Making Sense of the Health Insurance Marketplace

The good news about individual health insurance: More people will qualify for help paying their premiums in 2023 under a new law that extends tax credits until 2025.

In early 2022, nearly 17 million Americans had signed up for individual health coverage for the year, most of them using the Affordable Care Act (ACA) marketplaces (also called Obamacare). The vast majority of enrollees through the marketplaces have received a subsidy in the form of a tax credit cutting their premium.

Premiums are rising between 5 and 14 percent for 2023, more than in past years, but some people may find the increase makes them eligible for a subsidy. You can sign up on the federal site, HealthCare.gov, used by most states, from November 1 to January 15 each year.

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Be prepared for Medicaid changes

After COVID-19 was declared a public health emergency, states received federal aid to keep people in Medicaid, the joint state-federal health insurance program for people with low incomes. As a result, the uninsured rate fell to a historic low of 8 percent. Enrollment in Medicaid and a separate program for children jumped 26 percent to a record of nearly 90 million.

When the public health emergency ends January 11, an estimated 15 million people will lose coverage. Some could find insurance from employers and others are likely to switch to a subsidized ACA plan.

People in Florida, Texas, and 10 other states that did not expand Medicaid under the ACA are most at risk of losing coverage.

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Are you eligible for a subsidy?

To see if you can get a tax credit for ACA plan premiums, try this calculator. You can get help if the second-lowest cost silver plan costs more than 8.5 percent of your income.   

If your income is between $13,590 and $54,360 for an individual or between $27,750 and $111,000 for a family of four, you will be eligible for a credit.

Some people will be eligible for subsidies for their out-of-pocket costs.

Many people who are attracted to a bronze plan with a high deductible and lower premium might actually spend less if they choose a silver plan that covers more of their costs, notes the Kaiser Family Foundation.

To get started, check HealthCare.gov, or see if your state has its own website, listed here. If you didn’t apply for a discount up front, you can still get the tax break when you do your taxes. If you do get a discount and turn out to earn above the eligibility limit, you’ll owe money.

Check your state’s enrollment deadline. But remember that you can buy insurance even if you miss the deadline if you had a special situation during the buying time (this is true at many companies as well).

There are other circumstances that trigger a 60-day period to buy new insurance, if you:

• Get married
• Have or adopt a baby
• Become a U.S. citizen
• Leave prison
• Lose your other health coverage
• Move outside your current insurer’s coverage area

Don’t put off looking into your options for coverage. Polls in 2022 found that half of American adults had put off medical or dental care because of cost. Three in 10 say that they didn’t fill a prescription, cut pills in half, or skipped doses because of cost.   

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