Before the ACA, many people couldn’t get health insurance because they had preexisting conditions. But under the ACA, it’s no longer legal for an insurance company to deny you coverage.
The ACA also made health insurance more affordable by making it easier for people to receive financial help when buying a plan in the marketplace. It also makes it harder for insurance companies to raise your premiums without a reason.
Subsidies
Subsidies are a type of government financial aid that can help you afford health insurance. They’re tax credits that are applied directly to your premium payment.
The ACA uses a sliding-scale income cut-off to determine subsidy eligibility. In 2023, people with incomes between 100% and 400% of the federal poverty level (FPL) are eligible for subsidies to reduce their premiums.
If you earn less than these income limits, you can also receive a discount on your monthly premium by paying the cost of a benchmark plan instead. The price of the benchmark plan is tied to the second-lowest-cost Silver plan in your area.
You can find out your subsidy eligibility by using the ACA’s online tool, which calculates how much you can expect to pay for coverage. The subsidy amount is estimated based on your projected income for the year.
Pre-existing conditions
Before the Affordable Care Act, insurance companies could use your medical history as a way to charge you more for coverage or deny you coverage altogether. Pre-existing conditions affect about 130 million nonelderly people in the United States.
Generally, a pre-existing condition is a health problem that existed or was diagnosed before your start date for the plan. It can include asthma, diabetes, or cancer.
But under the new rules, it’s illegal for insurance companies to deny you coverage based on a pre-existing condition or charge you higher premiums.
You may also be able to show creditable coverage, which is health coverage you had before you enrolled in the plan. This can help offset the waiting period on a pre-existing condition.
But if you have a pre-existing condition, you can find ACA-compliant health insurance in the individual market or on your state’s health insurance exchange. These exchanges will allow you to shop for a plan without having to give your medical history to the insurance company.
Coverage options
If you don’t have access to employer-based health insurance, you can choose from many ACA plans. These plans are available on the Marketplace and offer essential health benefits.
The Marketplace allows you to compare plans based on price, benefits, and quality. You can also get help with your premiums and out-of-pocket costs.
There are two main types of ACA plans: Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO). With a PPO, you can use any in-network provider for your care. However, you may pay a higher co-pay or coinsurance if you use out-of-network providers.
ACA catastrophic health plans, on the other hand, cover preventive services without a deductible and are designed for people who want financial protection from serious illness or injury. They’re typically more expensive than ACA bronze or silver plans, but they can save you money in the long run.
Losing your job
Losing your job can be a major concern for many people who depend on health coverage through their employer. If you are unemployed, there are a number of options to qualify for health insurance through obamacare, including subsidized Marketplace plans and Medicaid.
You can also apply for a plan through a special enrollment period, called SEP, within 60 days of losing your job-based coverage. This allows you to enroll in a Marketplace plan midyear, rather than waiting until the fall open enrollment season.
During SEP, you will need to provide verification documents to show that you have lost qualifying health coverage in the past 60 days or that you will lose coverage in the next 60 days. These documents should include your name, the type of coverage and the last day you had it.
If you are unable to enroll in a Marketplace plan during SEP, you may be eligible to sign up for a COBRA continuation policy with your former employer. This is a cheaper option than buying Marketplace coverage, especially for low-income individuals.
