Navigator Guide FAQ of the Week: Who is Eligible for Marketplace Coverage?


Open Enrollment is underway and runs through January 15, 2022 in most states, giving many consumers more time to shop for coverage than previous years. And thanks to the American Rescue Plan, more people than ever are eligible for financial assistance. Our Navigator Resource Guide, supported by the Robert Wood Johnson Foundation, can help Navigators and consumers throughout the entire enrollment process. During Open Enrollment, CHIR will highlight FAQs that are likely top of mind for consumers and those assisting them. This week, we focus on who is eligible for marketplace coverage.

Who can buy coverage in the marketplace?

Most people can shop for coverage in the marketplace. To be eligible you must live in the state where your marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated.

Not everybody who is eligible to purchase coverage in the marketplace will be eligible for subsidies, however. To qualify for subsidies people must not be eligible for certain other types of coverage, such as Medicare, Medicaid, or an affordable employer plan.

I’m eligible for health benefits at work, but I want to see if I can get a better deal in the marketplace. Can I do that?

Assuming you meet other eligibility requirements, you can shop for coverage on the marketplace during open enrollment or a special enrollment period if eligible, but if you have access to job-based coverage, you might not qualify for premium tax credits.

When people are eligible for employer-sponsored coverage, they can only qualify for marketplace premium tax credits if the employer-sponsored coverage is unaffordable. The way this is calculated, coverage is unaffordable only if your cost for coverage for a single person under the employer plan is more than 9.61 percent of your household income in 2022 (for 2021, it is 9.83 percent of household income).

Can I buy a plan in the marketplace if I don’t have a green card?

Potentially, yes. In order to buy a marketplace plan, you must have a qualifying immigration status, such as permanent residency (green card), certain types of visas, or refugee status. You can find more information about qualifying statuses here.

If you are not lawfully present in the U.S., you are not eligible to buy a plan on the health insurance marketplace. However, you can shop for individual health insurance outside of the marketplace. To obtain coverage, contact a state-licensed health insurance company or a licensed agent or broker. Your state Department of Insurance can help you find one.

A previous policy instituted by the Trump administration expanded the definition of a “public charge” for immigrants applying for admission to the U.S. or permanent residency (green card). That rule is no longer in effect. Enrollment in health coverage programs such as Medicaid (except for institutional long-term care) will not impact public charge determinations.

Stay tuned for more weekly FAQs from our new and improved Navigator Guide, which can be accessed here.





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