❓ What is the ACA (Affordable Care Act)?
The Affordable Care Act — also known as “Obamacare” — is a federal law signed in 2010 that created the Health Insurance Marketplace where individuals and families can shop for health insurance plans. Key protections include: no denial for pre-existing conditions, children can stay on parents’ plans until age 26, free preventive care, and income-based subsidies that can dramatically lower your monthly premium.
❓ When is ACA Open Enrollment?
The annual Open Enrollment Period (OEP) for ACA Marketplace plans typically runs November 1 through January 15 (dates may vary slightly by year and state). Outside of open enrollment, you can only enroll if you have a Qualifying Life Event (QLE) like losing other coverage, getting married, having a baby, or moving to a new area — this triggers a 60-day Special Enrollment Period.
❓ How do I know if I qualify for an ACA subsidy?
You may qualify for a Premium Tax Credit (subsidy) if your household income is between 100% and 400% of the Federal Poverty Level — though enhanced subsidies through the Inflation Reduction Act have temporarily removed the 400% cap through 2025, meaning even higher earners may qualify for help. For 2025, a single person earning up to ~$62,000 or a family of 4 earning up to ~$127,000 may qualify. The exact amount depends on your income, location, and the benchmark Silver plan in your area.
❓ What’s the difference between Bronze, Silver, Gold, and Platinum plans?
Bronze: Lowest premiums, highest out-of-pocket costs. Plan pays ~60% of costs. Best if you’re healthy and rarely need care.
Silver: Moderate premiums and costs. Plan pays ~70%. Best value if you qualify for Cost-Sharing Reductions (CSR) at lower incomes.
Gold: Higher premiums, lower out-of-pocket costs. Plan pays ~80%. Good if you use healthcare frequently.
Platinum: Highest premiums, lowest out-of-pocket costs. Plan pays ~90%. Best if you have significant ongoing medical needs.
❓ Do I need health insurance if I’m self-employed?
While the federal individual mandate penalty was reduced to $0 in 2019, having health insurance is still strongly recommended — a single hospital visit can cost tens of thousands of dollars. If you’re self-employed, you can: purchase a plan through the ACA Marketplace (and likely qualify for subsidies), deduct 100% of your premiums on your tax return (self-employed health insurance deduction), or explore health sharing ministries or short-term plans as alternatives (though these have significant limitations).
❓ What’s the difference between an HMO and a PPO?
HMO (Health Maintenance Organization): Requires you to choose a primary care physician (PCP), get referrals for specialists, and use in-network providers only (except emergencies). Lower premiums and copays.
PPO (Preferred Provider Organization): No referrals needed, can see any provider (in or out of network), but you pay less when you stay in-network. Higher premiums but more flexibility.
Most ACA Marketplace plans in North Carolina are PPO or EPO (Exclusive Provider Organization, similar to HMO but sometimes without referral requirements).
❓ Can I get health insurance outside of open enrollment?
Yes, if you experience a Qualifying Life Event (QLE). Common QLEs include:
• Losing employer or other health coverage
• Getting married or divorced
• Having or adopting a baby
• Moving to a new state or county
• Turning 26 and aging off a parent’s plan
• Change in income affecting Medicaid/CHIP eligibility
A QLE triggers a 60-day Special Enrollment Period to select a plan.
❓ What is a Health Savings Account (HSA)?
An HSA is a tax-advantaged savings account paired with a High-Deductible Health Plan (HDHP). You contribute pre-tax dollars, the money grows tax-free, and withdrawals for qualified medical expenses are tax-free — a triple tax advantage. In 2025, contribution limits are $4,300 for individuals and $8,550 for families (plus $1,000 catch-up if 55+). Important: You cannot contribute to an HSA once you enroll in Medicare Part A or B.
❓ How much does ACA health insurance cost?
Costs vary widely based on your age, location, income, plan tier, and family size. Before subsidies, a 40-year-old in Raleigh, NC might pay $400–$700/month for a Silver plan. But with subsidies, many people pay $50–$200/month or even $0. The only way to know your actual cost is to check the Marketplace with your specific income and household details — or work with a licensed agent like Senior Benefits Hub who can run quotes for you at no extra cost.
