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ACA (Obamacare)

Affordable Care Act, also known as ACA or Obamacare plans, is health insurance that provides comprehensive medical benefits to individuals and families. Call Today!

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What is the Affordable Care Act?

The Affordable Care Act (ACA) is a comprehensive piece of healthcare legislation that was passed into law under President Obama. The three overarching goals of the ACA are to ensure more people can purchase affordable health insurance, to provide greater coverage to children and adults through the Medicaid program, and to reduce the cost of healthcare. The ACA is for anyone not covered by their employers, young adults, children, and individuals who make less than 138% of the poverty line.

What is Obamacare?

Obamacare, a term often used interchangeably with the Affordable Care Act, is simply another name for the same piece of healthcare law. Much confusion exists around the supposed differences between the two; a 2017 study by Morning Consult found that 35% of Americans either thought they were different policies or weren’t sure. The term came to prominence as Republican congressional leaders tried to saddle the president with responsibility for the law if it proved a failure.

How Does Obamacare Work?

Obamacare works by mandating insurance companies provide coverage for all Americans who need it, regardless of preexisting conditions. To sign up for Obamacare, individuals apply online, by call, or in person. Applicants answer a series of questions to help determine the type of insurance for which they are qualified and how much their monthly premium will be based on their income. They are then given a choice of several different levels of insurance coverage from which to choose. Individuals who willfully decide not to have coverage are required to pay an annual penalty as mandated by the legislation.

Are there different types of Obamacare insurance?

Yes, there are different types of health insurance plans under the Affordable Care Act. Obamacare coverage can vary depending on the level of coverage you purchase. In general, the plans are divided into four separate tiers.

The bronze level typically has a lower deductible but also has lower levels of coverage than other tiers.
The silver tier is generally considered to have moderate costs, including a lower deductible.
Plans within the gold tier usually have higher monthly premiums but lower deductibles and out-of-pocket costs.
Platinum plans generally have the highest monthly premiums but very low deductibles and care costs.

As you take a look at your Obamacare coverage options, you should compare the premiums, deductibles, and level of coverage provided by each plan. That way, you can determine which health insurance plan is best for your needs.

Who is Obamacare for?

Obamacare is designed to make healthcare affordable for people regardless of income. Individuals at all income levels can sign up for health insurance under Obamacare.

If you have a household income between 100% and 400% of the federal poverty level (FPL), you may qualify for a premium tax credit or special subsidies that will reduce health insurance costs.

When did Obamacare start?

Obamacare discussions started in February of 2009 when President Obama called a joint session of Congress to create a structure for healthcare legislation. The bill that emerged from committee hearings and markups was eventually passed by Congress and signed into law in March 2010. Americans were able to sign-up for Obamacare starting in 2013.

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 plans will run from November to December for coverage starting January and remain open until January. 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 CallUsaPros 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 CallUsaPros! 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.

What Does Obamacare Cover?

Under the ACA, insurance plans must allow parents to include their children on their plans up to age 26 and provide 10 essential services:

Preventive and wellness visits, including chronic disease management
Maternity and newborn care
Mental and behavioral health treatment
Services and devices to help people with injuries, disabilities, or chronic conditions
Lab tests
Pediatric care
Prescription drugs
Outpatient care
Emergency room services
Hospitalization

Who Is Eligible for Obamacare (Affordable Care Act) Coverage?

Health insurance can be costly — especially if you don’t have a job that offers health insurance as a benefit.

The Patient Protection and Affordable Care Act is a 2010 health-reform law better known as the Affordable Care Act, ACA, and, often, Obamacare.

The comprehensive ACA law has three main goals:

Make affordable health insurance available to more people.
Expand the Medicaid program.
Support medical care delivery that reduces costs.

Obamacare offers many consumer protections. The law protects you by offering coverage for people who have pre-existing conditions. The law also requires health plans to offer preventive care without out-of-pocket costs, and allow adults under the age of 26 to stay on a parent’s health insurance plan.

Who is not eligible for Obamacare?

Most people who live in the U.S. are eligible for healthcare coverage under Obamacare. However, there are exceptions.

You are not eligible for Obamacare if:

You do not live in the U.S.
You are incarcerated.
You are not a U.S. citizen, U.S. national, or lawfully present in the U.S.
You are covered by Medicare.

