Enrolling In Affordable Care Act Certified Health Insurance

Understanding Federal & State Exchanges and Private Marketplaces

Last Updated November 10, 2021

Federal Open Enrollment: Nov. 1, 2021 -Dec. 15, 2021 for Jan. 1, 2022 effective date.

About This Guide

Understanding your health insurance options can be frustrating. There are multiple exchanges and marketplaces to search for plans. You may also qualify for state and federal subsidies. In this guide, we explain where you should begin looking for health insurance based on the most common circumstances.

What State Do You Live In?

AK, AL, AZ, AR, DE , FL, GA, HI, IL, IN, IA, KS, LA, ME, MN, MS, MO, MT, NE, NH, NC, ND, OH, OK, OR, SC, SD, TN, TX, UT, VA, WV, WI, WY

CA, CO, CT, DC, ID, KY, MA, ME, MD, MN, NV, NJ, NY, NM, PA, RI, VT, or WA

Terminology To Know

Certified ACA Plan

An Affordable Care Act policy must meet 10 minimum essential services. These include, emergency services, abulatory patience services, hospitilization,  prescription drug benefit, laboratory services, mental health and substance use disorders, hospitilization, pediatric services, rehabilitative services, preventative and chronic disease management.

What is an exchange?

An exchange is simply a platform for enrolling. An exchange may be online or a licensed agents can help enroll in person or over the phone.

What are the types of exchanges?

“On-exchange” – Have health insurance plans that are available on the federal and state exchanges only. If you qualify for a subsidy and choose to use it on your health plan, then shopping on-exchange is your best option.

“Off-exchange” – Are private marketplaces that have ACA certified health insurance. Plans may be purchased directly from an insurance company, or with the help of a broker, like SASid.  Cost-sharing and premium subsidies are not available if you buy an off-exchange plan, even if you’d otherwise be eligible.  You may not claim the premium subsidy on your tax return if you bought an off-exchange plan.

The Federal Health Care Marketplace

Persons living in AK, AL, AZ, AR, DE , FL, GA, HI, IL, IN, IA, KS, LA, ME, MN, MS, MO, MT, NE, NH, NC, ND, OH, OK, OR, SC, SD, TN, TX, UT, VA, WV, WI, WY

Off-Exchange ACA Compliant Health Insurance

Most people will shop a private off-exchange marketplace to look for Affordable Care Act health insurance if they do not qualify for a federal or state subsidy.

Advantages of private Off-Exchange Marketplace

  1. Same plans as healthcare.gov with the same prices
  2. Fewer questions in the enrollment process
  3. Call licensed insurance agents for advice (free)

 

On-Exchange Health Insurance

Examples of subsidized coverage include Medicaid and the Children’s Health Insurance Program (CHIP). Marketplace insurance plans with premium tax credits are sometimes known as subsidized coverage too.

  • In states that have expanded Medicaid coverage, your household income must be below 138% of the federal poverty level (FPL) to qualify.
  • In all states, your household income must be between 100% and 400% FPL to qualify for a premium tax credit that can lower your insurance costs.
  • If your income is above 400% FPL, you may still qualify for savings on a 2021 Marketplace health insurance plan.

State Health Care Exchanges

Persons living in CA, CO, CT, DC, ID, KY, MA, ME, MD, MN, NV, NJ, NY, NM, PA, RI, VT, or WA

Off-Exchange Health Insurance

If you do not qualify for a state or federal subsidy, you may quote and enroll through the private off-exchange marketplace. The advantage of using a broker is accessibility to get answers to questions.

 

On-Exchange Health Insurance

Examples of subsidized coverage include Medicaid and the Children’s Health Insurance Program (CHIP). Marketplace insurance plans with premium tax credits are sometimes known as subsidized coverage too.

  • In states that have expanded Medicaid coverage, your household income must be below 138% of the federal poverty level (FPL) to qualify.
  • In all states, your household income must be between 100% and 400% FPL to qualify for a premium tax credit that can lower your insurance costs.
  • If your income is above 400% FPL, you may still qualify for savings on a 2021 Marketplace health insurance plan.

 

 

Where To Look

Visit your state’s exchange website. Links are below.

California: Residents can view/shop On-Exchange (Covered California) and Off-Exchange (Carrier Direct) plans, which will sync to your state and federal exchanges.

Colorado:  Connect for Health Colorado

Connecticut:  Access Health CT

District of Columbia:  DC Health Link

Idaho:  Your Health Idaho

Kentucky:  Kynect Website

Maine:  CoverME Website

Maryland:  Maryland Health Connection

Massachusetts:  Massachusetts Health Connector

Minnesota:  MNsure Website

Nevada:  Nevada Health Link

New Jersey:  New Jersey Health Link

New Mexico:  BeWellNM Website

New York:  New York State of Health

Pennsylvania:  Pennie Health Link

Rhode Island:  HealthSource RI

Vermont:  Vermont Health Connect 

Washington:  Washington Health Plan Finder

About SASid

SASid insurance development’s mission is to make health insurance simple to understand. Recognized by the Department of Health and Human Services, we’ve helped hundreds of thousands of people understand and access Affordable Care Act compliant insurance.

Licensed and Healthcare Certified Consultants

We’re here to help answer questions.

Hours of Operation:
M – F, 7:00 A.M. – 4:00 P.M. EST

855.826.0021

If you have an issue with your enrollment, please email applications@sasid.com with a screenshot of your issue.

 

Federal Recognition

“We thank SASid for their important work and incredible service they provide to so many consumers during Open Enrollment and beyond.” Randy Pate, Director for the Center for Consumer Information & Insurance Oversight within the United States Department of Health and Human Services.