Got Your ACA Subsidy Results? What to do Next...

Sarah Sullivan
October 27th, 2019 October 27th, 2019 |
Read time: 5 minutes

Products mentioned in this blog post:

Find out if you qualify for temporary coverage for emergencies and hospitalization – Don’t go uninsured between major medical plans.

You’ve used an ACA subsidy calculator to determine whether or not you could qualify for a federal subsidy for enrolling in ACA-qualifying major medical insurance.

But what do the results mean and what next steps should you consider? Select the option below that matches your results to learn more and find out what to do next.

You Do Not Qualify for a Subsidy

What it means: Your modified adjusted gross income is too high to qualify for a health insurance subsidy. Even so, you do have some options. There are a couple of important things to keep in mind when deciding what action to take:

First, remember there is no longer a federal tax penalty for going without ACA-qualifying coverage. However, there are some states with tax penalties.

You can only enroll in individual major medical coverage during the annual open enrollment period or if you qualify for a special enrollment period. If you’re not sure if you really need or want to pay for comprehensive coverage but it’s the open enrollment period, you may want to enroll in a plan now while you can.

Finally, you can cancel your ACA health insurance anytime if you later change your mind. On the other hand, you can apply for non-ACA policies year-round in most states, however, unlike ACA plans, short term policies are not guaranteed-issue, so you can be denied coverage due to a pre-existing condition or other factors, and they do not cover the essential health benefits.

What to do next: Decide if you should proceed with enrolling in individual major medical coverage, if a non-ACA, limited benefit plan like short term medical would meet your needs or if you want to risk going without any coverage at all (not recommended!).

We’ll talk about each option in more detail below.

Enroll in Major Medical Insurance

If you go ahead with a major medical plan, since you do not qualify for a subsidy, you have options for where to obtain your policy (and you may be able to find better rates away from the public exchanges).

You can choose to enroll in coverage through:

Learn about the difference between exchange-based health plans and those sold privately.

Decide which ACA plan metal level would work best for you and your family.

The only factors that impact your premium amount are where you live, your age, whether or not you smoke, how many people are included on your coverage, and which metal level you select. Your health, medical history, and gender cannot impact your premium.1

Don’t be underinsured

Even though more Americans have health insurance since the ACA became law, more Americans are also underinsured: 23% in 2018 as opposed to 9% in 2003.2 Learn more about what it means to be underinsured and find out if you may be underinsured. There are supplemental health insurance products that can help!

Need More Coverage? Get Supplemental Health Insurance

Major medical insurance can come with high deductibles. Supplemental insurance may provide additional fixed benefits that can be used to pay down your major medical deductible or to help with other bills and expenses that you'll continue to have while you're sick or injured.

Find out which insurance products are available in your area

Non-ACA Options: Short Term Medical, Supplemental Insurance

Let’s talk a little more about non-ACA, limited benefit health insurance as another option. These plans are not ACA-qualifying minimum essential coverage and are very different from ACA coverage.

They:

  • Cover few if any essential health benefits
  • Do not include coverage for pre-existing conditions
  • Are not guaranteed issue – meaning your application can be declined
  • Have annual and lifetime benefits limits

That said, if unsubsidized ACA plan premiums are more than you can afford, a short term medical policy may be an alternative to going uninsured if you qualify.

Short term health insurance premiums may be 54% lower than ACA plans because they provide less comprehensive benefits and do not cover pre-existing conditions3 as previously mentioned.

Find out how much a short term policy could cost you.

Get a Short Term Medical Insurance Quote

(Obtaining online quotes just takes a minute.)

A few other features of short term plans

  • Typically include coverage for medical services such as hospital room and board, diagnostic physician visits, ER services, surgery and intensive care up to your policy’s maximum benefit limit (with many services excluded from coverage).
  • Use your coverage soon after your application is accepted and your premium is paid – there is typically no waiting period
  • Enroll in coverage for 30 to 364 days or longer, depending on your state (short term plans are not available in all states)
  • Choose from a range of benefit levels and deductibles – your premium amount is partly based on the benefit level you select
  • With no network limitations, you can likely keep your doctor or qualify for discounts for using select network providers

Individualized Health Insurance Coverage

One-size-fits-all health insurance may not be right for you. Learn about insurance options to meet your unique needs.

Speak to a licensed agent today.

You Likely Qualify for a Subsidy

What it means: You can get help with your major medical costs if you enroll in ACA-qualifying coverage either through the federal exchange or your state’s marketplace if it runs its own. If you want to use your ACA subsidy (technically referred to as a “cost sharing reduction”), you’ll need to enroll in a silver metal level plan.4

What to do next: Obtain a silver level health plan from healthcare.gov or your state’s Exchange.

If you qualify for subsidies and it makes coverage affordable, a comprehensive major medical plan is the best health coverage you can get especially if you tend to use healthcare services.
ACA plans:

Supplemental Health Insurance

While subsidies help with monthly premiums, you may still be facing high out-of-pocket costs (i.e., deductible, coinsurance and copays). For example, in 2019, the average silver level deductible was $4,043.5 Get a quick refresher on how deductibles work.

That’s where supplemental health insurance may be able to help. Why not take some of the premium savings from your ACA plan and put it towards additional benefits?

These benefits can be used to help with your major medical deductible and other out-of-pocket healthcare costs. Learn more about how supplemental insurance can help.

Find out how much a medical gap policy could cost you.

Get a Gap Insurance Quote

You May Qualify for Medicaid

What it means: Your income may qualify you for low-cost or free ACA-qualifying coverage through Medicaid.

What to do next: If you qualify for Medicaid, it’s likely your best health insurance option.

You can apply for Medicaid one of two ways:

  1. At Healthcare.gov, when you go through the enrollment process on the federal marketplace, your information will be sent to your state’s Medicaid administrator and they’ll contact you about enrollment.6
  2. You can apply directly to your state’s Medicaid agency.7

Summary + Next Steps

Whether or not you qualify for a subsidy or Medicaid, you do have health insurance options.

You can supplement your major medical policy to get additional benefits that may help you avoid being underinsured, or enroll in non-ACA limited-benefit coverage via a short term medical insurance policy.

Remember to follow good online shopping practices when buying health insurance online to protect your personal information.

Want professional help assessing your options? Call 888-855-6837 to speak with a licensed insurance agent today!

Need Supplemental or Short Term Insurance?

Apply in 3 Easy Steps

  • Get a quote within seconds
  • Compare multiple plans
  • Finish application online

Originally Published On October 17th, 2019
Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

Footnotes

Get Health Insurance for 2020

Open enrollment is Nov. 1 to Dec. 15, 2019 in most states. Find out if you could qualify for an ACA subsidy.

 

ACA Subsidy Calculator

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