ACA / Obamacare

What is the Affordable Care Act?

The Affordable Care Act (ACA) is the name of the health care reform law and its amendments, which address health insurance coverage, costs, and preventive care. The Affordable Care Act is often referred to as Obamacare since it was signed into law in March 2010 by President Barack Obama.

Obamacare, or the Affordable Care Act (ACA), is a law in the U.S. that helps more people get health insurance and makes sure that insurance covers important things like check-ups and prescriptions. It also stops insurance companies from refusing coverage to people with pre-existing conditions, like diabetes or asthma. And if you’re a young adult, you can stay on your parents’ insurance until you’re 26, giving you peace of mind as you navigate early adulthood. There are online marketplaces where you can compare different options and find one that fits your budget. Plus, depending on your income, you may qualify for financial assistance to lower your monthly premiums.

Who is eligible for ACA plans?

To be eligible to enroll in a Marketplace plan, you must:

  •  Live in the United States
  •  Be a U.S. citizen, national or lawfully present
  •  Not be incarcerated
  •  Have income above 100% of the federal poverty level

However, even if you meet the above eligibility criteria, you’re not eligible to get a Marketplace plan if you’re eligible for Medicare or Medicaid coverage.

In addition to U.S. citizens, here are a few categories of immigrants who can enroll in Marketplace coverage:

  •  Lawful Permanent Resident (LPR) or Lawful Temporary Resident (LTR)
  •  Cuban/Haitian entrant
  •  Asylee and Refugee (eligible if they’ve been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days)
  •  Temporary Protected Status (TPS)
  • Work or student visa

What does health care reform like the ACA and American Rescue Plan (ARP) mean for you?

Sometimes little things happen; sometimes big things do. Sometimes they’re expected, sometimes they’re not. No matter what, a health plan can offer you the comfort of feeling like you’re ready for any circumstance. And you may qualify for financial help paying for it thanks to the Affordable Care Act and the American Rescue Act.

Depending on your income, your monthly cost may be as low as $0 per month, if you qualify,* and you may pay less when you see a doctor. All without sacrificing quality of care.

Our agents can see if you qualify for financial help through the Health Insurance Marketplace to help pay your monthly premium.

 

Factors to compare between plans

When comparing plans, there are a few factors you’ll want to take into consideration: network, cost and benefits.

Network
Look at each plan’s network and determine if your preferred providers are in-network. If your doctor is not in-network with a plan you are considering but you want to continue to see them, you may want to consider a different plan. You can always ask your doctor directly if they take the health plan you’re considering. If you don’t have any preferred providers, look for plans with large networks and doctors near you.

Cost
Examine the out-of-pocket cost differences between plans, including the deductible, copayments, and coinsurance of each plan. While a low premium can be appealing, it may lead to higher out-of-pocket costs, especially if you have a chronic condition or frequently need emergency care or extra visits with a doctor. However, if you know you’re in good health and don’t often need medical care, paying a higher premium may not be the right fit for you. Balance cost and coverage according to your financial and medical needs.

Benefits
While benefits are not often as important as a factor as network and cost are, it can be helpful in narrowing down your options. Compare the summary of benefits for each plan option you’re considering. See if any of your plans offers a wider range of services, like coverage for mental health care, fertility treatments or emergency coverage. If so, you’ll want to choose the plan with the benefits that help you and your family the most.

Key dates for Marketplace Coverage

 
  •  Nov. 1-Dec. 15: Enroll or renew plans for coverage starting on Jan. 1 for the following year.
  •  Dec. 15-Jan. 15: Enroll or renew plans for coverage starting on Feb. 1 for the following year.
Keep in mind that you may be eligible to get a health plan outside of the Open Enrollment Period if you qualify for a Special Enrollment Period (SEP). An SEP is caused by a qualifying event, such as having a baby, getting married, or moving to a new county. Also, if your household income is currently less than 150% of the federal poverty level, you’re eligible to enroll anytime during the year because of the ARP. Learn more about how and when to enroll in health insurance.

What are the Four “Metal” Categories?


Plans on the Health Insurance Marketplace are presented in four metal categories:

All metal plans cover the same set of essential health benefits and do not affect the quality of care you’ll receive. The categories are based on how you and the plan will share the costs for health care services.

Platinum

Platinum plans generally have the highest premiums but the lowest costs when receiving care. These plans are a good choice if you need a lot of care and can afford a high monthly premium.

Gold

Gold plans have a high premium and low costs when receiving care. These plans are a good choice if you need a lot of care.

Silver

Silver plans have a moderate premium and cost when receiving care. If you qualify for cost-sharing reductions, you must select a Silver plan to get the “extra savings.” These plans are a good choice if you’re willing to pay more for your care to have a lower premium, or if you qualify for extra savings.

Bronze

Bronze plans typically have the lowest premiums but the highest deductibles and other out-of-pocket costs. These plans are a good choice if you want peace-of-mind protection from worst-case medical issues.

Frequently Asked Questions

1. How can I get financial assistance to help me pay for my health insurance?

The government offers financial help to those who qualify to help pay part of the monthly cost of the health plan. Use the HealthCare.gov Eligibility Estimator to determine your eligibility.

The government reviews information such as:

  • Your household income
  • Your family size and individual ages
  • Where you live

The amount of financial help you get will be based on this information. If you qualify, you’ll pay a lower monthly cost for your health plan.

If you have CHIP coverage, you do not need to take any action.

For information on CHIP, call Florida KidCare at 1-888-540-5437 or Florida Healthy Kids at 1-888-540-KIDS (5437).

 

 

While ACA did help strengthen Medicare by lowering prescription drug costs and expanding preventive benefits, it does not impact how you apply or receive Medicare. However, ACA Marketplace plans are not Medicare plans and should not be purchased by anyone who qualifies for Medicare. So, ACA does not affect how you apply for Medicare.

 

 

When a health insurance plan is ACA-compliant, it means that it conforms to the regulations enacted by the Affordable Care Act (Obamacare). These compliant plans must include coverage for ten essential health benefits (EHBs):

  • Emergency services
  • Hospitalization
  • Ambulatory patient services (outpatient care received without being admitted to a hospital)
  • Preventive and wellness services
  • Pediatric services (includes vision and dental care)
  • Prescription drugs
  • Mental health and substance use disorder services
  • Pregnancy, maternity, and newborn care
  • Rehabilitative and habilitative services and devices
  • Lab tests

ACA-compliant plans also have other rules and regulations they must follow and meet, but the specifics can be different depending on the type of health plan.

 

 

There is no difference. Obamacare is an informal name used to refer to the Affordable Care Act, since it was signed into law by President Barack Obama.

 

According to Healthcare.gov, the purpose of the Affordable Care Act was to help more people in the U.S. get health insurance coverage by reducing the cost of coverage for people who qualify for it. As a health care reform act, its goal was to improve the quality of health care and health insurance and to reduce spending related to health care in the U.S. 

* To be eligible for $0 monthly cost, your Marketplace monthly advance premium tax credit must be equal to or more than the premium.

Policies have limitations and exclusions. The amount of benefits provided depends on the plan selected and the premium may vary with the amount of benefits selected.

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