Let's Talk About ACA and Health Insurance.... - Single Moms Income (2024)

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This post is sponsored by UnitedHealthcare. All opinions and, of course, personal stories are my own.

I think it would be fair to say that many people are confused when it comes to the Affordable Care Act and getting health insurance.

I, personally, was excited when the ACA law passed. Then after hearing so many opposing views and misinformation I became a little confused. Shortly after, I was asked by a then-client to help ghost write an eBook on all the new changes. To really understand what I was talking about I started reading fact-based books and articles, pushing all opinions aside.

I learned a lot.

An Intro to ACA

What I really want to talk about today is how do you know what health insurance, and more importantly, what kind of coverage you should have?

But first I think it’s important that you know the facts. (Not opinions, but facts.)

It would take all day to go over every fact so watch this video if you’re not really sure what’s going on. Or you can read my post here.

Important notes:

  • The Medicaid income limit has been increased in several states meaning if you’re struggling but not in the poverty limit you might qualify for Medicaid.
  • The healthier you are the cheaper your insurance will be. (Nothing new, right?)
  • Insurance companies cannot turn down people with pre-existing conditions.
  • The ACA marketplace (healthcare.gov or your state specific marketplace website) is sort of like a Travelocity or Expedia for Health Insurance, meaning you put in your information and are presented with several options from different health insurance companies.
  • Open enrollment runs from Nov. 15th – Feb. 15th

How Much Coverage Do You Need?

If you think you might be eligible for Medicaid then please, please do yourself a favor and find out! If you fall in the income eligibilities for Medicaid then you need to take advantage. There’s nothing wrong with having Medicaid.

If you don’t qualify for Medicaid then your next step is determining what kind of policy you want. And remember, the higher the deductible the lower the price. But what YOU need is specific to you.

When you get a quote through the marketplace you’ll see a bunch of different policies you can choose from with varying deductibles. The deductible will be what you pay before the insurance picks up and starts covering the bill. It’s also important to note that some policies only pay so much even after you meet the deductible so be sure that you know what you’re buying!

Take me for instance, I am young-ish (I’ll be 29 in September) and have had very minimal health problems. I very rarely ever go to the doctor and when I do I go through Urgent Care that charges a flat $50. (Because he’s the only doctor I like in my town.)

I also have a pretty decent emergency fund. I am completely fine with a $10,000 deductible with a health insurance company picking up 100% of the bill after that.

What’s important for me is avoiding huge medical debt. If something catastrophic were to happen to me I could cover the first $10,000. (It might break me but it wouldn’t put me in debt.) However, if I all of a sudden had a $50k+ medical bill I would be ruined.

In addition to the stress of being sick and/or badly injured I would be completely stressed out worrying about the $50k worth of debt.

You however might not be comfortable footing the first $10k. It’s an extremely personal decision and there is no one-size-fits-all solution.

After determining what kind of coverage you want and need you can then narrow down your options and look at pricing. (Which is also going to be an extremely important factor.) You can check out this UnitedHealthcare page to get help finding a policy too. In all honesty it really is a helpful and easy to use tool if you want to look at some of your options. (It took me all of two minutes to fill in the basic info.)

Getting Help and Receiving Your Policy (Plus My Biggest Frustration)

So the biggest frustration I’ve had so far is that I thought my ex had both of the girls covered on his policy last year. When he went to renew this year they said neither of the girls were ever covered.

Say what?

To make a long story short he and I both had trouble with the Marketplace website last year. He called the Marketplace hotline to get help and ended up talking to several different representatives. Although his intentions were to have coverage for both of the girls, that never happened. There was obviously some miscommunication somewhere along the line.

He never reviewed his policy when it came in! He just assumed that both girls were covered. Please be clear if you’re getting a policy via the phone and inspect your policy with a fine toothed comb when it comes in. You need to know what you have.

Wrapping It Up

Getting coverage really isn’t that hard of a concept. Log onto the Marketplace website put in your information and get quotes. We’re still in open enrollment period so if you want to save money you can check out UnitedHealthcare here and see what they can offer.

If you have to talk to a Marketplace representative be crystal clear on the type of policy you want and who you want covered. Then REVIEW your policy after you get it!

What have your experiences with the Marketplace been like?

