If you have an ACA plan and become eligible for Medicare, you should switch to Medicare. Keeping both can lead to complications and higher costs, as you cannot qualify for premium assistance once you are eligible for Medicare. 

You don’t! You cannot advise if someone qualifies for Medicaid. Medicaid uses Income, Federal Poverty Level, and factors such as age, disability status, pregnancy & household size to determine eligibility. ACA uses Income, % of Federal Poverty Level, and household size plus whether their state expanded Medicaid eligibility. When an agent submits an application, the Marketplace determines whether the client should go to Medicaid or ACA.   

There are no specific age restrictions for ACA coverage. However, individuals over 65 are generally eligible for Medicare and may not qualify for an ACA plan unless they aren’t eligible for Medicare. 

To help clients compare ACA plans, you must review coverage options, premiums, deductibles, out-of-pocket costs, and provider networks. The Health Insurance Marketplace offers tools to compare plans side-by-side, and you can assist clients in understanding their specific health needs.   NCC also offers the HealthSherpa platform that includes quote comparisons that can be sent to customers.

ACA open enrollment typically runs from November of the current calendar year to January of the following calendar year. Details Here (Special enrollment periods are available if certain life events occur (e.g., marriage, loss of coverage, or moving). 

If someone does not have ACA insurance and does not qualify for an exemption, they may face a penalty (though the penalty was reduced to $0 at the federal level starting in 2019, some states still enforce their own penalties). 

ACA plans primarily focus on offering health coverage for those under 65 who are not eligible for Medicare. Medicare is a federally managed program for those 65 and older or with certain disabilities. ACA plans generally offer more comprehensive coverage and flexibility in choice of plans and providers. 

ACA plans vary by state, but they generally come in four levels: Bronze, Silver, Gold, and Platinum. These levels reflect the percentage of healthcare costs the plan covers. You should check your state’s marketplace for specific plans available. 

No, people who are eligible for Medicare cannot use ACA plans, and as such, agents cannot sell ACA insurance to individuals already enrolled in Medicare. 

• Be a U.S. citizen or legal resident. 
• Be under 65 (unless not eligible for Medicare). 
• Not have access to affordable employer-sponsored insurance or other qualifying health coverage. 

Income limits for ACA subsidies depend on the Federal Poverty Level (FPL) and household size. Typically, individuals with incomes between 100% and 400% of the FPL may qualify for subsidies, but these limits vary slightly by state. 

Commissions for selling ACA plans are typically paid Per Member Per Month as long as coverage is in force.    The compensation amount varies by state and carrier.  

Yes, individuals can transition from an ACA plan to Medicare when they become eligible, and they are encouraged to enroll in Medicare during the 7-month Initial Enrollment Period (3 months before, the month of, and 3 months after their 65th birthday). 

ACA plans often include prescription drug coverage as part of their benefits. Coverage varies by plan, but most include a formulary of drugs covered under the plan, with varying levels of cost-sharing. 

While the federal penalty for not having ACA coverage was eliminated starting in 2019, some states may impose a penalty for not having coverage, including California, Massachusetts, New Jersey, Rhode Island, and Washington, D.C.