With the launch of public health insurance exchanges back in October, much attention has been paid to new options under the Affordable Care Act (ACA) for the uninsured and for full-time employees of small businesses. But ACA provisions also offer options for other types of workers, notably the self-employed and part-time workers.

Just how many people fall into these categories? It turns out, quite a few.

In fact, an estimated 42 million Americans are self-employed. And, of the approximately 155 million employed Americans, about 27 million work part time.

If you fall into one of these two categories – or know someone who does – here are four things to consider when exploring coverage alternatives in the age of the ACA.

1. There are more existing options than you might think.

First, it’s important to know that there are options available to you outside of the ACA, but that you might not know about. For example:

  • If you don’t have insurance of your own, you might be eligible for coverage through your spouse’s employer-sponsored insurance. While this benefit has been trimmed from many employer group policies to cut costs, approximately 12% of plans still include coverage for spouses.
  • If you are a part-time worker, it’s worth asking your employer if the company offers health plans to cover you, even if you have to pay for them yourself.
  • Affiliations can also be sources of health insurance. If you are part of a union or professional association, you might be able to purchase health plans offered for members.
  • Veterans, check your eligibility for veterans benefits.
  • If you are over 65, you are eligible for Medicare. And despite concern from seniors already on Medicare, the ACA does not affect you. You can determine your eligibility for Medicare here.

2. You have three new options under the ACA

If none of the options above are available to you, then consider the new ones made possible with the passage of the ACA. Here they are:

  • Dependent coverage has been extended under the ACA to include children until they turn 26 years old. This means if you are under 26, you can remain on your parents’ insurance until you reach that age.
  • Some states have opted to expand their Medicaid program with federal funds, enabling previously excluded individuals to be covered. The expansion includes people under 65 years of age who are living at 138% or below the poverty line. If you live in a state that has expanded Medicaid to more people, you may now qualify based on your income. Click here to see if your state opted to expand Medicaid coverage.
  • If neither of the above applies to you, you can option purchase individual health plans on public exchanges. In fact, even if your employer currently offers health coverage to part-time workers, they might direct you to the public exchanges anyway. And some employers, including Trader Joe’s and Home Depot, are offering cash to their part-time workers to help offset the cost of healthcare purchased on the exchange.

3. You might qualify for a federal subsidy

If buying a health plan on your state’s exchange is your best choice, you’re ready to shop for plans. The most important thing for you to know is that you may be eligible for a federal subsidy.

Generally speaking, the ACA provides sliding scale subsidies for people who earn up to 400% of the U.S. poverty level, which is about $46,000 for an individual and about $94,000 for a family of four. Knowing how much of a subsidy you qualify for lets you know how much you can afford to spend a plan. To find out, you need will need to visit your state exchange website where you will be led through the process of determining your subsidy eligibility.

As a self-employed or part-time worker, you may not know you exact income right now or how it might fluctuate during the year. But make sure to have good estimates in mind when you go online.

The next step is to use your state exchange’s comparison tools to compare coverage levels, premiums and out-of-pocket costs for different plans. Be sure to consider the fact that the cheapest coverage may not offer the benefits best suited for you.

Consider if and when your eligibility will change, which is linked to fluctuations in your income. If you are currently at the lower end of the income scale, and your income declines, you could become eligible for Medicaid. If your income goes up, you might lose all or part of your subsidy.

4. There are places where you can go for advice – and it’s free

Thanks to a $67 million federal grant for training and authorizing navigators to walk people through enrollment options on the exchange, navigators and assisters can be great resources for exploring plans under the ACA.

In addition, there are web brokers who are authorized to both help you explore and enroll in plans of the federally managed exchange. Some web brokers serve individuals and others are offering their services to employers to help them help their part-time workers sort out eligibility comparing and purchasing plans on public exchanges.

And a Q&A published on the NPR website answered a few questions posed by some self-employed workers about their options under the ACA.

Maximizing the odds

If you are self-employed a part-time worker, the road to the right health plan is not always clear and finding the right plan takes time and effort. And while open enrollment deadline for purchasing plans on public exchanges is March 31, 2014, waiting until the last minute could mean you end up with a less-than-optimal plan.

A combination of doing your homework to determine your eligibility for available options, and consulting knowledgeable experts, will help ensure you have the best plan possible to meet both your financial and health needs.

