About Affordable Care Act

What is Obamacare? (Affordable Care Act)

Obamacare is the slang term for the Patient Protection and Affordable Care Act of 2010 (ACA). It makes health care more affordable for everyone by lowering costs for those who can’t afford them. Obamacare  is essentially a framework of federal rules around health-care coverage. It aims to reduce the amount of uncompensated care the average U.S. family pays for by requiring everyone to have health insurance or pay a tax penalty. Going forward in this article, ACA and Obamacare will be used interchangeably and will refer to the Patient Protection and Affordable Care Act of 2010.

How does Obamacare work? The individual mandate

The original coverage requirement in Obamacare included a tax penalty for those that did not purchase a health insurance plan. This is known as the individual mandate. The penalties were designed in part to offset the cost of paying for the health care of people without health insurance, due to hardship situations or other exemptions.

In December 2017, the Trump administration passed a tax bill repealing the individual mandate. This repeal is still in effect in 2020, eliminating the fine for those without health insurance plans in most states. A few states do have their own mandates in 2020, including California, Connecticut, Hawaii, Maryland, Minnesota, New Jersey, Rhode Island, and Washington.

What does Obamacare cover?

The specific coverage you receive with your plan under Obamacare will vary based on the plan you choose. However, the act has required coverage for some medical services, including:

  • Preventative care
  • Emergency care
  • Outpatient care when you are not admitted to the hospital
  • Hospitalization
  • Pregnancy and newborn care
  • Services for mental health and substance use disorders
  • Rehabilitative services
  • Pediatric care
  • Laboratory services

Under Obamacare, insurance companies cannot refuse you coverage or charge you more for your plan if you have a pre-existing condition. A pre-existing condition is one that was diagnosed before your new insurance coverage began.

Obamacare Open Enrollment Period

The Open Enrollment Period (OEP) is the time when you can shop for a new health insurance plan for the upcoming year. The OEP for 2021 plans will run from November 1, 2020 to December 15, 2020. Some states operate their own exchanges such as PA, NJ, MD, etc and they extended the Open Enrollment to 1/31/2021.  If you do not enroll in a plan during the OEP, you may not be able to purchase ACA-compliant coverage unless you experience a qualifying event, such as:
  • 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
If you find yourself without insurance and are not eligible for a qualifying event, you may be able to enroll in a short-term plan depending on the state where you live. Contact eHealth to learn more about your choices in short-term plans that can provide you with the coverage you need until the next OEP.

What is Individual Health Insurance (Affordable Care Act)?

The Patient Protection and Affordable Care Act is an act established by President Obama to make health insurance affordable to everyone in the United States

How to Qualify for Affordable Care Act?

  • - Applicants must file taxes.
  • - Must enroll during the open enrollment period or special enrollment period.
  • - Must be a legal resident in the United States.

When is Open Enrollment?

  • Starts from November 1st to December 15th of each year. Some states operates their own changes and set their own Open Enrollment period. For example, PA which operates its own state exchange has open enrollment from 11/1 to 1/15 of next year.
  • All applicants must apply during Open Enrollment unless there is a special reason, in which you can apply during special enrollment period

What is the Special Enrollment Period?

If you face certain life events, such as losing health coverage, moving, getting married, having baby, etc. you might qualify for a special enrollment period.

Is there a penalty for not having health insurance?

If you live in the following states, you may have to pay tax penalty for not having health insurance: Massachusetts, New Jersey, Vermont, California, Rhode Island, DC.

What is the cost of health plans?

  • - Plans are determined based on your location, age, income, and household size
  • - Each plan includes co-pay, co-insurance, deductible, and out-of-packet-maximum