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Anyone without health insurance has about two weeks left to get 2023 coverage through the public marketplace — and subsidies could make it affordable.
Open enrollment for the Federal Health Exchange runs through January 15, with coverage coming into effect on February 1. (If your state has its own exchange, the last day of enrollment may be different.) After the enrollment window closes, you “Generally need to experience a qualifying life event — i.e., child birth or marriage — to qualify for a special enrollment period obtain.
Most Marketplace registrants — 13 million up from 14.5 million in 2022 — are eligible for federal subsidies (technically tax credits) to help pay rewards. According to the Centers for Medicare & Medicaid Services, four out of five customers will be able to find 2023 plans for $10 or less per month after accounting for those tax credits.
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Some people may also be eligible for cost-sharing assistance, such as B. Deductibles and co-payments for certain plans.
Most often, individuals who insure through the federal (or state) exchange are self-employed or do not have access to workplace insurance, or are not eligible for Medicare or Medicaid.
As of December 15, nearly 11.5 million people had selected a plan through the marketplace, according to CMS.
The tax credits are now more generous
Subsidies are still more generous than before the pandemic. The subsidies, which were temporarily expanded for the years 2021 and 2022, were extended until 2025 in the Anti-Inflation Act, which came into force in August.
This means there is no income cap to qualify for subsidies and the amount anyone pays for rewards is capped at 8.5% of their income as calculated by the exchange. Prior to the changes, assistance was generally only available to households with incomes between 100% and 400% of the federal poverty line.
The Marketplace Subsidies you are eligible for are based on factors such as income, age, and the second cheapest “Silver” plan in your geographic area (which may or may not be the plan you sign up for).
For the income portion of the determination, you must estimate it during the 2023 filing process.
A good estimate is important
Be aware that it is important to make a good estimate.
If your annual income is higher than what you declared when registering, this may mean that you will not receive as much benefit as you receive. And any overage would need to be accounted for at tax time in 2024 – which would reduce your refund or increase the amount of tax you owed.
“You don’t want a nasty surprise when you pay your taxes next year,” said Cynthia Cox, director of the Kaiser Family Foundation’s Affordable Care Act program.
If you are entitled to more than you received, the difference would either increase your refund or reduce the amount of tax you owe.
In any case, you can adjust your income estimate at any time during the year or identify relevant life changes (e.g. birth of a child, marriage, etc.) that could affect the amount of subsidies you are entitled to.
Falling behind on rewards can mean you get dropped
Be aware that if you fail to pay your premiums (or your share of them), you may face cancellation of coverage and unpaid claims.
For insured persons who receive subsidies, the insurance cover usually lapses after three months if the contributions are not made up for. Depending on the federal state, there is only a waiting period of about one month before termination for those who pay the full contributions because they are not entitled to funding.
If you end up without insurance, you will not be able to re-enroll through the marketplace unless you qualify for a special enrollment period.
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