When you complete your Marketplace application, your "Eligibility Results" will tell you if you're eligible for any plans, programs, and savings. Here's more information on the programs and savings you may be eligible for, which may appear on your "Eligibility Results":
- Marketplace health plans (also called Qualified Health Plans (QHPs)): You may be able to enroll in a Marketplace health plan. All plans in the Marketplace cover the same set of essential health benefits. You can see exactly what each plan covers when you compare plans.
- Advance payments of the premium tax credits: A tax credit in the Marketplace that can be used right away to lower your monthly premium costs. You can choose how much of the tax credit to apply to your premiums each month. Any amount that’s left over at the end of the year, you get back as a credit when you file your federal income tax return. If your income changes during the year, however, you could get more or less tax credit.
- Cost-sharing reductions: A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category. If you're a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for additional cost-sharing reductions.
- State Medicaid Program: Medicaid is a joint federal and state health coverage program that helps with medical costs for children, pregnant women and adults with limited incomes, including many elderly adults and individuals with disabilities. All state Medicaid programs must cover certain benefits such as preventive care, immunizations, screening and treatment of health conditions, doctor and hospital visits, dental care for children, and in some states, adult dental care. States may cover additional benefits as well. In most cases, these services are provided at no cost to families. Children who are enrolled in Medicaid also qualify for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit that provides comprehensive and preventive health care services for children under age 21.
- State emergency Medicaid program: Emergency Medicaid is a medical program for treating people when there’s an emergency service to treat an emergency medical condition. People are eligible for Emergency Medicaid when they qualify for Medicaid based on their income and other requirements in the state, but they don’t have eligible immigration status for Medicaid. Some people may be eligible for Emergency Medicaid but can also choose to enroll in a Qualified Health Plan and get a tax credit to help pay for insurance. Other people are only eligible for Emergency Medicaid.
- Refugee Medical Assistance: Refugee Medical Assistance is a federally funded program that helps with medical costs for certain protected groups, like refugees and asylees with limited incomes. Refugee Medical Assistance is available for the first 8 months of admission to the U.S., grant of asylum, or certification as a victim of human trafficking. Refugee Medical Assistance pays for a full set of services including preventive care, immunizations, screening and treatment of health conditions, and doctor and hospital visits. In most cases, these services are provided at no cost.
- Children’s Health Insurance Program (CHIP): CHIP is an insurance program jointly funded by state and federal government that provides health coverage to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but can’t afford to purchase private health insurance coverage. All state CHIP programs cover routine check-ups, immunizations, hospital care, dental care, and lab and X-ray services. States may also cover additional benefits. Children get free preventive care, but premiums and other cost-sharing may be required for other services. Some states may require a waiting period before enrollment in CHIP, if a child previously had other health insurance.
- State Medicaid based on disability or age: Some people may qualify to get more health services and pay less for their care if they have special health care needs, like:
- A medical, mental health, or substance abuse condition that limits their ability to work or go to school
- A condition that requires help with daily activities, like bathing or dressing
- Long-term care at home or in the community
- Residence in a long-term care facility or nursing home
- A condition such as blindness or being terminally ill