In November, President Obama reversed a controversial provision of the Affordable Care Act, making good on his “if you like your plan, you can keep it” promise by allowing extensions for plans that otherwise would be cancelled under the ACA’s requirements. While some states have rejected the offer to extend plans, many have approved the extensions and it is now up to individual insurers to decide whether or not they want to offer them. Blue Cross Blue Shield has already approved the extension in several states, pushing off plan changes and potential premium hikes to 2015.

Though enrollment on the federal managed exchange website was disappointing, California’s results improved: by November 19th, 80,000 people had enrolled through its state-run exchange, Covered California. 

The State Exchange Table continues to provide the latest information on carrier participation and plan rates.

Latest Developments:

State Run Exchanges and Partnerships –

Arkansas: Arkansas’s health insurance exchange board unanimously approved an application for a $3.5 million grant to study creating a state exchange, as opposed to relying on the one run externally by the federal government. This marked the state’s first step towards creating its own state-run exchange.

Jay Bradford, Arkansas’ Insurance Commissioner, also confirmed that insurers in the state will have the option to extend health insurance plans. Extended plans that were slated to be cancelled will now be good through December 30th, 2014.

California: Despite requests from California Insurance Commissioner Dave Jones, California state officials have rejected Obama’s offer to permit insurers to extend plans poised to be cancelled in 2014. Exchange executive director, Peter Lee, explained that allowing extensions could delay program implementation in the state.

California enrolled more individuals in health insurance plans on its state-run exchange, Covered California, than all 36 states on the federal exchange, according to recently released numbers. As of November 19th, 80,000 Californians had enrolled and state officials expect that number to continue to climb.

According to recent reports, 23% of enrollees in Covered California, the state-run exchange, are aged 18 to 34 years old, a demographic considered key to offset the cost of older and potentially less healthy enrollees.

Covered California prepared to launch the online enrollment portal for small businesses after repeated delays. Enrollment for the Small Business Health Options Program (SHOP) was supposed to open on October 1st. Once employers enroll via SHOP, their employees can browse online and select a plan. [Note: The program officially launched on December 2nd]

The California attorney general’s office recently shut down 10 websites masquerading as Covered California, the state’s health insurance exchange. The plans sold on these fraudulent sites were not eligible for subsidies and Attorney General Kamala Harris urged shoppers on the exchange to visit coveredca.com – the official site – and not any other sites that might have similar names that falsely imply affiliation with the state site.

Colorado: Controversial ads aimed at young uninsured Coloradans continue to air in the state, despite criticism around their depictions of the use of alcohol and sex to catch the attention of so-called “young invincibles.” A recently released ad campaign featured a woman clutching her birth control pill pack and ogling an attractive man accompanied by the controversial tagline, “Let’s hope he’s as easy to get as this birth control.” The ads have gotten national attention, but the question remains whether the ads, created by two Denver-based nonprofits, will be successful in upping enrollment.

As of November 18th, Colorado reported just 6,001 successful enrollments, significantly lower than the 11,000 plus number predicted by state officials.

Almost 250,000 Colorado residents are poised to have their current policies cancelled, due in part to non-compliance with new standards under the Affordable Care Act. Twenty-three carriers cancelled plans in the state, however it was reported that some of these cancellations might have been due to normal business practices.

The mandatory Medicaid application step in Colorado’s health insurance enrollment has been a boon for the Medicaid program, but its 45-day approval process has become a time-consuming obstacle for individuals attempting to enroll in plans on the exchange. Members of the Connect for Health Colorado advisory board expressed their concern that the lengthy approval process could be driving away potential customers.

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The beleaguered Healthcare.gov still suffers from glitches that impede the online enrollment process, but people are getting through.

Not so for those attempting to enroll on the Spanish-language version of the site, Cuidadodesalud.gov. Despite the exchange being open for over two months, the site’s online enrollment feature only just opened for a soft launch on Friday, December 6th to a limited group of enrollees for testing prior to a full-scale launch.

This is just one of the roadblocks for uninsured Latinos attempting to enroll in health insurance on the federal exchange. And the stakes are high for the federal government if it is to meet enrollment targets, as Latinos make up about 32% of the uninsured population nationwide.

