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Learning Center / General / ACA Benefits: Understanding the Affordable Care Act

ACA Benefits: Understanding the Affordable Care Act

December 8, 2023

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The Affordable Care Act (ACA) encourages the development and deployment of innovative medical care delivery techniques with the goal of lowering overall healthcare costs. These methods include initiatives focused on improving care coordination, emphasizing preventive services, encouraging value-based care, and implementing new payment models to incentivize quality and efficiency in healthcare delivery. In this guide, we'll help you get a better idea of what is the Affordable Care Act and how it works, so you can determine if you're eligible for coverage.

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA), popularly known as the Affordable Care Act and Obamacare, is a comprehensive healthcare reform law that went into effect in March 2010. It attempts to promote individual and family access to affordable health insurance coverage by offering subsidies known as premium tax credits. These subsidies assist in lowering the price of insurance for households earning between 100% and 400% of the federal poverty level (FPL).

How does Obamacare work?

Obamacare works by implementing various provisions to improve access to health insurance coverage for individuals who may face barriers such as a lack of workplace health insurance, financial constraints, or preexisting conditions. Here's a breakdown of how it works:

  1. Health Insurance Marketplaces: Individuals can compare health plans through marketplaces under the ACA to compare different insurance options, consider coverage advantages and pricing, and choose a plan for their healthcare requirements.
  2. Subsidies and Premium Tax Credits: The ACA provides financial help in the form of premium tax credits. These credits are available to qualified persons with earnings ranging from 100% to 400% of the FPL. Credits help reduce monthly premium payments, making coverage more accessible. The amount of the tax credit is determined by your income and household size. In the next section, we'll cover more on what is the Affordable Care Act to see if you qualify for eligibility.
  3. Medicaid Expansion: The ACA offered states the option to expand their Medicaid programs to cover more people, including adults with incomes below 138% of the federal poverty level. Not all states chose to expand Medicaid.
  4. Essential Health Benefits: Health insurance plans must provide a set of essential health benefits under Obamacare. Preventive care, hospitalization, prescription medications, maternity care, mental health services, and other services are included. The ACA ensures that individuals have access to health coverage and critical medical care by mandating certain basic benefits.
  5. Preexisting Condition Protections: Insurers cannot deny coverage or charge higher premiums based on preexisting conditions.

We streamline the process of understanding the features, costs, and benefits of each plan, helping you make the best decision when it comes to health insurance coverage for you and your family. You can compare ACA plans online using our website!

Does everyone qualify for the Affordable Care Act?

You are eligible for an ACA plan if:

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

You are not eligible for an ACA plan if:

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

What is the highest income to qualify for Obamacare?

The ACA uses your Modified Adjusted Gross Income (MAGI), rather than the Adjusted Gross Income that appears on your tax return, to determine potential savings. When calculating possible savings for health insurance coverage in any given year, an estimated household income will be taken into consideration.
If your household income is between 100% and 400% of the federal poverty level, you'll likely be eligible for a premium subsidy. In 2023, a single-person household can earn $14,580 to $58,320 and qualify for the subsidy. While a family of four can earn $30,000 to $120,000 would qualify. These income limits do not apply to Hawaii or Alaska. In the next section of our "What is the Affordable Care Act Guide" we'll cover important enrollment period dates.
Our website can help you determine if you're eligible for premium tax credits or other subsidies under the ACA. We can help you evaluate whether you qualify for financial assistance to reduce the cost of your health insurance premiums by providing us with information about your income and household size.

When is the enrollment period for ACA health plans?

Here are the most important dates for choosing healthcare coverage:

  • November 1-December 15: Open Enrollment starts for health coverage for the following year, allowing you to get coverage as early as January 1. This is the first day you can enroll in, re-enroll in, or change health plans through the Health Insurance Marketplace.
  • January 1: Coverage begins if you've paid your first premium and are already enrolled or changed your plan by December 15.
  • January 15: Open Enrollment period ends. This is the last day to enroll in or change health plans for the current year. You can still enroll in or change plans but you must qualify for the Special Enrollment Period. Qualifying events for the Special Enrollment Period include things like losing other coverage, getting married, or having a baby.
  • February 1: This is when coverage starts for those who paid their premium and enrolled in or changed plans from December 16 through January 15.

Visit our website to compare ACA healthcare coverage options.

What does the Affordable Care Act cover?

Consumers are not required to pay anything out-of-pocket for preventive-care services. ACA plans are required to cover the 10 essential health benefits:

  • Emergency services
  • Outpatient care
  • Preventive and wellness services
  • Rehabilitative services
  • Prescription drugs
  • Pediatric services, including oral and vision care for children
  • Pregnancy, maternity, and newborn care
  • Hospitalization
  • Laboratory services
  • Mental health and substance use disorder services

If you're enjoying our "What is the Affordable Care Act Guide" check out our other guides, like our Obamacare/ACA vs Medicare Guide.

What doesn't the Affordable Care Act cover?

The ACA does not cover vision or dental insurance for adults.

What if I underestimated my income for Obamacare?

If you believe your income is different than what was reported to the state or federal marketplace, contact them to adjust your subsidy. You can do this at any point during the year.

Get Help With ACA Plans

To learn more about your eligibility for health insurance under the ACA, call our licensed insurance agents at 1-877-590-3245, Monday to Friday, 8 AM to 8 PM ET.  You can also experience for browse and compare ACA health insurance plans online through our website. In just a few clicks, you'll see details about different plan types, coverage options, deductibles, copayments, and networks.

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