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Obamacare “Do You Qualify” Flow Chart

Update: You might bet better off just calling to speak with an agent direct about what your options for healthcare might be outside of open-enrollment.

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Because you are out of the open-enrollment period for Obamacare, this means that you have two options for health insurance currently if it is not offered by your employer. You can obtain healthcare under the ACA (Obamacare) if you have what is called a “qualifying life event”. Changing jobs, if you moved, had a baby and a number of other “qualifying life events”.

Another option, is to obtain a short term health insurance plan, or Short Term Health Plan, also called STHP. It is important to note that short term plans do not meet the minimum requirements set by the ACA. Additionally, short term plans are not regulated like ACA complaint plans are. So the insurance carriers offering short term health insurance are allowed to reject anyone who has a pre-existing condition. For numerous reasons, this make short term health insurance not an option for millions of Americans. For more information on short term health plans the website STHP.com is an excellent resource. Again though we want to note that Short Term Health Plans are not a great long term option, and some people will not even qualify.

(We just  posted a copy of the 21 page Obamacare Insurance Application form)

Posted by Sarah Kliff on March 20, 2013 at 9:26 am:  Consumer advocates and Wonkblog commenters had similar questions: Why on earth would the federal government create such a complex form to obtain a public benefit?

obamacare qualifying flowchart small


For me, at least, the flowchart below provides a bit of an answer. It comes from the National Association of Insurance Commissioners, which represents the regulators who oversee each state’s insurance market. It is an attempt to draw up the most basic, simple questions to determine eligibility for insurance subsidies or Medicaid.

You don’t have to spend much time with the chart to get that, it’s really not simple at all. (click here for a larger version).

It can take as many as six questions just to determine an individual’s ability to buy insurance. An eight-question chain sorts out eligibility to eschew employer coverage and buy an individual plan with a tax credit instead.

In a way, this is a natural extension of the law’s structure. The Affordable Care Act grows two different insurance programs, Medicaid and the individual market. Information on income levels is needed to figure out who qualifies for which one.

The Obama administration isn’t collecting 21 pages of information for its own entertainment. It’s collecting 21 pages of information to figure out where people land on this flowchart.


  1. Denni September 29, 2013

    Just got my letter fom BCBS. My monthly payment goes from $200 to $ 1100. I’m electing to go with the penalty. My health insurance is now instantly unaffordable.

  2. Tracey October 10, 2013

    Wow, Denni. I too will be taking the penalty because this stupid ObamaBullCrap says I qualify for NOTHING even though I’m unemployed so they are forcing me to take the penalty. I guess making people take the penalty is how they are going to fund this idiotic healthcare fraud.

  3. Molly October 30, 2013

    What I’m finding out is that most of the “Marketplace” options will cost approximately $200 – $600 per month depending on which plan you choose and depending on whether or not your income qualifies you for tax credits.

    If you make less than $15,500 (like me because I lost my job) you’ll be placed in a Medicare/Medi-Cal plan which is NOT what I want but at least I’ll have coverage until finding a new job and won’t have to pay the penalty.

  4. Anonymous March 31, 2014

    Thank you for making this simple. i already have medicaid and medicare and its expanded. my dr. is David Clay at Fayetteville Diagnostic
    clinic and I dont feel like I need to change. I wanted to make double sure I was signed up so their wouldnt be a problem. I didnt recieve one word in the mail. I was so suprised. thank you and have a great day.

  5. Carlton Dickson April 1, 2014

    I make approximately $9,000.00 per year. I was informed that I do not qualify for Obama Care Health Insurance. Is this correct? If not, what must my annual salary be for me to qualify. I was informed to get my annual salary up to at least $12,000 per year and then I could apply for Obama care. Is this correct information.

  6. Charlotte Gilbert April 1, 2014

    This is true you would qualify for Medicaid/Medicare in your state

  7. aaron May 21, 2014

    I am disabled and I don’t qualify for Oboma care so who does?

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