Applying for a ACA Marketplace Health Insurance Plan

Steps to make it easier and what to expect…
What is the easiest way to apply for an ACA subsidized plan?

A Marketplace consumer can use an agent in all 3 application methods below:

  1. Use a government approved online “Web Broker” (easiest method in most cases)
  2. Use a specific insurance company website to integrate with the Marketplace
  3. Go direct and apply online at
Can I apply online myself without any assistance?

Yes, but why make it harder on yourself?  As a health agent, I have access to the easiest application methods, tax credit calculators, software to match your doctors to the networks, and special agent portals with client status updates to track the progress .


Who should buy a health plan ON the Marketplace?

Consumers who have low enough income to qualify for financial assistance. If so, you MUST buy your health insurance plan “ON the Marketplace” in order to receive financial assistance (called advanced premium tax credits (APTC).  This financial assistance or APTC can lower your monthly health insurance premiums.

Am I eligible for APTC?  APTC is determined by your Modified Adjusted Gross Income (MAGI), your household size, and how that relates to the Federal Poverty Level (FPL) guidelines. In Arizona, if you’re between 138% – 400% FPL, then you may be eligible for APTC.  If below 138%, then you may be eligible for AHCCCS / Arizona Medicaid.  If above 400% FPL, then you are NOT eligible for APTC.

Am I eligible for lower deductible plans? In addition to APTC, if a consumer is between 138% and 250% of FPL, you’re also eligible to buy a Cost Sharing Reduction (CSR) plan with reduced deductibles and out of pocket maximums, but only if you buy a Silver plan.

Am I eligible for Advanced Premium Tax Credits (APTC) ?

First, you must not have access or coverage through other entities like you or your spouse’s employer group plan, Medicare, Medicaid, or the VA.  Basically, you must be in a position that you need to buy your own health insurance.  Examples include:  The self employed, pre-retirees, employees of small companies who don’t offer group insurance, small business owners, and the unemployed.

Second, your income must be above 138% FPL and below 400% FPL in Arizona.  Below 138% and you’re eligible for Medicaid.  Above 400%, and you’re income is too high for APTC eligibility.

Third, other factors including your age(s), household size, county of residence, and the premium of the Second Lowest Cost Silver Plan (SLCSP).  This SLCSP is the baseline for which all tax credits are calculated. You can quickly see if you’re eligible using our web broker link, or the Kaiser Subsidy Calculator.

How much APTC can I receive to reduce my premiums?

The Advanced Premium Tax Credit (APTC) is sent from the IRS to the insurance carrier of your choice, each month, to lower your insurance premium.  You pay the additional amount each month to make up the difference for the full premium required.  The dollar amounts that people receive can be between $0 a month to over $1000 a month.  The older you are, and the lower income you receive, creates a scenario for the highest amount of tax credits to offset the large premiums. How much you ultimately receive depends on:

  1. The age(s) for everyone on the policy
  2. The number of people in your household
  3. The County where you reside
  4. The Second Lowest Cost Silver Plan in your county
  5. Your household projected income or FPL %

All tax credits that you receive in advance are subject to a “clawback” at the end of the year when you reconcile and file your taxes.  If your income is higher than you initially projected, you could be subject to paying back some or ALL of that tax credit.  Be very careful not to go over 400% FPL, as there is no maximum on the amount that can be “clawed” back.  If income comes in lower than you projected, you may be eligible for an additional refund of APTC.  Some people request for a lower amount of tax credits “advanced” than initially awarded; and instead pay a higher monthly premium with the hopes of getting the tax credit back in the form of a refund when they reconcile and file their taxes.

What is a Cost Sharing Reduction (CSR) Silver Plan?

Many consumers still don’t realize the incredible benefits afforded to those with income under 250% Federal Poverty Level (FPL).  In addition to receiving tax credits to lower the premium each month, you may also be eligible for a “free upgrade” to a Platinum or Gold plan and experience much lower deductibles, copays and out of pocket maximums.

BUT, you must buy a Silver Plan that typically represents a 70% actuarial value (AV).  (Gold is 80% and Platinum is 90%) The best possible plan that anyone can buy is the 94% AV CSR Plan (Cost Sharing Reduction).  In Arizona, it’s a thin range to qualify for this plan as your FPL must be between 138% and 150% (due to AZ expanding medicaid for under 138% FPL).  If you are within that range, then you are eligible for the richest upgrade to a 94% AV CSR Platinum Plan. I’ve seen out of pocket maximums on these plans as low as $500 to $1000 a year.  These are the richest benefit plans I have sold in my entire 10+ year career, and great prices when factoring in the subsidy / tax credit.

If you are between 150% and 200% of FPL, then you receive the second best upgrade to a 87% AV CSR plan, which is between a Gold and a Platinum AV Plan.  This is still an incredible plan at Silver Plan subsidized prices.  Out of pocket maximums that I’ve seen are between $1100 and $2500 a year.

Lastly, if you are between 200% – 250% FPL, then you qualify for the 73% AV CSR plan.  Since the increase is just 3% above the typical 70% Silver Plan, this CSR plan does not make a large impact on plan benefits. As always, it’s best to call me for the best advice, as everyone is in a different situation.

What does the entire process look like?

Getting coverage is a 3-step process.  An agent makes it a more pleasant, streamlined experience:

  1.  Your Application – The method of enrollment you choose will determine the length of time it takes to complete.  The size of your family will also be a big determinant.  Using a Web Based approved broker to apply for an ACA plan speeds up this 1st step dramatically.
  2. Documents Required – Many consumers get approved for a plan, but are required to send in proof of projected income, and/or citizenship documents.  You have typically 30- 90 days to send this in to the government before your financial assistance is taken away, or the policy is terminated.
  3. Carrier Connection – Sometimes, the biggest problem has been related to the file transfer from the government to the insurance carrier.  While that has diminished, some carriers are delayed in getting out bills and medical cards in the mail.  Just be on top of things.

William A Steffen

Arizona Health Agent


Web Broker Link

Be prepared with:

  1. Income projection for NEXT year
  2. Current insurance coverage details
  3. Social Security numbers for everyone
  4. List of doctors and medications
  5. U.S. residency document numbers