ACA Marketplace Connection
What is The Affordable Care Act (ACA)?
The Affordable Care Act (ACA), also known as Obamacare, is a federal law enacted in 2010. It requires all U.S. citizens and legal residents to have health insurance or pay a penalty. The ACA established the Health Insurance Marketplace, an internet-based system, to provide public access to shop for qualified health plans and apply for financial assistance (tax credits) to reduce monthly premiums.
When can I Apply and Enroll?
For coverage beginning January 1st, apply for coverage between November 1st and December 15th. Outside the Open Enrollment period, you may only get health insurance if you have a Life Changing Event. Visit an Assister to apply for a Special Enrollment Period (SEP).
Who Is Eligible?
- US Citizens
- Immigrants lawfully present in the U.S.
- People with pre-existing health conditions
What Will You Need To Apply?
Returning individuals and families that want to renew their coverage or apply for an exemption need to bring:
- Folder with Marketplace username & password
- Marketplace letter with Application ID
- Current family income information
Individuals applying for the first time, please provide the following information for all the people reported in your income tax return:
- Names, birth dates, and Social Security numbers
- Family income information (tax return, W2, pay stubs, net income from self-employment, unemployment, Social Security benefits, pensions, etc.)
- Proof of Legal Status (Resident card, Visa, Citizenship Certificate, etc.)
- Employer’s name, address, and phone number
- If job-based health insurance is available, please provide cost of premiums and health benefits covered
- Email address that you can access on your cell phone or computer
How Can You Apply?
Get Free Assistance Today!
- Call Us at (210) 977-7997
- Visit us online at EnrollSA.com
- In-person/virtual appointments available at the following locations:
- In-person and virtual appointments available at the following locations:
| South Park 6315 South Zarzamora San Antonio, TX 78211 |
Noemi Galvan Eling 5542 Walzem Road San Antonio, TX 78218 |
| Palo Alto 9011 Poteet Jourdanton Fwy San Antonio, TX 78224 |
Berto Guerra Jr. 5439 Ray Ellison Boulevard San Antonio, TX 78242 |
| Southside 3750 Commercial Avenue San Antonio, TX 78221 |
New Braunfels County Line 1034 West County Line Road New Braunfels, TX 78130 |
Who Does Not Need To Apply?
People with coverage from Medicare, Medicaid, CHIP, COBRA, TRICARE, Veterans Health Programs, job-based insurance, student health plans or private insurance do not need to apply. Others that don’t need to apply are people without legal status, some Americans living abroad and non-tax filers.
If your job offers health insurance, neither you nor your family may qualify for assistance, unless the plan costs more than 9.66% of your yearly salary or the plan does not cover the Essential Benefits required by law. If family coverage is more than 8.05% of the household income, you may qualify for an exemption. However, if the employer does not offer coverage for the family, your family may qualify for assistance.
People on CareLink or other medical discount programs do not meet the federal requirement to have health insurance and may be penalized. We recommend that they apply in the Marketplace and enroll in a health insurance plan or apply for an exemption.
What are the Plans, Benefits, and Costs?
Health Insurance companies can offer four types of plans that cover the same benefits at different percentages:
- Bronze=60%
- Silver=70%
- Gold=80%
- Platinum=90%
Premium rates (paid monthly) will vary based on income, family size, age, coverage area and the type of plan you choose.
People with incomes between 100% to 400% of the Federal Poverty Level will qualify for additional assistance to reduce out-of-pocket costs but must select a Silver-level plan to receive these benefits.
What is Covered?
The following are the 10 Essential Health Benefits covered by the plans:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity & New Born Care
- Mental Health and Substance Abuse Services & Treatment for Behavioral Health
- Prescription drugs
- Rehabilitative Services & Devices
- Lab tests
- Preventive and Wellness Services & Chronic Disease Management
- Pediatric Services (including dental & eye care for children)
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time of the year. There is no limited enrollment period for Medicaid or CHIP. If you qualify, coverage can begin immediately.
