FAQs ACA Marketplace

1. What is ACA Marketplace?

a. Affordable Care Act, or Obamacare is a comprehensive health insurance program in the United States.

2. What is the PTC or subsidy (Premium Tax Credit?) 

a. The premium tax credit reduces the cost of monthly premiums and is based on your household income and number of dependents living in the home.

3. How will enrolling in an ACA health plan affect my taxes?

a. Individuals who have ACA health insurance receive Form 1095-A, which provides information needed for filing taxes.

4. Do I have to pay back the subsidy if I earned more income that I initially put on the application?

a. Yes, when you file your taxes for the year you used the Premium Tax Credit/Subsidy, you will have to pay back the adjusted amount. 

5. How much does it cost?

a. The premium varies and based on income per month.  A licensed agent can run quotes.

6. What happens if I don’t pay the first premium on time?

a. Your health insurance plan premium is due upon enrollment and prior to the first of the month for coverage to start the following month. If you do not pay the premium on time, you could lose coverage and must start over.

7. How will I know if my doctors are in network?

a. An In Network list of Primary Care doctors will be checked prior to enrolling.

8. How soon can I make my first appointment?

a. You can make your first appointment as soon as the first of the month your plan is effective if you have your member number.

9. How do I check to see if my prescription is covered?

a. Prescriptions are checked prior to enrolling.

10.  What do I need to do about services or procedures already scheduled?

a. Notify your doctor’s office that you will have new insurance and the effective date at least two weeks prior to services so that your insurance information is updated in their system.

11.  Do I need prior authorization?

a. In some instances, you might need prior authorization for prescriptions or services. Please contact member services on the back of your card and they will look up the exact service or medication to verify if you need prior authorization.