Health Care Options
Health Care Coverage Options for AmeriCorps Members
December 16, 2013
The content below is applicable to full-time AmeriCorps members serving in programs receiving AmeriCorps State and National grants. (It is not applicable to members enrolled in Professional Corps or Education Award Only grant programs). If you have specific questions that aren't answered below, please follow up with your program manager.
Overview: What Are Your Options?
- Family health care coverage: Under the Affordable Care Act, you can stay on your parent’s health insurance policy until your 26th birthday. You can even remain on your parent’s plan if you are married, not living with your parent(s), attending school, or not financially dependent on your parent(s). For more information about this option, please see: https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/. In addition, if you are married you may be able to get coverage on your spouse’s plan.
- Health care coverage purchased through the Health Insurance Marketplace: You may be eligible to obtain health care coverage through the Health Insurance Marketplaces where you are serving, and you may qualify for financial assistance to lower the costs of insurance. In some cases, insurance may be available with no monthly premium. Learn more at HealthCare.gov. In addition, your program may be able to help you pay for coverage you obtain through the Health Insurance Marketplace. If they do so, this assistance may be considered taxable income.
- Medicaid coverage: Under the Affordable Care Act, many states are expanding their Medicaid program. Depending on the amount of your stipend and where you serving, you may be eligible for Medicaid. For more information, please see: HealthCare.gov.
- Current health plan offered by your AmeriCorps Program: Currently serving full time AmeriCorps members already receive insurance through their programs. Your program may elect to continue to offer you the same plan they are offering you now, even if it does not meet all of the requirements under the ACA so long as it meets the requirements for AmeriCorps programs (you can find what is required for AmeriCorps programs on page 11 of the document found here: http://www.nationalservice.gov/sites/default/files/documents/FinalProvisions6-25-13.pdf).
- For example, your current plan may exclude coverage of pre-existing conditions. If your current AmeriCorps health plan does not meet the new consumer protection standards of the ACA and you do not have other coverage, you may be required to pay a tax payment at the end of the year under the individual responsibility provision. Before deciding to forego other coverage that may be available to you, you should review your options at HealthCare.gov because you may qualify for free or low cost health insurance. See the question-and-answer section below for more details.
Questions and Answers
- There is no one type of health plan covering all AmeriCorps members. AmeriCorps requires that programs provide a minimum level of coverage to their members. At a minimum, AmeriCorps programs are required to provide health plans that were short-term, limited duration (no more than 364 days) plans that include physician services for injury or illness, cover emergency room and hospital room and board, have an annual deductible of not more than $250, require members to pay no more than $1,000 out of pocket per year, and cover up to a maximum of $50,000 per event (the equivalent of an annual limit of $50,000). They are not required to cover preventive care or pre-existing conditions.
- The minimum benefits AmeriCorps programs must provide do not meet all of the requirements under the ACA. For example, AmeriCorps programs may offer plans that do not cover people with pre-existing conditions, do not include access to preventive care without cost sharing, and have dollar limits on essential health benefits. Plans like these will not satisfy the individual responsibility requirement.
- Therefore, if you only have the type of coverage described above and do not have other coverage that meets the individual responsibility requirement, you may be subject to a payment under the individual responsibility provision, depending on your individual circumstances. However, in some instances, you may not be subject to the individual responsibility payment. You can receive an exemption from coverage for different reasons. For example, you may be exempt if you do not have to file a tax return because your income is too low or you are affected by your state’s decision not to expand Medicaid coverage under the health care law. For a complete list of exemptions and information on how to apply, please visit: https://www.healthcare.gov/exemptions.
Medicaid and the Marketplace
- Under the Affordable Care Act, many states are expanding their Medicaid program. Eligibility depends on your state and is based on your income. Single individuals with incomes up to about $15,000 per year may qualify for Medicaid. For example, if your living allowance is below a certain income level and you do not have other income, you may be eligible for Medicaid. The income level varies by family size, other family members’ income, and other factors. To see if you qualify for Medicaid, please visit: https://www.healthcare.gov/do-i-qualify-for-medicaid/.
- You can also find a private health insurance plan through the Health Insurance Marketplace. Based on your income you can qualify for lower costs on your monthly premiums, and may even be able to find a plan with no monthly premium. Financial assistance is based on your income, and a single individual with incomes below about $46,000 per year may qualify.
- You qualify for an exemption from the individual responsibility payment if you were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the ACA. You can keep your current health insurance without being subject to a fee.
Communicating with AmeriCorps Programs
- As you know, AmeriCorps programs operate across the country. Therefore, we wanted to provide our grantees with options that could best meet their needs and those of members like you.
- Organizations that get funding for AmeriCorps members have been made aware of the options available to you. These options include organizations offering health insurance that provides the new consumer protections, staying on your parent’s or spouse’s health insurance plan, enrolling in a private health insurance plan in the Marketplace or Medicaid if you qualify, or continuing to offer the health plan they have used for many years (keeping in mind that coverage may not be considered minimum essential coverage).
- We are committed to working with your programs to make sure AmeriCorps members get quality, affordable health coverage.