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Let's Talk About ACA and Health Insurance.... - Single Moms Income (2024)

FAQs

What is the highest income to qualify for ACA? ›

The income range is $30,000 to $120,000 in 2024 for a family of four. (Income limits may be higher in Alaska and Hawaii because the federal poverty level is higher in those states.) The American Rescue Plan Act of 2021 also extended subsidy eligibility to some people earning more than 400% of the federal poverty level.

What income is used to determine Affordable Care Act? ›

The Marketplace uses a measure of income called Modified Adjusted Gross Income (MAGI). It isn't a line on your tax return. Your total household MAGI amount includes countable income for each person listed on your federal income tax return for the year you're getting help paying for coverage.

Is ACA affordability based on household income? ›

For coverage starting January 1, if you're offered job-based coverage through a household member's job, affordability is based on the premium amount to cover everyone in the household. Total household income includes incomes from everybody in the household who's required to file a tax return.

Who qualifies as a dependent for ACA? ›

Typically, dependents can include your spouse, children under a certain age (often up to 26), and sometimes other relatives like stepchildren or legally adopted children. It's important to check your specific plan's rules regarding dependent eligibility.

How much is Obamacare a month for a single person? ›

Average Obamacare costs per month by plan type
Health insurance plan memberAverage monthly cost for an HMO planAverage monthly cost for a PPO plan
Adult individual age 21$342$404
Adult individual age 27$361$423
Adult individual age 30$390$458
Adult individual age 40$438$516
17 more rows
Jan 3, 2024

Will I get penalized if I underestimate my income for Obamacare? ›

If you receive Affordable Care Act tax credits and underestimate your annual income, you may have to pay them back. The rules vary depending on the year. Nolo was born in 1971 as a publisher of self-help legal books.

What is not counted as income? ›

Nontaxable income won't be taxed, whether or not you enter it on your tax return. The following items are deemed nontaxable by the IRS: Inheritances, gifts and bequests. Cash rebates on items you purchase from a retailer, manufacturer or dealer.

What disqualifies you from the premium tax credit? ›

A19. If you enroll in an employer-sponsored plan, including retiree coverage, that is minimum essential coverage you are not eligible for the Premium Tax Credit for your Marketplace coverage, even if the employer plan is unaffordable or fails to provide minimum value.

What is the lowest income to qualify for healthcare.gov 2024? ›

Federal Poverty Level (FPL)
Family size2023 income numbers2024 income numbers
For individuals$14,580$15,060
For a family of 2$19,720$20,440
For a family of 3$24,860$25,820
For a family of 4$30,000$31,200
5 more rows

Does ACA go by gross or net income? ›

Under the Affordable Care Act (ACA), eligibility for Medicaid, premium tax credits or premium subsidies, and cost-sharing reductions or is based on modified adjusted gross income (MAGI).

What is the 95% rule for ACA? ›

Employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties. This is known as the employer mandate.

Does healthcare.gov want gross or net income? ›

To report expected income on your Marketplace health insurance application, you can start with your most recent year's adjusted gross income and update it based on income and household changes you expect for the coverage year.

How does the ACA define a household? ›

The Marketplace generally considers your household to be you, your spouse if you're married, and your tax dependents. Your eligibility for savings is generally based on the income of all household members, even those who don't need insurance.

What income is used to calculate healthcare subsidies? ›

Under the Affordable Care Act, eligibility for subsidized health insurance is calculated using a household's Modified Adjusted Gross Income (MAGI). You are expected to pay a premium contribution limit (a percentage of your annual income) for healthcare coverage.

Who are the two types of qualifying individuals who can be dependents? ›

A dependent must be either a qualifying child or qualifying relative.

Is ACA based on adjusted gross income? ›

Under the Affordable Care Act (ACA), eligibility for Medicaid, premium tax credits or premium subsidies, and cost-sharing reductions or is based on modified adjusted gross income (MAGI). But the ACA has its own calculation of MAGI, which differs from MAGI calculations used for other purposes.

What is the Medi-Cal income limit in 2024? ›

EWC 2024 Income Eligibility Guidelines
Number of Persons in Family/HouseholdMonthly Gross Household IncomeAnnual Gross Household Income
1$2,510$30,120
2$3,407$40,880
3$4,303$51,640
4$5,200$62,400
5 more rows
Mar 8, 2024

Why am I not eligible for Covered CA? ›

You do not have other health coverage (such as free Medi-Cal or employer-sponsored insurance) that prevents you from qualifying for insurance through Covered California. Covered California stated that you are not a California resident. Covered California stated that you did not pay your premiums by your due date.

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