The Affordable Care Act (ACA): Understanding Eligibility and Benefits
Eligibility for ACA Health Insurance
The Affordable Care Act (ACA) has made health insurance more accessible and affordable for many individuals and families. One key aspect of the ACA is the expansion of Medicaid eligibility for low-income individuals.
Medicaid is a government-sponsored health insurance program that provides coverage to low-income individuals, families, and children. Under the ACA, states were given the option to expand Medicaid coverage to include individuals with incomes up to 138% of the federal poverty level (FPL). In Texas, however, the state has not expanded Medicaid.
As a result, individuals in Texas who earn more than 138% of the FPL but less than 400% of the FPL may fall into a coverage gap. This means that they are not eligible for Medicaid and may struggle to afford private health insurance.
Income Limits and Subsidies
For individuals who do not qualify for Medicaid, the ACA provides premium subsidies to help make health insurance more affordable.
Individuals with incomes below 150% of the FPL (about \$20,000 for a single person in 2024) are eligible for full subsidies. This means that they may not have to pay any monthly premiums for their health insurance.
Individuals with incomes between 150% and 400% of the FPL are eligible for partial subsidies. The amount of the subsidy is based on the individual’s income.
How to Apply for ACA Health Insurance
Individuals can apply for ACA health insurance through their state’s health insurance marketplace. In Texas, the marketplace is called Get Covered Texas.
When applying for health insurance, it’s important to provide accurate information about your income and household size. This information will be used to determine your eligibility for subsidies.
Seeking Assistance
If you’re having difficulty understanding the ACA or applying for health insurance, don’t hesitate to seek help. You can contact a licensed agent or visit your state’s health insurance marketplace website. Certified agents can provide you with free assistance and help you find the right health insurance plan for your needs and budget.
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