FPL, SEP, APTC, CSR? Terms to know when looking at health insurance plans

If you have shopped for health insurance for yourself or your family, you have heard a slew of acronyms. It can be difficult to look at plans when you need a dictionary just to understand what may affect your cost. While the open enrollment period is over, you still have options to enroll outside of that time. You may qualify for a plan today and should know what options are available that can lower your cost and provide greater coverage.

Federal Poverty Level (FPL)
This is a measure of income that determines eligibility for savings on health insurance among other federal and state assistance programs. For instance, as of 2022 if an individual makes less than $19,320 a year, they are below 150% FPL.

Special Enrollment Period (SEP)
You may enroll in an ACA (Affordable Care Act) compliant Individual or Family plan during the Special Enrollment Period also known as SEP, if you experience certain life events. These events allow you to enroll any time of year. SEP events include:

  • New! FPL of less than or equal to 150%*
  • Losing your health coverage through a life event
  • Getting married or divorced
  • Having or adopting a child
  • Permanently moving somewhere with different health insurance options
  • Aging off your parent’s health insurance plan at age 26
  • Losing your job, losing your Medicaid or CHIP eligibility, or expiring COBRA coverage
  • Having a change in income or household status that changes your eligibility for tax credits or cost-sharing reductions
  • Your plan being involuntarily canceled by your insurance company
  • Depending on where live COVID-19 can impact your eligibility

*Through the American Rescue Plan, starting in March of 2022, those that have an FPL of less than or equal to 150% can now enroll in a plan anytime of the year through an SEP.

Advanced Premium Tax Credit (APTC)
This is a tax credit that you can take to receive a lower monthly premium on your health insurance plan. If your expected yearly income qualifies, you will get an advance tax credit to lower your premium. A couple of things to remember:

  • If you take more premium tax credit than you are due in your final income for the year, you will have to pay back the excess when you file your tax return.
  • If you have taken less, then you will get the excess.

Cost Share Reduction (CSR)
This is a discount that lowers what you pay for copays, coinsurance, and deductibles. You must enroll in a Silver plan to qualify for CSRs. They are also known as “extra savings.” These lower your out-of-pocket-maximum, which once paid, your plan pays for 100% of covered services.

Have questions? Visit our website to learn more about Individual and Family plans and programs or contact us at (877) 507-1451.