Congressman Bill Pascrell

Representing the 9th District of NEW JERSEY

Coverage Options

How to Enroll | General ACA Information

What are your coverage options?

In addition to improving the overall quality of health care, lowering costs for patients, and eliminating some of the worst insurance company practices, the Affordable Care Act (ACA) provides new opportunities for health insurance coverage, which will help 30 million currently uninsured Americans get coverage. This section outlines health insurance options available under the ACA and provides information on how to enroll.

Health Insurance Marketplace

What is the Health Insurance Marketplace?

The Health Insurance Marketplace provides consumers with a new way to buy private health insurance with the help of tax credits to off-set the cost of premiums. The Marketplace offers an array of private health insurance plans and allows consumers to choose a plan that suits their and their families’ needs. It provides a straight-forward “apples-to-apples” comparison of different plans, which helps consumers make informed decisions about the plan they’re getting.

Who is eligible to purchase health insurance on the Health Insurance Marketplace?
Marketplaces are for people who:

  • Are currently uninsured
  • Have health insurance through their employers, but the cost of that coverage exceeds 9.5% of their annual pre-tax income
  • Are not eligible for Medicaid, CHIP, or Medicare

Marketplaces are NOT for people who:

  • Are 65 or older – these people are eligible for Medicare
  • Have health insurance through their employers AND that insurance meets the affordability standards (9.5% of annual pre-tax income)

What is the Premium Tax Credit and how do I know if I’m eligible?

The Premium Tax Credit helps off-set the cost of purchasing an insurance plan on the Marketplace. It is an advanceable tax credit, meaning that consumers will receive the credit in advance of filing their taxes to help buy insurance now (not through a refund at the end of the year). The Premium Tax Credit is available to consumers with household incomes between 100% and 400% of the Federal Poverty Level (FPL), and who don’t qualify for other health insurance coverage (400% FPL equals $45,960 for an individual and $94,200 for a family of four in 2013). Your eligibility for the Premium Tax Credit will be assessed when you submit your application to determine eligibility for the Health Insurance Marketplace.

What is the Cost Sharing Reduction and how do I know if I’m eligible?

The Cost Sharing Reduction is a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments if you purchase a qualifying plan on the Health Insurance Marketplace. The Cost Sharing Reduction is generally available to those with income 250% FPL or below (250% FPL equals $28,725 for an individual and $58,875 for a family of four in 2013). The Cost Sharing Reduction discount will be applied automatically for consumers who qualify based on their income – no separate application is necessary.