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Kaiser Family Foundation

I received a Form 1095-A from the Marketplace. What is that?

Form 1095-A gives you information about the amount of advanced premium tax credit (APTC) that was paid during the year to your health plan in order to reduce your monthly premium.  This information was also reported to the IRS.  The APTC paid on your behalf during the year was based…

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Kaiser Family Foundation

My kids are eligible for the Children’s Health Insurance Program. Can I enroll them in our Marketplace health plan and get premium tax credits for them instead?

You can add your children to your Marketplace plan, but because they are eligible for your state’s Children’s Health Insurance Program (CHIP), they are not eligible for premium tax credits. The exception to that is if you live in a state that has a waiting period for enrolling in CHIP.…

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Kaiser Family Foundation

Last year, during Open Enrollment, I applied for financial assistance and the Marketplace determined I was eligible for premium tax credits. Toward the end of this year, though, I lost my job and my total income for this year ended up being just under 100% of the federal poverty level. Will I have to repay the premium tax credits that reduced my premiums all year?

No, there is a special rule to protect people in your circumstance.  If the Marketplace found you were eligible for premium tax credits at the time you enrolled (because your best estimate at that time was that your annual income would be between 100% and 400% of the federal poverty…

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Kaiser Family Foundation

Are short-term policies available everywhere?

No.  Several states have prohibited the sale of short-term policies unless they follow all of the standards that apply to plans sold through the Marketplace — including standards prohibiting discrimination against people based on their pre-existing conditions.  These states include California, Massachusetts, New Jersey, and New York; other states may…

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Kaiser Family Foundation

Mi ingreso es muy bajo, por lo que solo debo pagar alrededor de $30 al mes por la prima de mi seguro de salud. El subsidio cubre el resto, que es más del 90% de la prima total. No pude pagar cuatro primas seguidas. ¿Puede la aseguradora cancelar mi cobertura a pesar de que recibió el 90% del pago a tiempo del IRS?

Si. Una persona que recibe un subsidio por adelantado tiene un período de gracia de 90 días para pagar todas las primas adeudadas. Si el monto adeudado por todos los pagos de primas pendientes no se paga por completo al final del período de gracia, la aseguradora puede finalizar la…

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Kaiser Family Foundation

¿Cómo puedo averiguar si mi médico está en la red de un plan de salud?

Cada plan que se vende en el mercado debe proporcionar un enlace en el sitio web del mercado a su directorio de proveedores de salud para que los consumidores puedan averiguar si sus proveedores forman parte de esa red. La información de la red de proveedores que proporcionan las compañías…

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Kaiser Family Foundation

Can I adjust the level of subsidy I collect in advance during the year when my income goes up or down? How often during the year can I make adjustments?

Yes, you can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family or insurance-eligibility changes to the Marketplace. Changes that are reported by enrollees will be verified by the Marketplace. Then the Marketplace will send…

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Kaiser Family Foundation

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

The rules are somewhat different depending on the plan your parents have. If your parents are covered under a small employer plan (less than 50 workers) provided by an insurance company through the Marketplace or outside of the Marketplace, or if your parents are covered under a nongroup policy they…

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The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.