What is Obamacare?
Most people in the US get their health insurance through their employers. Those who are 65 or older receive Medicare, and those living below the poverty line qualify for Medicaid. But what happens if you make too much money for Medicaid, you’re too young for Medicare, and you don’t get health insurance from your employer? The only option left is to pay for private insurance, but rising US healthcare costs make that difficult for many.
Regardless of your age, work status, or income, you deserve to have health insurance that provides for your individual needs. Most importantly, it should be affordable. That’s the very principle that Obamacare (also known as the Affordable Care Act) was founded upon.
The Affordable Care Act (ACA), signed into law in 2010, was created to improve the quality and affordability of health insurance in the United States. It offers financial assistance to those who cannot afford a plan on their own—so that no one will go without comprehensive medical care.
Ready to find an affordable health insurance plan that you can rely on? Keep reading to learn how Obamacare has revolutionized the way we receive medical care—and how it can benefit you.
How Does Obamacare Work?
Traditionally, you pay a monthly premium for health insurance coverage. Obamacare works the same way, but it provides you subsidies (in the form of tax credits) that help lower the cost of your insurance bill each month.
It also offers a second way to save: cost-sharing reductions for qualifying individuals. Cost-sharing reductions lower the amount you have to pay for deductibles, copayments, and coinsurance. If you qualify for cost-sharing reductions, you also pay a lower out-of-pocket maximum (the total amount you pay in a year for covered health expenses). You can find out if you’re eligible for cost-sharing reductions based on your income—the lower your income within the range, the more you’ll save. So where do you go to get this affordable healthcare coverage?
The federal government created an online health insurance marketplace, which helps maximize enrollments and makes the process of shopping for health insurance as streamlined as possible. To enroll in Obamacare, simply head to the marketplace to apply for a subsidy that will lower the cost of health insurance for you and your family (more on that below).
In addition to the nationwide health plan marketplace, several states have created their own databases to help their residents secure health coverage. If you live in one of the following states, you’ll use the accompanying website to shop for a health insurance plan.
- California: Covered California
- Colorado: Connect for Health Colorado
- Connecticut: Access Health CT
- Delaware: Choose Health Delaware
- District of Columbia: DC Health Link
- Hawaii: Hawaii Health Connector
- Idaho: Your Health Idaho
- Kentucky: Kynect: Kentucky Healthcare Connection
- Maryland: Maryland Health Connection
- Massachusetts: Massachusetts Health Connector
- Minnesota: MNSure
- Nevada: Nevada Health Link
- New Mexico: BeWellNM
- New York: New York State of Health
- Rhode Island: HealthSource RI
- Vermont: Vermont Health Connect (VHC)
- Washington: Washington Healthplanfinder
- West Virginia: West Virginia Health Insurance Marketplace
Understanding the Costs of the Healthcare Marketplace
Ready to choose your health insurance coverage from the marketplace? It’s important to know that, just like with traditional health insurance from an employer, not all plans are alike. In addition to offering plans from a variety of insurance companies, the Healthcare Marketplace also offers several different types of plans, with varying costs and conditions.
The insurance plans offered are divided into four “metal tiers”, ranging from bronze to platinum. Each plan varies in cost, adhering to a price structure that matches its coverage rate.
For example, if you choose the bronze plan, you’ll pay the lowest monthly premium of all four metal plans—but it will also come with higher deductibles and out-of-pocket costs.
On the other hand, if you’re a platinum plan-holder, you’ll pay the highest premium each month—but 90% of your medical costs will be covered. Bronze and silver plans are usually the ideal choice for young, relatively healthy individuals who don’t require frequent medical care, while gold and platinum plans are best suited for those with consistent medical needs.
These four individual plans apply whether you’re required to select your health coverage via the Healthcare Marketplace, or via one of the state-specific healthcare exchange websites (see above). They’re categorized by the percentage of medical costs covered by the insurance company:
- Bronze: The insurer covers 60% of medical costs, and the plan-holder pays 40%.
- Silver: The insurer covers 70% of medical costs, and the plan-holder pays 30%.
- Gold: The insurer covers 80% of medical costs, and the plan-holder pays 20%.
- Platinum: The insurer covers 90% of medical costs, and the plan-holder pays 10%.
Once you shop and apply for plans in the Health Insurance Marketplace, you’ll find out exactly how much you stand to save on your health coverage.
When Do I Need to Enroll for My Health Insurance Plan?
Each year, the Health Insurance Marketplace offers an open enrollment period during which you can shop for a new health insurance plan for the upcoming year, or switch to a new one. It’s important to know, however, that missing the designated enrollment period comes with a penalty.
If you don’t enroll during the open enrollment period, you will not be able to purchase ACA-subsidized coverage until the following year. The only exceptions to missing this deadline are if you experience a life event that qualifies for a Special Enrollment Period, including:
- 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
Open enrollment dates are typically November 1 through December 15, with coverage starting on January 1. However, the federal government has declared a Special Enrollment Period (SEP) this year, extending the Healthcare Marketplace deadline to August 15, 2021.
What Does Obamacare Cover?
In addition to making affordable health insurance available to more people, Obamacare also implemented a new rule for the insurance companies to follow. Under the ACA, insurers can no longer deny coverage or charge you more for your plan if you have a pre-existing condition. The specific coverage you receive will vary depending on the type of insurance plan you choose. However, ACA has required coverage for some medical services, including:
- Preventative care and wellness visits
- Ambulatory services
- Emergency room services
- Hospitalization
- Chronic disease management
- Pregnancy, maternity, and newborn care
- Outpatient care (clinic visits)
- Mental and behavioral healthcare
- Rehabilitative and habilitative services
- Pediatric care
- Laboratory services
- Prescription medication
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Michael Giusti is a senior insurance analyst, business journalist, and university professor with over 20 years of experience. He serves as department chair at Loyola University New Orleans and contributes to Insurance Thought Leadership, U.S. News, and other leading financial outlets.
