The Health Insurance Marketplace, established under the Affordable Care Act (ACA), provides a platform for individuals and families to find and enroll in health coverage. If you are considering applying for health insurance through the ACA Marketplace, it’s important to understand who is eligible to do so. While there are many variables to determine your eligibility, including tax credits to help with cost, these are the key criteria that you need to meet in order to apply for health insurance on the ACA Marketplace.
Requirements for ACA Marketplace eligibility
To be eligible to enroll in health coverage through the Marketplace, you must meet the following criteria:
- Residency: You must live in the United States to qualify for health coverage on the ACA Marketplace. This means you need to have a permanent address within the country.
- Citizenship or Lawful Presence: You must be either a U.S. citizen or a national, or be lawfully present in the U.S. Lawful presence, also called a “Lawful Permanent Resident,” includes having a valid visa or green card. If you are not a U.S. citizen, it’s important to check the eligible immigration statuses to ensure you meet the requirements.
- Not Incarcerated: Individuals who are currently incarcerated are not eligible to apply for health coverage through the ACA Marketplace.
Additional considerations for ACA eligibility
While the above requirements determine your eligibility to apply for health insurance on the ACA Marketplace, there are a few additional factors to consider:
- Living Abroad: If you are living abroad, it’s crucial to know that the health insurance available through the Marketplace generally covers healthcare services provided within the United States. Therefore, if you are not residing in the U.S., purchasing Marketplace insurance may not be suitable for your needs.
- U.S. Nationals: U.S. nationals include U.S. citizens and individuals who owe permanent allegiance to the U.S. While most non-citizen U.S. nationals are born in American Samoa or abroad to American Samoan parents, it’s important to consult the specific criteria to determine if you fall into this category.
- U.S. Territories: Residents of U.S. territories, such as Puerto Rico, Guam, the U.S. Virgin Islands, and others, may have separate healthcare systems, including their own Marketplace or Medicaid coverage. Generally, residents of U.S. territories are not eligible to apply for health coverage through the federal or state Marketplace unless they reside within the service area of a Marketplace.
Understanding the eligibility criteria of the ACA Marketplace is an important first step to actually applying for health insurance coverage. For a deeper dive into the plan, including a glossary and complete rules and regulations, visit