Beyond the Basics provides training and resources on eligibility guidelines and the enrollment process for health coverage available in the marketplace, through Medicaid, and through the Children’s Health Insurance Program (CHIP). It’s geared towards enrollment assisters (navigators, Certified Application Counselors), as well as advocates, state and local officials, and others who help people enroll in health coverage. Beyond the Basics is a project of the Center on Budget and Policy Priorities.
Navigators and Certified Application Counselors, known as assisters, are individuals who are trained and certified to help people get and keep their health coverage. Assisters provide free, unbiased, one-on-one help with completing applications for Medicaid and marketplace health insurance, as well as walking people through the plan comparison and enrollment process. They also provide health insurance literacy education to ensure that people know how to use their health coverage to access health care services.
Updated September 2024 Millions of uninsured Americans are eligible for a premium tax credit to help them pay for health coverage. The premium tax credit is only available to people without another offer of affordable and adequate coverage; in most cases, this will mean that people with an offer of…
Updated September 2024 ↓ Download PDF In general, an individual must not be eligible for minimum essential coverage (MEC) to be eligible for premium tax credits (PTC) in the marketplace, although there are a few exceptions. Being eligible for MEC means the insurance is available to the individual, even if they…
Updated September 2024 This Employer Coverage & Premium Tax Credit Eligibility Guide explains eligibility rules for individuals with offers of employer-sponsored coverage. It covers how to determine whether employer-sponsored coverage is affordable and minimum value, as well as special rules that reduce an employee’s required contribution. The guide also offers…
In this Beyond the Basics office hours session hosted on September 3, 2024, CBPP’s Jenny Sullivan and Allison Orris were joined by Lynn Cowles, Health and Food Justice Programs Manager at Every Texan and former Navigator program manager. They provided a brief refresher on the rules used to determine household…
Eligibility for subsidies in the Marketplace is determined in part by using specific percentages and thresholds that are indexed and change each enrollment year. In addition, people who received advance premium tax credits (APTC) in the prior enrollment year will need to complete a tax return for that year and…
In 2014, a Supreme Court decision gave states the choice whether to expand Medicaid to cover adults with incomes below 138 percent of the poverty line. As a result, individuals earning between 100 and 138 percent of poverty can qualify for a premium tax credit in states that do not…
