March 15, 2021 Helpful:  0 Unhelpful:  0

The Affordable Care Act (ACA), also known as Obamacare, was signed into law in 2010. It was created to provide affordable, quality healthcare to millions in the United States who don't get insurance through an employer or the government.


HealthCare.gov is the federal government's health insurance marketplace under the Affordable Care Act. It serves states that don't have their own health insurance marketplace (find your state's marketplace). 

Based on income and household information you provide, HealthCare.gov determines if you qualify for: 

• Medicaid 
• Children's Health Insurance Program (CHIP) 
• Subsidies or tax credits for private health plans on the ACA marketplace


• Website: https://www.healthcare.gov 
• Phone: https://www.healthcare.gov/contact-us

Required Benefits

ACA plans offer 10 essential health benefits

1. Outpatient care
2. Emergency services
3. Hospitalization
4. Pregnancy, maternity, and newborn care
5. Mental health and substance abuse services
6. Prescription drugs
7. Rehabilitative services and devices
8. Laboratory services
9. Preventive/wellness services and chronic disease management 
10. Pediatric services which include dental and vision 

Plans must also include birth control and breastfeeding coverage (equipment and counseling).

Pre-existing Conditions 

Under ACA, insurance companies can't refuse to cover pre-existing conditions (i.e., asthma, cancer, diabetes) or charge more if you have one. They also can't put annual or lifetime limits on your coverage. 

Penalty for Not Having Insurance 

There is no longer a federal penalty for not having health insurance (starting in 2019) but some states have implemented their own coverage mandates. In 2021, these states require health insurance: 

• California
• District of Columbia
• Massachusetts 
• New Jersey
• Rhode Island
• Vermont (mandate but no penalty for 2022)

Subsidies and Tax Credits

For those who fall below a certain income, monthly premiums can be offset by cost-sharing subsidies or tax credits. For those who don't qualify, plans can be very expensive.

You can find out if you qualify for subsidies, tax credits, Medicaid or the Children's Health Insurance Program (CHIP) by using this HealthCare.gov interactive form. If your state operates its own marketplace, it will provide a link to it (state marketplaces should have something similar).

If you don’t qualify for financial help, buying a plan outside the ACA marketplace is an option. Sometimes there are more plans available "off-marketplace" because many health insurance companies don’t put all their plans on the ACA marketplace. Under the Affordable Care Act, all major medical coverage plans “on-marketplace” or “off-marketplace” must be ACA-compliant. Learn more about off-marketplace plans.


The exchange includes PPO plans (Preferred Provider Organization), HMO plans (Health Maintenance Organization), POS plans (Point-of-Service), and EPO plans (Exclusive Provider Organization). 


There are different plan categories: Bronze, Silver, Gold, and Platinum. Bronze has the lowest monthly premiums but highest costs when you need care (somewhat like catastrophic insurance), while Platinum has the highest monthly costs with the lowest costs when you get care. 


Catastrophic plans are available to people under 30 or to anyone of any age who meets the hardship exemption. Catastrophic plans have low monthly premiums and very high deductibles. These plans cover the same ten essential ACA health benefits and some include preventive services at no cost. 


When to Apply 

You apply for ACA health insurance plans during a specific time of the year called Open Enrollment. It’s usually between November 1 to December 15. The dates vary from state to state so be sure to check with your state

You can enroll outside of Open Enrollment under these circumstances:

• You have a qualifying life event (move outside your coverage area, get married, have a child, lose a job, experience a significant change in income and more). This is known as a Special Enrollment Period (SEP) and you have at most 60 days after the life event to change your health plan. See if you qualify for a special enrollment period

• If you are an American Indian or Alaskan Native, you can enroll in an ACA health insurance plan any time and change plans as often as once a month. 

Assistance Finding and Applying for a Plan

• HealthCare.gov has a 24/7 hotline (except holidays) if you have any questions.

• HealthCare.gov and most state-based marketplaces have an interactive form that helps you find a plan that's right for you based on income, household info, and healthcare usage.

• If you prefer a more personal touch, you can find an agent, broker, or assister who can help you apply for a plan. State marketplaces have similar — California provides a way to connect with certified enrollers, New York has a page where you can find brokers, navigators or certified counselors.

• Should you use an agent, broker or assister? Assisters can help you apply for a marketplace health plan or Medicaid/Children's Health Insurance Program (CHIP). Agents and brokers only sell marketplace health plans. If you think you might qualify for Medicaid/CHIP, start with an assister. 

Alternatives to ACA Health Insurance 

Private plans are available outside the ACA marketplace. Learn more »

Updated:  October 19, 2021


There are no comments.