Perhaps even more important, nearly half of uninsured Latinos are under the age of 26.  This age group, the so-called “young invincibles,” is a key target population, since their healthy numbers offset enrollees with preexisting conditions that require costly procedures and care.

In California alone, Latinos make up a whopping 60% of those without insurance, according to the California HealthCare Foundation. State-by-state percentages can be seen in this chart.

In addition to being a large percentage of the uninsured, Latinos are the least informed, likely in part because of the language barrier. A recent survey revealed that 69% found the Affordable Care Act  “complicated and confusing;” 71% could not name a single policy that was included in it.

First on the list of obstacles for uninsured Latinos attempting to enroll is the state of the Cuidadodesalud.gov.

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It’s been a rough couple of months for public health exchanges, many of which have taken heat for technology glitches that have prevented people from accessing them to shop or enroll in health plans. But based on the number of people who have tried, one thing is clear: huge numbers of people want access to exchanges – and a number of them are the younger uninsured.

Some in the media have taken to calling this demographic “young invincibles” – healthy 18-34 year olds who are widely considered crucial for health insurance enrollment if The Affordable Care Act (ACA) is to be considered successful.

Why is signing up young people so important? Because to make a profit, private health insurance companies must balance the cost of their aging and ill consumers with healthy ones – people who pay, but do not require much care. A risk pool made up of only older, less healthy people could spell financial disaster for insurers.

Some critics argue that the ACA expects young, healthy people to “pick up the tab” for older, sicker people by paying higher premiums than they would have otherwise with very little benefit.

Supporters suggest this is a false comparison because many young people now have minimal or no plans at all, believing that they don’t need them – hence, the moniker “young invincibles.” Comparing the cost of more comprehensive coverage offered by health plans in public exchanges with skeleton coverage or no coverage at all, they say, is like comparing apples and oranges.

The debate about young people, health insurance, and public exchanges has been going on since the ACA was passed in 2010. What is new is who is joining the conversation about the status of the ACA. You guessed it: young people.

Several weeks ago, for example, BuzzFeed, a website devoted to viral content trending in real time, weighed in on the foundering Oregon health insurance exchange, Cover Oregon. BuzzFeed cautioned its readers that the exchange is optimized only for Internet Explorer, leaving users on other browsers such as Safari or Google Chrome out of luck.

With the subhead, “Good luck, Mac users,” BuzzFeed noted, “Internet Explorer was the most popular web browser in 2003 and was discontinued on the Mac platform a decade ago.”


Still, even as BuzzFeed criticized Cover Oregon for being technically out of touch, the site provided tips for its readers on how to prepare and enroll in health plans on exchanges.

Meanwhile, Gawker, a blog site that explains itself with the tagline, “Today’s gossip is tomorrow’s news,” informed its readers that… “the launch of President Obama’s healthcare law was something of a disaster, marred mostly by the program’s broken website. But now we know just how awful the enrollment numbers were from those first few days.”

Gawker then revealed that just six people successfully enrolled in health insurance plans on the first day of operation for the now famously flawed federal exchange website, Healthcare.gov.

Double ouch.

But at least they’re paying attention.

Both BuzzFeed and Gawker focus mostly on pop culture, youth trends and ubiquitous “best of” lists. But it’s a pretty good bet that having entered the conversation about the ACA, they’re going to stay in it.

That’s a good thing because one of the biggest challenges of enrolling young people is not convincing them to do it, but rather informing them that the option is available. A recent survey by the Commonwealth Fund revealed that a large majority of young adults wanted health insurance and that 7.8 million would benefit from gaining new or better coverage under the ACA, but that only 27% were aware of option to buy insurance on public exchanges.

This sizeable knowledge gap has implications for the success or failure of the ACA, but also for the future of this population. Youth-oriented sites like Buzzfeed and Gawker might be just what is needed to bridge that gap.

Of course, it remains to be seen just how many young people will buy health plans on exchanges. That won’t be known until the end of enrollment period on March 31, 2014, when the numbers and demographics of people who bought insurance will be made public.

In the meantime, it’s reassuring to know that in between watching episodes of American Horror Story, a popular horror television series available on Netflix, speculating about Kim Kardashian’s upcoming wedding to Kanye West, young people might actually be reading up on their health care options.

That’s a status update worth sharing/liking.