Examples of qualifying life events:

• Marriage
• Having a baby
• Adopting a child or placing a child for adoption or foster care
• Moving outside your insurer’s coverage area
• Losing other health coverage due to losing job-based coverage, divorce,  COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances. Important: Voluntary ending coverage does not qualify you for a special enrollment period. Neither does losing coverage that does not qualify as minimum essential coverage, IE: temp health plans.
• Gaining citizenship
• Leaving incarceration
• Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
• For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
• Or others as determined by the Centers for Medicare & Medicaid Services (CMS)

Do you qualify for a subsidy?

You may qualify for an income subsidy if your income is between 100% and 400% of the Federal Poverty Level (FPL), which for 2024 was set at an annual income of $15,060 for a single person. If you are married and/or have children the FPL benchmark is higher and you would add $5,380 per person in your household. No one pays more than 8.5% of their MAGI (Modified Adjustable Gross Income) income thru 2025. If your projected income changes during the year your subsidy will get readjusted when you file your income tax. Example: If you had more household income than you estimated for the year, you would be responsible to pay part or all of the tax credits back. The same is true in reverse. If income is less than projected, then any amounts in your favor would be in the form of additional tax credits. Also note that Wisconsin residents that have income less than 100% of the FPL may qualify for WI Badgercare.