Applying for coverage under the ACA

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Getting covered through the Affordable Care Act might feel like a combination of doing your taxes and making a big purchase that requires research.

You’ll need accurate income information for your household, plus some understanding of how health insurance works. Federal agencies will verify your identity, citizenship and income, and you have to sign that you’re providing truthful information, subject to perjury laws.

When the state health insurance markets open Oct. 1, consumers can apply online, via a call center, in person or by mail.

Here’s an overview of what to expect applying online:

  • Go to and click on “Get Insurance.” The site has links to every state market. You’ll set up an account and password. You’ll provide your contact information and the best way to reach you. Treat your password like a bank account or credit card password.
  • Now you can tackle the application. You’ll need birth dates and Social Security numbers for yourself and other family members listed on your federal tax return. You’ll also be asked if you’re a citizen. Legal immigrants will need their immigration documents.
  • Next, you’ll be asked about income. You may need your most recent tax return, pay stubs and details on other kinds of income, such as alimony, pensions and rents. You can still apply if your income is too low to file a tax return. You’ll also be asked if you have access to health insurance through your job and may be required to take that insurance if available.
  • Your personal and income details will be routed through a new government entity called the data services hub, which will ping agencies like Social Security, Homeland Security and the Internal Revenue Service for verification. The feds will also rely on a major private credit reporting company to verify income and employment.
  • If you’re like most people, you’ll get a tax credit to help pay your premiums. The credits are based on your income and keyed to the premium for a plan known as the “second-lowest cost silver plan” in your area. With your tax credit, you can finally shop for insurance.
  • You’ll have up to four levels of coverage to consider: bronze, silver, gold and platinum. Plans at every “metal level” cover the same benefits and have a cap of $6,350 a year in out-of-pocket expenses for an individual and $12,700 for families. Bronze plans generally have the lowest premiums, but cover only 60 percent of medical costs on average. Platinum plans have the highest premiums, but cover 90 percent of costs. Make sure your doctors and hospitals are in the plan you pick.

Rose Venditti McIver: 215-949-4207;