Individual Coverage 

Special Enrollment vs. Open Enrollment- Do I qualify?

  • Unless it’s the Open Enrollment Period, November 1st- December 15th for 2018, a "special circumstance" is needed to enroll into a health insurance plan. That qualifies as a Special Enrollment.

What qualifies as a "Special Enrollment"?

  • Certain Life events Include:

Losing Health Coverage


Getting Married

Having a Baby

Adapting a Child

  • If you qualify for a Special Enrollment Period, you usually have up to 60 days following the event to enroll in a plan.

Using the Health Insurance Exchange-

For certain people looking for Individual health insurance, getting insurance through the Health Insurance Marketplace or Exchange is potentially more affordable, depending on whether you qualify for an Advanced Premium Tax Credit (APTC) or short-handedly known as your subsidy. For people who qualify for subsidies, using the Exchange is mandatory. For people who don’t qualify for a subsidy, there’s no reason to go through this channel and although its considered allowable, it unnecessarily complicates enrollment and other forms of coordination.

How do I know if I qualify for a subsidy?

The Health Insurance Exchange or Marketplace is a government-run servicing department which helps individuals and families shop for health insurance after determining their Advanced Premium Tax Credit (APTC) or subsidy.

Figuring out your APTC?

1) Is your income within 400% of the Federal Poverty Level 

2) Also consider Family size or the # of dependents on your tax return

2018 Federal Poverty Level Chart:

How do I report my income?

  • Rule #1: Report expected household income for the year you’re applying for coverage, not last year’s income.
  • Rule #2: On you tax return, report EVERYONES income, even if certain members aren’t applying for health coverage.

How do I estimate my income?

  • Step #1: Find your household adjusted gross income (AGI).
  • Step #2: Add the following kinds of income: Tax-exempt foreign income, tax-exempt social security benefits, tax-exempt interest.
  • Step #3: Estimate changes throughout the year.

Examples include: pay raises, employment changes, changes in supplemental income, etc.