Navigator Guide FAQs of the Week: Who is Eligible for Marketplace Coverage?

November 1 marked the first day of the Marketplace Open Enrollment Period in most states. CHIR updated its Navigator Resource Guide just in time for the annual enrollment window. The Navigator Guide, supported by the Robert Wood Johnson Foundation, provides an easy-to-use online resource for assisters, including over 300 searchable frequently asked questions (FAQs), fact sheets for all 50 states and DC, and an “Ask an Expert” feature.

During Open Enrollment, we’ll highlight FAQs from the Navigator Guide about Marketplace eligibility, enrollment, financial assistance, and other common questions that arise throughout the signup process. This week, we’re taking a look at who is eligible for Marketplace plans.

Who can buy coverage in the Marketplace?

Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated.

Not everybody who is eligible to purchase coverage in the Marketplace will be eligible for subsidies, however. To qualify for subsidies people must not be eligible for certain other types of coverage, such as Medicare, Medicaid, or an affordable employer plan. (45 C.F.R. § 155.305; 26 U.S.C. § 36B(c).)

I’m eligible for health benefits at work, but I want to see if I can get a better deal in the Marketplace. Can I do that?

Assuming you meet other eligibility requirements, you can shop for coverage on the Marketplace during open enrollment or a special enrollment period if eligible, but if you have access to job-based coverage, you might not qualify for premium tax credits.

When people are eligible for employer-sponsored coverage, they can only qualify for Marketplace premium tax credits if the employer-sponsored coverage is unaffordable. The way this is calculated, coverage is unaffordable only if your cost for coverage for a single person under the employer plan is more than 8.39 percent of your household income in 2024 (for 2023, it is 9.12 percent of household income). (IRS Rev. Proc. 2023-29.)

Can I buy a plan in the Marketplace if I don’t have a green card?

Potentially, yes. In order to buy a Marketplace plan, you must have a qualifying immigration status, such as permanent residency (green card), certain types of visas, or refugee status. You can find more information about qualifying statuses here.

If you are not lawfully present in the U.S., you are not eligible to buy a plan on the health insurance Marketplace. However, you can shop for individual health insurance outside of the Marketplace and some states may offer you financial assistance, depending on your income. To obtain coverage, contact a state-licensed health insurance company or a licensed agent or broker. Your state Department of Insurance can help you find one. (45 C.F.R. § 155.305.)

Open Enrollment runs through January 15 in most states. Stay tuned for additional FAQs of the week and check out the Navigator Resource Guide for even more FAQs and helpful resources.