions of Americans, but there are still some who fall into the coverage gap. This gap exists for people who make too much to qualify for Medicaid but not enough to afford private health insurance.

If you’re in the coverage gap, you may be wondering what your options are.

One option is to slightly inflate your income on your ACA application to qualify for a subsidized plan. This is a risky move, as it could lead to penalties if you’re caught. However, if you’re confident that your income will increase in the future, it may be worth considering.

Another option is to look into your state’s Medicaid expansion program. Some states have expanded Medicaid to cover people with incomes up to 138% of the federal poverty level (FPL). If your state has expanded Medicaid, you may be eligible for coverage even if you don’t meet the traditional Medicaid income requirements.

Finally, you can also consider purchasing a private health insurance plan. Private health insurance plans can be expensive, but they may be your only option if you don’t qualify for Medicaid or ACA subsidies.

It’s important to note that the ACA coverage gap is a complex issue with no easy solutions. If you’re in the coverage gap, it’s important to weigh your options carefully and make the decision that’s best for you and your family.

Tips for Avoiding the Coverage Gap

If you’re worried about falling into the coverage gap, there are a few things you can do to avoid it:

Make sure you’re aware of your state’s Medicaid expansion program. If your state has expanded Medicaid, you may be eligible for coverage even if you don’t meet the traditional Medicaid income requirements.
Estimate your income carefully when applying for ACA subsidies. If you’re self-employed, it’s important to estimate your income accurately. If you underestimate your income, you could end up paying back the subsidies you received.
Consider purchasing a private health insurance plan. Private health insurance plans can be expensive, but they may be your only option if you don’t qualify for Medicaid or ACA subsidies.

The ACA coverage gap is a complex issue, but it’s important to be aware of your options if you’re at risk of falling into it. By taking the steps outlined above, you can help ensure that you have access to affordable health insurance coverage.

If you’re still unsure about what to do, you can always reach out insurance licensed agents for help. Trained agents have the experience and expertise to help you navigate the ACA and find the best health insurance plan for your needs.