If you are not a U.S. citizen or national but lawfully present in the U.S., you also may qualify for Obamacare if your immigration status is one of the following:

Lawful permanent resident or green card holder
Refugee
Asylee
Cuban or Haitian entrant
Immigrant paroled into the U.S.
Immigrants granted conditional entrance before 1980
Deferred action status, excluding Deferred Action for Childhood Arrivals (DACA)
Lawful temporary resident
Those with an administrative order issued by the U.S. Department of Homeland Security that stays their removal
Member of a federally recognized Indian tribe, or an American Indian born in Canada

Battered spouse, child, and parent
Victim of trafficking, along with a spouse, child, sibling, or parent
Those granted withholding of deportation or withholding of removal, under the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment, or Punishment (CAT), or immigration laws
Non-immigrant status, including those with worker visas and student visas
Temporary protected status (TPS)
Deferred enforced departure (DED)
Resident of American Samoa

What is the income level to qualify for Obamacare?

While anyone can buy health insurance under Obamacare, those with household incomes between 100% and 400% of the federal poverty level (FPL) may qualify for financial assistance that reduces premiums and out-of-pocket costs.

Using federal poverty levels, a family of four would qualify for subsidies with a household income of $27,750 to $111,000. A single person would qualify for subsidies if they made $13,590 to $54,360. (Federal poverty level amounts are higher in Alaska and Hawaii.)

How do Medicaid and Obamacare differ?

Obamacare refers to the law passed to expand health coverage across the United States, and Medicaid expansion was a big part of that law. Medicaid, in general, is an assistance program, while Obamacare is an actual insurance plan purchased from a company. Medicaid also covers people with a much lower income than those who receive tax subsidies through Obamacare. In addition, you can enroll in Medicaid throughout the entire year, while there is only a certain time frame for marketplace insurance.

How Does the Affordable Care Act Make Health Insurance Cheaper?

The use of premium tax credits (PTCs) helps families pay for health insurance purchased via the health insurance marketplace. Only certain individuals qualify for the premium tax credit and must complete Form 8962 with their tax returns.

Requirements to qualify for premium tax credits can include:

Low household income or receive unemployment
Tax filing status other than Married Filing Separately
Be a victim of certain domestic abuse and spousal abandonment
Not claimed as a dependent by another person
Unable to get health insurance coverage via an employee-sponsored plan
Not eligible for coverage through a federal program, such as Medicaid, Medicare or TRICARE

What is the Patient Protection and Affordable Care Act?

The Affordable Care Act is actually two pieces of legislation – the Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010. The PPACA is predominantly concerned with ensuring millions more low-income Americans are eligible for Medicaid. It also works to improve existing Medicaid provisions and strengthen the Children’s Health Insurance Program (CHIP). Some specific goals of the PPACA include working to improve long-term care services, quality of care, delivery systems, and access for more Americans.

Is Medicaid Obamacare?

Because Obamacare includes Medicaid provisions in its legislation, it can be confusing whether these two things are the same. The important thing to remember is that, while Obamacare health insurance is provided by private companies, Medicaid is a government-funded and government-run program. Obamacare did change Medicaid, though; under the legislation, states have the option to expand Medicaid, thereby making it easier for more people with incomes under a certain level to be covered.

Obamacare VS. Affordable Care Act

Obamacare and the Affordable Care Act are used interchangeably to refer to the same law. It’s vitally important to remember this when it comes to listening to news about policy or picking a candidate to represent your needs and views.

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

Pros

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.

Cons

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.

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 CallUsaPros, 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.

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 CallUsaPros website to find a plan that fits your needs and budget.

Is the Affordable Care Act working?

When considering whether the Affordable Care Act is working, it’s important to assess its success by a number of metrics. Now that the legislation has been active for five years, analysts can use data to better understand its impact on the American healthcare system.

The ACA set out to ensure more Americans were insured regardless of their income or the state of their health. The number of Americans lacking health insurance has dropped by nearly 50% since its inception. The mandate on coverage for preexisting conditions remains in place.

Another goal of the ACA was to make health insurance more affordable for more people. According to data from the New York Times, 85% of the 7.3 million Americans who signed up for insurance during the first enrollment period received subsidies to decrease their costs. Premiums differ based on the number of insurance providers in each state. States with more options typically have lower premiums as insurance companies fight for their share of the market. The ACA has also been beneficial to the health insurance industry, which has seen significant growth in new clients since its introduction.

Learn more about the Affordable Care Act, or Obamacare, and how it could help you access an affordable health insurance plan. Call Today!