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Individual Health Insurance

The onset of the ACA led to the usage of many terms and intricacies that the everyday consumer may find confusing. What is an APTC (Advance Premium Tax Credit), what and is the OEP, what is an SEP (Special Enrollment Period) and how does a person qualify for one? Is there a difference between On-Exchange and Off-Exchange coverage? Below are some highlights, but please contact us if you have anymore questions:

  • Affordable Care Act (ACA): The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act and nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Under the act, hospitals and primary physicians would transform their practices financially, technologically, and clinically to drive better health outcomes, lower costs, and improve their methods of distribution and accessibility.
  • Advance Premium Tax Credit (APTC): An Advance Premium Tax Credit is a tax credit you can take in advance to lower your monthly premium. When you apply for coverage in the Health Insurance Marketplace, you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium.

If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return.

If you’ve taken less than you qualify for, you’ll get the difference back.

  • Open Enrollment Period (OEP): The Open Enrollment Period is the period of time when you can enroll in or change On-Exchange health insurance plans. 2018 Open Enrollment runs from November 1, 2017 to December 15, 2017. This is different than Medicare's Annual Enrollment Period, and the dates don't coincide!
  • Special Enrollment Period (SEP): A Special Enrollment Period is a 60-day window where you may enroll in a qualified On-Exchange health insurance plan outside of the Open Enrollment Period. There are specific circumstances, including: 

Losing job-based coverage

Losing COBRA coverage

Losing eligibility for Medicaid or CHIP

Losing eligibility for Medicare

Losing coverage through a family member

Losing coverage due to divorce or legal separation


Having or adopting a child, or placing a child in foster care

Death of someone on your On-Exchange plan resulting in you no longer being eligible for it

Moving to a new home in a new ZIP code or county

Moving to the U.S. from a foreign county or United States territory

A student moving to or from the place they attend school

A seasonal worker moving to or from the place they both live and work

Moving to or from a shelter or other transitional housing


An SEP is highly time-sensitive, so contact us if you have questions about whether you qualify for one!