How do I apply for Obamacare or Marketplace insurance?
What to gather before you start, the four ways to apply, and the steps where applications most often go wrong.
The application takes about half an hour if you have your information ready. Most of the difficulty is in the preparation and in a few specific spots where people get tripped up.
What to gather first
- Names, dates of birth and Social Security numbers for everyone in your tax household
- Immigration document numbers for any lawfully present member who is not a citizen
- Your best estimate of household income for the coming year
- Recent pay stubs, or profit and loss records if self employed
- Employer name and contact information, plus any coverage they offer and what it costs
- Policy numbers for any current coverage
- Your doctors' names and your medication list, for choosing a plan afterward
See the full document checklist.
Four ways to apply
- Online at HealthCare.gov, which is the fastest route
- By phone with the Marketplace call center, available around the clock during open enrollment
- With a licensed agent, at no additional cost to you
- With a certified navigator or assister, who can help with the application but cannot recommend a specific plan
Texas uses the federal marketplace. There is no separate state exchange to find.
Where applications go wrong
- Income estimate. Report expected income for the coverage year, not last year's. Self employed applicants should use income net of expenses.
- Household definition. Include everyone on your tax return, even if they will not be on the plan. This is the most common error.
- Employer coverage questions. Answer accurately about what your employer offers, since an available affordable offer generally disqualifies you from a subsidy.
- Document requests. The Marketplace often asks for proof of income, identity or immigration status. Upload it promptly, because missing the deadline can end your coverage.
- Choosing on premium alone. The cheapest premium usually carries the highest deductible.
Watch for document requests after you enroll. They arrive by mail and through your Marketplace account, and they have real deadlines. This is the single most common reason coverage gets terminated for people who did everything else right.
Choosing the plan
After eligibility is determined you pick a plan. Consider in this order:
- Are your doctors in network? Check with the provider's billing office, by plan name.
- Are your medications on the formulary, and at what tier?
- If you qualify for cost sharing reductions, look hard at silver plans, since that is the only metal level where those savings apply.
- Compare total exposure: premium plus deductible plus out of pocket maximum.
- Then compare the extras.
After you enroll
- Pay the first premium. Coverage does not start until you do, and this stops more enrollments than anything else.
- Watch for your card and your member portal login.
- Report income or household changes during the year rather than waiting for tax time.
- Keep the Marketplace's mail. Some of it needs a response.
Common follow-up questions
When can I apply?
Open enrollment runs November 1 through January 15. Outside that window you need a qualifying life event. See special enrollment periods.
Does using an agent cost more?
No. Premiums are set by the insurer and filed with the state, and are identical whether you enroll on your own or with an agent.
What if I miss a document deadline?
Your coverage or your subsidy can be terminated. Contact the Marketplace immediately, since it is sometimes fixable if you act quickly.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
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