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Understanding The Advanced Premium Tax Credit
Who Qualifies?
To qualify, you must meet the following criteria:
- Must have legal presence in United States
- Must meet income guidelinesby being above 138% of Federal Poverty level and the cost of the second lowest silver plan must be more than 8.5% of income.
- Must file taxes with IRS and must file jointly if married
- Cannot be enrolled in other qualified health coverage including employer coverage
When is the enrollment period?
Open Enrollment runs from October 15 – December 15 each year
Special Enrollment Periods generally last for 60 days and begin on the date of change:
You get married.
Your family size increases from having a baby or adpoting.
You move to Idaho and you had insurance where you moved from.
You are newly eligible and have income between 138% and 150% of Federal Poverty Level.
You haev a loss of other minimal essential coverage including Medicaid.
What are the steps to get coverage?
- Create Your Health Idaho account
- Complete application on Your Health Idaho. You will need to indicate your adjusted gross income for the year and may need documentation to prove your income.
- Provide documentation showing you qualify for the special enrollment period. If signing up during Special Enrollment Period, you will need documentation.
- Enroll in a plan.
- Make your first payment. In order for the policy to be active you must make the first payment known as a binder payment
Types of coverage
- Bronze Plans
- High Deductibles
- High Out of Pocket Maximums
- HSA plans available
- Lower premiums
- Silver Plans
- Lower deductibles than Bronze plans (You can also qualify for cost sharing which lowers your copays, deductibles and out of pocket maximum, depending on income.)
- Can have more benefits prior to reaching deductible
- Higher premiums than Bronze plans.
- Gold Plans
- Lower deductibles
- Can have lower out of pocket maximums
- Generally have lower member coinsurance
- Higher premiums
What to do after you enroll
- Make your first payment.
- Make sure you receive your member cards.
- If you have any changes in income, household size, address or if you go to jail, report it.
- When you get a notice from either the insurance company or Your Health Idaho, talk to your agent to make sure everything is still in good standing.
- Any phone or email solicitations, contact your agent.
What to expect after enrollment
- Receive a confirmation email from Parker Insurance stating your plan and your premium.
- Receive information regarding your plan from the carrier within 10 business days.
- Receive notices from Your Health Idaho regarding any changes to your plan or Advanced Premium Tax Credit.
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