The Affordable Care Act

October 01, 2013, was a huge date in the history of health care.  Now, everyone is eligible for health insurance, whether you have a pre-existing condition or not.   This date really marks a lot of change for people living with HIV/AIDS.  Now, persons living with HIV/AIDS can access both private health insurance and health insurance through the federal Health Insurance Marketplace.  You can visit healthcare.gov to apply for health insurance during open enrollment.  Open enrollment starts November 1, 2015. February 15 was the last day to enroll in or change a Marketplace plan for 2016. You can still get coverage two ways:

  • If you qualify for a Special Enrollment Period due to a life change like marriage, having a baby, or losing other coverage
  • Through Medicaid and the Children’s Health Insurance Program, which provide coverage to families and individuals with limited income or other reasons.

You may also qualify for a special enrollment period that allows you to create an account and sign up for health insurance using the Marketplace website (healthcare.gov).  Once enrolled in the Marketplace, you may access the Health Insurance Program.


What is the Affordable Care Act?

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The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.


What is Federal Poverty Level (FPL)?

A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.

(The amounts below are 2014 numbers and used for calculating eligibility for Medicaid and the Children's Health Insurance Program (CHIP). 2013 numbers are used for calculating eligibility for lower costs on private insurance plans in the Marketplace for 2014 coverage.)

$11,670 for individuals$15,730 for a family of 2$19,790 for a family of 3$23,850 for a family of 4$27,910 for a family of 5$31,970 for a family of 6$36,030 for a family of 7$40,090 for a family of 8


What is a tax credit?

The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.

What is special open enrollment?

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A time outside of the Open Enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. If you don’t have a special enrollment period, you can’t buy insurance through the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days.


What is the Health Insurance Marketplace?

A resource where individuals, families, and small businesses can: learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace, and information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace encourages competition among private health plans, and is accessible through websites, call centers, and in-person assistance. In some states, the Marketplace is run by the state. In others it is run by the federal government.