If you are enrolled in an Affordable Care Act (ACA) health plan, you may already know that the ACA offers many benefits and protections for consumers, such as covering essential health benefits, preventing discrimination based on pre-existing conditions, and providing subsidies to lower the cost of premiums and out-of-pocket expenses. But did you know that there are also special programs and subsidies that can help you get more out of your ACA coverage? In this blog post, we will explain what these programs and subsidies are, how they can benefit you, and how to access them.

Special Enrollment Periods

One of the special programs that the ACA offers is the special enrollment period (SEP). This is a time outside of the regular open enrollment period (which usually runs from November to December each year) when you can enroll in or change your ACA plan if you experience certain life events, such as:

• Losing your health coverage due to job loss, divorce, aging out of a parent’s plan, etc.
• Moving to a new area where different plans are available
• Having a change in your household size, such as getting married, having a baby, adopting a child, etc.
• Becoming eligible for a new subsidy or a change in your subsidy amount
• Experiencing a hardship or a complex situation that affects your ability to enroll, such as a natural disaster, a medical emergency, a domestic violence situation, etc.

To qualify for a SEP, you must report your life event to the health insurance marketplace within 60 days of the event. You can do this online, by phone, or with the help of a local agent or navigator. You will then have 60 days to enroll in or change your plan. Depending on your situation, you may also be able to change your plan type, such as from a bronze plan to a silver plan, or vice versa.

Cost-Sharing Reductions

Another special subsidy that the ACA offers is the cost-sharing reduction (CSR). This is a discount that lowers the amount you have to pay for deductibles, copays, coinsurance, and other out-of-pocket costs when you receive health care services. To qualify for a CSR, you must:

• Have an income between 100% and 250% of the federal poverty level (FPL), which is $13,775 for an individual and $18,570 for a couple in 2022
• Enroll in a silver plan through the health insurance marketplace
• Not be eligible for other types of coverage, such as Medicaid, Medicare, or employer-sponsored coverage

If you are eligible for a CSR, you will automatically receive it when you enroll in a silver plan. You do not have to apply for it separately. The CSR will reduce your out-of-pocket costs based on your income level. For example, if you have an income of 150% FPL, your silver plan will have an actuarial value of 94%, which means that the plan will cover 94% of your health care costs on average, and you will only have to pay 6%. This is much lower than the standard actuarial value of a silver plan, which is 70%.

Premium Tax Credits

The most common and well-known subsidy that the ACA offers is the premium tax credit (PTC). This is a subsidy that lowers the amount you have to pay for your monthly premium, which is the amount you pay to your insurance company for your coverage. To qualify for a PTC, you must:

• Have an income between 100% and 400% of the FPL, which is $55,100 for an individual and $74,480 for a couple in 2022
• Enroll in a plan through the health insurance marketplace
• Not be eligible for other types of coverage, such as Medicaid, Medicare, or employer-sponsored coverage
• File a federal income tax return for the year you receive the PTC

If you are eligible for a PTC, you can choose to receive it in one of two ways:

• As an advance payment, which means that the marketplace will estimate your PTC based on your projected income and household size, and send it directly to your insurance company each month to lower your premium. You will then have to reconcile the amount you received with the amount you actually qualify for when you file your tax return. If you received more than you should have, you may have to pay some or all of it back. If you received less than you should have, you may get a refund.
• As a lump sum, which means that you will pay the full premium amount to your insurance company each month, and then claim your PTC as a refundable credit when you file your tax return. You will then receive the full amount of your PTC as a refund or a reduction of your tax liability.

The amount of your PTC depends on your income, household size, and the cost of the benchmark plan in your area. The benchmark plan is the second-lowest-cost silver plan available through the marketplace. The PTC is calculated as the difference between the cost of the benchmark plan and the percentage of your income that you are expected to pay for that plan. The percentage of your income that you are expected to pay for the benchmark plan varies depending on your income level, and ranges from 0% to 8.5% in 2022.

For example, if you are an individual with an income of $30,000 (about 270% FPL) in 2022, and the benchmark plan in your area costs $500 per month, your PTC would be calculated as follows:

• The percentage of your income that you are expected to pay for the benchmark plan is 8.33%, which is $208.25 per month ($30,000 x 0.0833 / 12).
• The difference between the cost of the benchmark plan and the percentage of your income that you are expected to pay for it is $291.75 per month ($500 – $208.25).
• Your PTC is $291.75 per month, which you can use to lower the cost of any plan you choose through the marketplace.

How to Access These Programs and Subsidies

If you are interested in accessing these special programs and subsidies, you will need to enroll in a plan through the health insurance marketplace. You can do this online, by phone, or with the help of a local agent or navigator. You will need to provide some information about your income, household size, and other eligibility factors. The marketplace will then determine if you qualify for any of these programs and subsidies, and show you the plans and prices available to you.

You can also use our online tool to compare plans and prices, and see how much you can save with these programs and subsidies. Our tool is easy to use and will help you find the best plan for your needs and budget. You can also contact us if you have any questions or need any assistance with your enrollment.

ACA coverage can offer you many benefits and protections, as well as special programs and subsidies that can help you get more out of your coverage. By taking advantage of these opportunities, you can ensure that you and your family have access to quality and affordable health care.

How to Save Money and Access More Benefits with ACA Coverage: A Real-Life Story

We spoke to David Jones, a 40-year-old accountant and father of three, who shared his experience with ACA coverage and how he used the special programs and subsidies to lower his costs and access more benefits.

How did you enroll in an ACA plan and what made you choose it?

I enrolled in an ACA plan through the health insurance marketplace online. I chose it because I needed health insurance for myself and my family, and I did not have any other options. My employer did not offer health insurance, and I did not qualify for Medicaid or Medicare. I also wanted to have a plan that covered the essential health benefits, such as preventive care, prescription drugs, and mental health services.

How did you use the special programs and subsidies to get more out of your ACA coverage?

I used the special enrollment period, the cost-sharing reduction, and the premium tax credit to get more out of my ACA coverage. I used the special enrollment period when I moved to a new state, where different plans were available. I was able to change my plan to a better one that had a lower premium and a larger network of providers.

I also used the cost-sharing reduction, which lowered my deductible, copay, and coinsurance. This helped me save money when I needed to see a doctor or get a prescription. I also used the premium tax credit, which reduced my monthly premium by more than half. I chose to receive it as an advance payment, so I did not have to pay the full amount upfront.

How has having ACA coverage benefited you and your family?

Having ACA coverage has been a great benefit for me and my family. We are able to access quality and affordable health care, without worrying about being denied coverage or charged more because of our income, age, or pre-existing conditions. We can also get preventive care, such as screenings, vaccines, and check-ups, at no extra cost. We feel more secure and confident about our health and our future. We are very satisfied with our ACA coverage and how it has helped us get more out of our health insurance. We would recommend it to anyone who is looking for a good health insurance option.

Note: The name of the interviewee has been changed to preserve his privacy.

How can DiskQuote help you find the right ACA plan for your new situation?

At DiskQuote, we work with the reliable Health Insurance and Medicare Companies to get you insurance prices. We can help you compare and enroll in an ACA plan that suits your budget and health goals.

If you are interested in getting an ACA plan for 2023, don’t wait until the last minute. Contact us today and let us help you find the deal for your health insurance. Visit our contact page to fill out a simple form. Don’t let life changes affect your health insurance coverage. Update your ACA plan today with DiskQuote! 😊