The best way to determine your eligibility for a Marketplace health plan is to sign up for an intake appointment with one of our health insurance specialists. In general, to be eligible you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated. Visit ProsperHealthCoverage.org or call the health coverage helpline at (512) 381-4520 to schedule an appointment.
Most people who are eligible to purchase coverage in the Marketplace receive some financial help to pay for coverage. More than 90% of people Foundation Communities helped in 2019 received some financial help. You may not be eligible for financial help if you have other health insurance options, such as an offer of health insurance from your employer.
When can I sign up?
Marketplace open enrollment runs from November 1 through December 15. This is the only time of the year when you can sign up for a Marketplace health insurance plan, unless you have a qualifying event, such as moving, getting married, or having a baby.
How much does it cost?
Everyone’s situation is different. There are a range of plans and prices available, depending on your income and family size and the type of coverage you choose. More than 90% of people we help at Foundation Communities get some financial help to pay for coverage, which reduces the “sticker price” of monthly premiums. Don’t let concerns about cost be a barrier to exploring your options. Our health insurance specialists will walk you through the plans and prices. You may be surprised at the choices available to you.
Can I get financial help to pay for my plan?
More than 90% of people we help at Foundation Communities get financial help to pay for their health coverage. The subsidies, or tax credits, can reduce the monthly cost you pay for your plan (the premium). You may also be eligible for help covering office visit co-pays and other healthcare expenses. Our health insurance specialists will help you get the maximum financial help available.
Will my plan cover any pre-existing conditions?
All Marketplace health insurance plans cover pre-existing conditions, as well as a range of other health benefits. See the full list of essential health benefits on Healthcare.gov.
Will a Marketplace health plan cover coronavirus testing and/or treatment?
Marketplace health plans are required to cover laboratory tests and services, though the coverage for specific tests may vary plan by plan. COVID-19 testing and treatment is covered by Marketplace health plans, just the same as any other viral infection.
If you currently have a Marketplace health insurance plan and your household has been affected by COVID-19, please get in touch with us because you may be able to change your plan or get additional financial help. Call us at 512-381-4520. Some changes to consider:
- Reduced hours/reduced income
- College student now living at home because campus closed
Can I get help finding the best plan for me/my family?
Yes! Foundation Communities’ health insurance specialists have researched all the plans and prices to help you find the best plan to meet your healthcare needs and budget. You can get started by signing up for an initial intake appointment at ProsperHealthCoverage.org, or by calling us at 512-381-4520.
Can I change my health plan after I’ve signed up?
You can change your health plan any time between November 1 and December 15. After the December 15 deadline you can only make changes if you have a qualifying event, such as moving, getting married, or having a baby. Our health insurance specialists can help you make changes to your plan year-round if your circumstances have changed.
I’m currently unemployed. What happens if I get a new job after I’ve signed up for a health plan?
Everyone’s situation is different. If you get a new job please reach out to us so we can help you determine your best option. Call our health insurance helpline at 512-381-4520.
I’m currently unemployed and on COBRA. Can I sign up for a different plan through the Marketplace?
Yes! Open enrollment is the only time of year you can switch from COBRA to another plan unless you have a qualifying event, such as moving, getting married, or having a baby. We strongly encourage anyone on COBRA to explore their options. Marketplace health plans may be more affordable, and you may qualify for financial help to pay for coverage. You can get started by signing up for an initial intake appointment at ProsperHealthCoverage.org, or by calling us at 512-381-4520.
I lost my job because of COVID-19. Do my unemployment payments count in determining any financial help I might get to pay for my plan?
Yes. You’ll need to report your expected unemployment compensation when applying for health coverage through the Marketplace. When you apply for a Marketplace health plan, a health insurance specialist will help you estimate your income for 2021 to determine what financial help you qualify for.
What if I don’t know what my income will be next year? Can I still sign up for a health plan?
Yes! Make an appointment to get started with one of our health insurance specialists. They will help you estimate your income for 2021 and find the best plan option to meet your healthcare needs and budget. Sign up at ProsperHealthCoverage.org or call 512-381-4520.
What’s the difference between a Bronze, Silver, or Gold health plan?
The different levels determine how you and your health insurance split costs for your health care. The quality and type of care is not affected. For example, a Gold level plan may have a higher monthly cost (the premium), but you will pay a smaller percentage of the costs when you need care. A Bronze level plan may have less costly monthly premiums, but you’ll pay more when you need care. Our health insurance specialists can help you determine which type of plan is best for your healthcare needs and budget.
How can I find out if my doctor is in my chosen plan, or if my medications are covered?
Each year we research all the plans and prices so we can help you find the best plan to meet your healthcare needs and budget. Make a list of your doctors and medications before your appointment with a health insurance specialist. They will review the plans to make sure they have the coverage you need. Sign up for an intake appointment to get started at ProsperHealthCoverage.org or call 512-381-4520.
Can I be charged extra for any reason, like my age or because I’m a woman?
Marketplace health plans cannot charge you more because you’re a woman, or because you are pregnant or have pre-existing conditions. You can be charged up to 50% more if you use tobacco. Premiums can increase as you get older.
How do I apply for financial help to pay for my health plan?
When you sign up for a Marketplace health plan you’ll provide information about your household size and income. This will help determine how much financial help you will get. Our health insurance specialists will walk you through the sign-up process to make sure you qualify for the maximum financial help to pay for coverage.
Does my $1200 tax credit from earlier this year count as income for determining any financial help I might get to pay for my plan?
No. You don’t need to include the tax credit/stimulus payment in the income you report on your Marketplace application. These payments don’t impact your eligibility for financial help to pay for health care coverage through the Marketplace.
How will my immigration status affect my ability to sign up for a Marketplace health plan, or get financial help to pay for it?
Immigrants who are lawfully present in the U.S. can purchase health insurance on the Marketplace. Our health insurance specialists are experienced with helping immigrants sign up for health insurance and submit information to verify their status, if necessary. Only the person(s) applying for health coverage need to provide information about their immigration status. Undocumented household members who are not eligible for Marketplace plans do not need to provide any information.
Does financial help to pay for Marketplace health plans count against the public charge?
Receiving financial help for Marketplace health insurance does not count toward the determination of a public charge for anyone. Do not be afraid to insure yourself and your eligible family members. If you are a lawful permanent resident or green card holder, nothing about public charge applies to you. If you have a humanitarian status (for example, if you are an asylee or refugee), nothing about public charge applies to you.
Marketplace insurance and financial assistance do not affect your ability to become a resident or a citizen. But they can help you and your family stay healthy! If you have any questions or concerns about public charge related to Marketplace insurance plans, call us at 512-381-4520. We are here to help!