In 2010, President Barack Obama passed the Affordable Care Act (ACA) or Obamacare to help reduce healthcare costs for families and ensure more people were able to access health insurance. Originally, it required everyone to have qualifying insurance, or they would face a tax penalty. However, it has evolved over the years.

In this guide, we’ll cover the basics of Affordable Care Act coverage or Obamacare, including what it covers, the enrollment period, and more.

Understanding Obamacare

Obamacare is a colloquial term used to describe the Affordable Care Act (ACA). This law was put into place to make it easier for people to purchase the health insurance they need. 

Key components of Obamacare:

Individual Mandate

The Affordable Care Act mandates that health insurance companies are required to provide certain levels of coverage with every plan. When it was first implemented, it required Americans to carry health insurance just like they carry car insurance. However, as of 2019, health insurance is no longer required at the federal level. Some states may still require it, so it’s important to check what the current mandate is based on where you live.

Health Insurance Marketplace

The Health Insurance Marketplace, established under the Affordable Care Act (ACA), provides a centralized platform for individuals and families in the United States to review, compare, and purchase health insurance plans. These marketplaces, often referred to as Health Insurance Exchanges, serve as a crucial component of the ACA’s efforts to increase access to affordable healthcare coverage.

Here are a few things to keep in mind:

1. Accessibility: The Health Insurance Marketplace is accessible through a dedicated website, toll-free phone numbers, and in some cases, in-person assistance. This accessibility ensures that people can explore their insurance options regardless of their preferred method of interaction.
2. Plan Variety: The Marketplace offers a range of health insurance plans from different private insurance providers. These plans are categorized into metal tiers, including Bronze, Silver, Gold, and Platinum, each offering varying levels of coverage and cost-sharing.
3. Subsidies: One of the key features of the Health Insurance Marketplace is the availability of premium tax credits, also known as subsidies. These subsidies are designed to make health insurance more affordable for individuals and families with lower incomes. Eligible individuals and families can receive financial assistance to help reduce their monthly premium costs.
4. Open Enrollment Period: The Marketplace operates on an annual Open Enrollment Period during which individuals can enroll in, renew, or make changes to their health insurance plans. This period typically occurs in the fall and lasts for several weeks, providing an opportunity for individuals to review and select the plan that best fits their needs for the upcoming year.
5. Special Enrollment Periods: In addition to the Open Enrollment Period, Special Enrollment Periods (SEPs) are available to those who experience certain qualifying life events, such as marriage, having a child, or losing other healthcare coverage. SEPs allow individuals to enroll or make changes to their coverage outside of the regular enrollment period.
6. Standardized Information: The Marketplace provides standardized information about each plan, making it easier for consumers to compare benefits, premiums, deductibles, copayments, and other features. This transparency helps individuals make informed decisions about their healthcare coverage.
7. Preventive Services: All plans offered through the Marketplace are required to cover essential health benefits, including preventive services, without additional cost-sharing. This means that preventive care, such as vaccinations and wellness check-ups, is often covered at no out-of-pocket expense.
8. Consumer Assistance: Navigating the complexities of health insurance can be daunting, which is why the Marketplace offers assistance through trained professionals and certified enrollment counselors who can help individuals understand their options and complete the enrollment process.

Medicaid Expansion

Medicaid Expansion, a pivotal provision within the Affordable Care Act (ACA), brought about a fundamental change in the landscape of healthcare coverage in the United States. This initiative allowed individual states to broaden their Medicaid programs, offering access to healthcare coverage for a more extensive demographic of low-income individuals and families. Traditionally, Medicaid eligibility was limited to specific categories like pregnant women, children, the elderly, and those with disabilities.

However, Medicaid Expansion extended coverage to include adults with incomes up to a certain percentage of the federal poverty level, varying by state. The federal government provided substantial financial incentives to encourage states to adopt this expansion, covering the costs for newly eligible enrollees initially and eventually maintaining a 90% federal match rate.

Crucially, Medicaid Expansion had a profound impact on improving healthcare access. It significantly reduced the number of uninsured individuals by providing them with an affordable avenue to access primary care, preventive services, and treatment for chronic conditions. This played a vital role in addressing healthcare disparities and ensuring that those previously without affordable healthcare options gained coverage.

