Eligibility defines which employees and dependents may enroll, based on factors such as full-time status, the waiting period, and class definitions. Rules must be applied consistently to avoid discrimination and compliance issues.
It depends on your state. In states that expanded Medicaid, you qualify on income alone up to 138% of the federal poverty level. In non-expansion states, eligibility is narrower and some low-income adults fall into a coverage gap with no Medicaid or Marketplace subsidies.
Medicaid and CHIP are state-run, federally funded programs giving free or low-cost coverage to lower-income adults, families, children, pregnant women, seniors, and people with disabilities. Eligibility is mainly income-based and varies by state; apply any time of year.
If the spouse is a bona fide W-2 employee, listing them as an employee can help the group qualify (it adds an eligible employee). If they don’t actually work in the business, they’re a covered dependent (spouse).
Income doesn’t affect eligibility for employer or unsubsidized individual plans, but it determines eligibility for ACA premium tax credits, cost-sharing reductions, and Medicaid/CHIP.
Eligibility usually depends on full-time status (commonly 30+ hours a week), being a W-2 common-law employee (not a 1099 contractor), completing any waiting period, and, for owners; the business’s entity type and the carrier’s owner rules.
It depends on the state and carrier. Many carriers require at least two enrolling people (such as two owners, or an owner plus a W-2 employee); some accept a “group of one” partnership. A solo owner with no employees usually buys individual coverage instead.
Under the ACA, a full-time employee is one who averages at least 30 hours per week or 130 hours per month. This definition drives ALE status and determines who must be offered coverage.