Individuals with income below 150% of the federal poverty level, and
those who experience certain life events such as marriage, childbirth, adoption, loss of insurance coverage, moving, etc... can enroll anytime
Savings continue with the Inflation Reduction Act
For Maryland, find us on Maryland Health Connection
For Pennsylvania, find us on Pennie
Eligibility
To be eligible to enroll in a Qualified Health Plan (QHP) through the Individual Marketplace, individuals:
- Must be a resident of the state where he or she will apply for coverage.
- Must be a United States (U.S.) citizen or national, or a lawfully present non-citizen.
- Cannot be incarcerated.
You can apply for your eligible family members even if you aren't eligible for coverage yourself
Eligibility Restrictions
Individuals eligible for or enrolled in Minimum Essential Coverage (MEC) plans are generally not eligible to enroll in a QHP. MEC includes but is not limited to:
- Employer-sponsored coverage, unless determined to be inadequate or unaffordable.
- For 2022, if the employee’s premium contribution toward the employer’s self-only plan exceeded 9.61% of household income, such a plan was considered unaffordable for premium credit eligibility purposes. This affordability threshold decreased to 9.12% for 2023 and further down to 8.39% for 2024.
- If, on average, the estimated payment by the insurance company is less than 60% of the total cost of all covered services, the plan is considered inadequate for premium credit eligibility purposes.
- Medicare
- Medicaid and Children’s Health Insurance Program (CHIP). You can still enroll in a QHP when you are eligible for Medicaid or CHIP but you will not have the Premium Tax Credit (PTC) or Cost Sharing Reduction (CSR).
- TRICARE (the Department of Defense heath care program)
- Veterans Health coverage through the Department of Veterans Affairs
- Health care coverage such as local, state, or government employee’s health plans; or grandfathered health plans.
Enrollment periods
- Eligible individuals can enroll in Qualified Health Plans (QHPs) during the annual Open Enrollment Period (OEP), or during a Special Enrollment Period (SEP).
- The OEP runs from November 1st to January 15th. The coverage effective date will be January 1st for enrollment completed through December 15th. Enrollment after December 15 will have a coverage start date of February 1st.
- A life event such as marriage, divorce, childbirth, adoption, loss of insurance coverage, moving, etc.… grants a SEP to enroll in or change QHPs.
Enroll anytime if your household income is below 150% of the Federal Poverty Level
Premium Tax Credit (PTC)
To be eligible to receive the PTC, individuals must meet the following criteria:
- File federal income tax returns.
- Enroll in a plan through a Marketplace, Federal or state-based.
- Not be eligible for Minimum Essential Coverage.
- Have annual household income between 100% and 400% of the federal poverty level (FPL). However, the American Rescue Plan (ARP) signed into law on March 11, 2021, temporarily lifted the 400% FPL limit for the plan year 2021 and 2022. Per this ARP provision, eligible individuals with income above 400% of FPL qualified for PTC if their premium for the second lowest silver plan in their area exceeded 8.5% of their income. Signed into law on August 16, 2022, the Inflation Reduction Act (IRA) extended this provision through 2025.
- You can use all, some, or none of your premium tax credit in advance to lower your monthly premium when you enroll in a Bronze, Silver, Gold, or Platinum plan.
- If you use more Advanced Premium Tax Credit (APTC) than you qualify for based on your final yearly income, you must repay the difference when you file your federal income tax return.
- You can buy health insurance through other sources, but the only way to get a premium tax credit is through the Health Insurance Marketplace.
This website is not a State-Based Marketplace (SBM) or the Federal Facilitated Marketplace (FFM). You can access the FFM at https://www.healthcare.gov/
Additional information on Plans we assist with are provided on the EDE quoting platforms. We contract with technology companies maintaining the quoting platforms to streamline your health insurance coverage buying experience, securely. Learn more about the EDE process.