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ACA Rules for Individuals

Individual Mandate 
The Affordable Care Act or ACA (commonly known as Obamacare) requires most individuals to obtain a plan approved by the ACA, for themselves and their family members or pay a penalty. The penalty or fee for those who do not obtain health insurance is as follows:

2.5% of income, or $695 per adult, whichever is greater. 

There are a very limited number of exceptions to the insurance mandate, mainly affecting non-citizens, American Indians, incarcerated individuals, religious objectors and people suffering from poverty or hardship. Exceptions are also available for people with short gaps in coverage of fewer than three months

When Can I Enroll?

Open enrollment general begins November 1 and ends January 15th. These rules are set by the government and are subject to change.
 
Open enrollment means you can enroll at that time. Everyone is accepted. Outside of the open enrollment period, you must have a change in your health insurance, family status or location. The following are “triggering events” that will allow you to enroll in an individual health plan outside of open enrollment -
  • Birth of a baby, adoption of a child or placement of a child for foster care
  • Change in marital status
  • Move to a new permanent address in your state
  • Changes in your income that affect the financial assistance you qualify for
  • Change of tribal status
  • Become a U.S. citizen
  • Leaving incarceration
  • Change of dependency status of someone on your plan
  • Death of a covered member of your household
  • Turning 26 and aging off your parent’s plan
  • Starting/ending AmeriCorps service
  • Incorrectly or inappropriately enrolled in a health plan for some reason that is not due to an error or omission on the part of Connect for Health Colorado
  • Violation of the contract you had with your health insurance carrier
  • Loss of an exemption to purchase health insurance coverage
  • Change in affordability of employer-sponsored insurance
  • Loss of minimum essential coverage

How Can I Enroll?

You may enroll through a marketplace or directly through the insurance carrier or through an insurance broker like Benefit Link Corporation.

Health Insurance Marketplace -
The ACA calls for the creation of health insurance marketplace, also known as Affordable Health Insurance Exchanges, for individuals and small businesses to purchase private health insurance. The marketplace allows for direct comparisons of private health insurance options on the basis of price, quality, and other factors, and coordinates eligibility for premium tax credits and other affordability programs. The Marketplace became operational in 2014.
 
The marketplace is the only place one may apply for coverage and receive financial assistance from the government. The financial assistance is known as a subsidy. This means the government pays part of your premium. As a broad guideline, the following are the upper-income limits to be eligible for a subsidy:
  • Up to $46,680 for individuals
  • Up to $62,920 for a family of two
  • Up to $79,160 for a family of three
  • Up to $95,400 for a family of four
  • Up to $111,640 for a family of five
  • Up to $127,880 for a family of six
  • Up to $144,120 for a family of seven
  • Up to $160,360 for a family of eight
You must apply through Connect for Health Colorado to be eligible for a subsidy. This requires you to first apply for and be denied for Medicaid. You must assign us as your broker if you wish assistance in this process.

You may only apply for a subsidy if you are not offered coverage through your employer. If your insurance costs 9.5% or more of your income, you may be eligible for a subsidy. Your employer is not allowed to pay for individual health coverage.
Connect Health Colorado

Medicaid Eligibility

  • Medicaid is the nation's health insurance program for low-income individuals and families. You must apply through Connect for Health Colorado and/or Peak to get qualified. The following are the upper income limits for Medicaid in Colorado.
  • $16,105 for an individual
  • $21,707 for a family of two
  • $27,310 for a family of three
  • $32,913 for a family of four
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