However, it’s important to note that the decision to expand Medicaid was left to individual states, leading to variations in eligibility criteria and availability of coverage. This resulted in ongoing debates and discussions about the program’s impact on state budgets, healthcare access, and the broader healthcare system, making Medicaid Expansion a continually relevant and evolving issue in healthcare policy.

Subsidies and Tax Credits

Subsidies and tax credits are pivotal financial mechanisms that have reshaped the landscape of healthcare affordability, particularly within the framework of the Affordable Care Act (ACA) in the United States. These provisions are aimed at alleviating the financial burdens associated with health insurance premiums and medical expenses. A cornerstone of these mechanisms is the Premium Tax Credit, which assists eligible individuals and families in mitigating the costs of health insurance premiums. These credits are meticulously calculated, taking into account income and the price of coverage, with the primary goal of ensuring that healthcare premiums do not impose an undue strain on household budgets. Eligibility hinges on a range of factors, including income levels and household size, typically encompassing those with incomes falling between 100% and 400% of the federal poverty level.

In tandem with premium tax credits, the ACA introduced Cost-Sharing Reductions (CSRs), an additional layer of subsidies designed to curtail out-of-pocket expenses such as deductibles, copayments, and coinsurance, particularly for those with lower incomes. For individuals purchasing silver-level health insurance plans through the marketplace, CSRs work to make healthcare services more financially accessible.

Medicaid Expansion has been a pivotal part of the ACA’s strategy to extend affordable health coverage, particularly for low-income individuals and families. In states that embraced Medicaid Expansion, many individuals gained access to Medicaid, offering free or low-cost healthcare coverage, thereby reducing the need for premium tax credits. Additionally, some individuals opt for advanced premium tax credits, which are applied directly to their monthly insurance premiums, further lowering the immediate financial burden associated with health coverage.

However, it is important to note that the receipt of premium tax credits or CSRs necessitates a reconciliation process during annual tax filings. This process ensures that the amount of financial assistance received during the year aligns accurately with the individual’s or family’s actual income and circumstances.

These mechanisms provide essential financial support, making health insurance premiums and out-of-pocket costs more manageable for millions of Americans. Eligibility is primarily determined by income and other criteria, rendering subsidies and tax credits indispensable resources for individuals and families seeking healthcare coverage through the marketplace.

Essential Health Benefits

Essential Health Benefits represent a cornerstone of healthcare reform in the United States, established under the Affordable Care Act (ACA). These benefits are a set of ten categories of healthcare services and treatments that all insurance plans, both individual and small group, are required to cover. The goal is to ensure that individuals and families have access to comprehensive and essential healthcare services, regardless of the specific insurance plan they choose. The ten categories encompass a broad spectrum of care, including preventive services, prescription drugs, hospitalization, maternity and newborn care, mental health and substance use disorder services, and pediatric care, among others. By mandating these core benefits, the ACA aims to enhance the quality of healthcare coverage, promote preventive care, and reduce the prevalence of medical bankruptcies resulting from insufficient insurance coverage. Essential Health Benefits have become a fundamental component of health insurance plans in the United States, playing a crucial role in improving access to vital medical services and ensuring that individuals have the coverage they need for their healthcare needs.

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How does Obamacare work?

Obamacare, officially known as the Affordable Care Act (ACA), has reshaped the landscape of healthcare in the United States since its passage in 2010. Whether you’re exploring your insurance options, seeking information on preventive care, or navigating the intricacies of healthcare reform, we’ll provide valuable insights into how Obamacare functions and how it may impact your access to healthcare services.

Obamacare Open Enrollment Period

The Open Enrollment Period (OEP) is the time when you can shop for a new health insurance plan for the upcoming year. The federal OEP for 2023 plans will run from November 1, 2022 to December 15, 2022 for coverage starting January 1, 2023 and remain open until January 15, 2023. Some states have a state-run health exchange, and therefore have an open enrollment period that may differ slightly from the federal open enrollment period. If you do not enroll in a plan during the OEP, you may not be able to purchase ACA-compliant coverage unless you experience a qualifying event, such as:

• Loss of a job
• Move to a new coverage area
• Birth of a child
• Loss of existing coverage
• Family event, such as marriage, divorce, or death

If you find yourself without insurance and are not eligible for a qualifying event, you may be able to enroll in a short-term plan depending on the state where you live. Contact eHealth to learn more about your choices in short-term plans that can provide you with the coverage you need until the next OEP.

