The ACA transformed how Americans access and pay for health insurance. Whether you buy coverage through the marketplace, have employer insurance, or are on Medicaid, the ACA likely affects your healthcare in some way.
Key Protections Under the ACA
The ACA established several critical consumer protections:
- No denial for pre-existing conditions: Insurers cannot refuse to cover you or charge more because of health conditions like diabetes, cancer, or asthma
- No lifetime or annual limits: Plans cannot cap how much they'll pay for your care
- Young adults on parents' plans: You can stay on a parent's health plan until age 26
- Free preventive care: Vaccinations, screenings, and annual checkups are covered at no cost
- Essential health benefits: All plans must cover a minimum set of services
- Out-of-pocket maximums: There's a limit on how much you pay each year
The 10 Essential Health Benefits
All ACA-compliant plans must cover these categories of care:
The Health Insurance Marketplace
The ACA created HealthCare.gov (and state-based marketplaces) where individuals and families can shop for coverage. The marketplace allows you to:
- Compare plans side-by-side
- See if you qualify for subsidies
- Enroll in coverage during Open Enrollment
- Apply for Medicaid if eligible
Metal Tier Plans
Marketplace plans are organized by "metal tiers" that indicate how costs are shared between you and the insurance company:
Bronze plans have the lowest premiums but highest out-of-pocket costs. Platinum plans have the highest premiums but cover more of your care. Silver plans are often the best choice for those receiving subsidies.
The Martinez family earns $65,000/year. Through the marketplace, they qualify for a premium tax credit of $800/month. A Silver plan that costs $1,200/month only costs them $400 after the subsidy. They also qualify for cost-sharing reductions that lower their deductible and copays since they chose a Silver plan.
Premium Tax Credits (Subsidies)
The ACA provides financial help to make insurance affordable:
Who Qualifies?
- Individuals and families without access to affordable employer coverage
- Those not eligible for Medicare, Medicaid, or CHIP
- Income above 100% of the federal poverty level
- Through 2025, there's no upper income limit (thanks to enhanced subsidies)
How Subsidies Work
Premium tax credits reduce your monthly insurance payment. The amount depends on your income and the cost of a "benchmark" Silver plan in your area. You can take the credit in advance (reducing your monthly bill) or claim it when you file taxes.
If you qualify for subsidies, Silver plans often provide the best value. That's because cost-sharing reductions (lower deductibles and copays) are only available with Silver plans, and these savings can be worth thousands of dollars per year.
Cost-Sharing Reductions (CSRs)
In addition to premium help, the ACA provides cost-sharing reductions for lower-income households (100-250% of the federal poverty level). CSRs lower your:
- Deductible
- Copays
- Coinsurance
- Out-of-pocket maximum
CSRs are only available with Silver plans purchased through the marketplace.
Medicaid Expansion
The ACA expanded Medicaid eligibility to adults earning up to 138% of the federal poverty level. As of 2024, 40 states and DC have adopted the expansion, providing coverage to millions of previously uninsured Americans.
If you apply through the marketplace and your income qualifies, you may be automatically enrolled in Medicaid rather than a marketplace plan.
See If You Qualify for ACA Subsidies
Our licensed agents can help you navigate the marketplace, estimate your subsidies, and find the best plan for your needs and budget.
Get Free GuidanceFrequently Asked Questions
Is Obamacare still in effect?
Yes, the Affordable Care Act remains the law of the land. The health insurance marketplaces continue to operate, protections for pre-existing conditions are in place, and subsidies are available. Enhanced subsidies through the Inflation Reduction Act are available through 2025.
Is there still a penalty for not having health insurance?
The federal individual mandate penalty was reduced to $0 starting in 2019. However, some states (California, Massachusetts, New Jersey, Rhode Island, and DC) have their own mandates with penalties for going uninsured.
Can I buy an ACA plan outside of Open Enrollment?
Only if you have a qualifying life event (like losing coverage, getting married, or having a baby) that triggers a Special Enrollment Period. Otherwise, you must wait until the annual Open Enrollment period (November 1 - January 15 for most states).
What if I can't afford marketplace coverage even with subsidies?
You may qualify for Medicaid if your income is low enough and your state expanded coverage. You might also qualify for the Children's Health Insurance Program (CHIP) for kids. Our agents can help you explore all options.