See all of your options for ACA-compliant health insurance with eHealth! Our team of licensed insurance agents can help you navigate all possible plans and find a plan that provides the amount of coverage you need for an affordable price.

Obamacare costs and subsidies

When you enroll in a health insurance plan, you typically pay a monthly premium to keep that plan. Obamacare includes subsidies to help lower income individuals cover the cost of their plans. These subsidies, also known as tax credits, are still in effect in 2021.

On March 11, 2021, President Biden signed the American Rescue Plan Act (ARPA) into law. This act increased the subsidies previously included in Obamacare, so millions more Americans could qualify for federal assistance with the cost of their healthcare plans. Under the ARPA, those within 100% to 150% of the federal poverty level (FPL) could qualify for zero-premium silver plans, while those between 150% and 400% of the poverty line could receive higher subsidies overall. Americans making more than 400% of the FPL previously did not qualify for any assistance. However, the ARPA has now restricted premiums to 8.5% of the income of those that fell into this income bracket.

The ARPA will continue to be in effect in 2022, ensuring Americans can still receive the federal assistance they had in 2021 to pay for their insurance plan premiums. Keep in mind that premiums will vary from plan to plan and state to state, so compare plans in your area to ensure you get the best coverage for your needs and budget.

Pros and cons of Obamacare

There are several significant benefits of Obamacare. Some of the top benefits include:

• The Affordable Care Act has made health insurance more affordable for many people. It requires that health insurance companies spend at least 80% of their premiums on paying for people’s medical care, which has caused many premiums to go down.
• It is also possible for people with pre-existing health conditions to find health insurance. Insurance companies can now no longer refuse coverage to someone just because they have pre-existing conditions.
• More screening procedures are covered. Preventative care is now covered to a much greater extent than it was before.
• Prescription drugs also cost less. It is now not as expensive for someone to get coverage for their prescription medications.

On the other hand, there are some drawbacks that people also need to consider. They include:

• Health insurance premiums have gone up as a result of Obamacare, for some people. Individuals who were used to paying very low premiums in the past now might pay higher premiums because health insurance companies are required to cover more people.
• You could pay a significant fine if you don’t have health insurance. In some states, people are now required by law to have health insurance, or they pay a penalty on their taxes.
• If you purchase insurance on the marketplace, you need to enroll at specific times of the year. You need to pay attention to special Obamacare enrollment periods.

What does Obamacare cover?

The specific coverage you receive with your plan under Obamacare will vary based on the plan you choose. However, ACA plan required coverage includes:

• Preventative care
• Emergency care
• Outpatient care when you are not admitted to the hospital
• Hospitalization
• Pregnancy and newborn care
• Services for mental health and substance use disorders
• Rehabilitative services
• Pediatric care
• Laboratory services

Under the Affordable Care Act, insurance companies cannot refuse you coverage or charge you more for your plan if you have a pre-existing condition. A pre-existing condition is one that was diagnosed before your new insurance coverage began.

Do you have to pay a penalty for not having Obamacare insurance?

It depends. As we mentioned, health insurance is no longer required at the federal level, but some states do still enforce it. 

In those cases, if you do not have health insurance for any length of time, you will be required to pay a penalty. Children may also be required to have health insurance.

The size of the penalty can vary depending on how long you go without health insurance and how many other people in your family do not have health insurance. To avoid paying this fine, you must make sure that you have health insurance if it’s required. 
If you do live in a state that requires health insurance coverage for everyone, then you can use eHealth’s free tool to find a plan that fits your needs and budget.

How do you get Obamacare insurance?

If you are interested in signing up for an ACA health plan, you’ll need to shop on an insurance marketplace. At eHealth, we understand that a lot of jargon is involved, and you may have difficulty deciding which plan is right for your needs. We can provide you with access to a comprehensive comparison tool that will make it easy for you to consider coinsurance, deductibles, copays, and premiums. 

We also have licensed insurance agents who can help you find the right ACA plan based on your budget.

Find an insurance plan that suits you

Use our tool to compare the coverage and costs of a variety of health plans to ensure you have insurance in case of illness or accident. We make it easy to find a plan that suits your needs quickly.

Finding the right insurance plan at the right price is easier with eHealth. Although pricing is regulated in healthcare, the expertise and experience of the eHealth brokers helps individuals find the best coverage
for their need. You may purchase your insurance plan through a phone call, chat, or online, with certified licensed brokers in every state. Check out all your options for individual
and family health insurance.