The Affordable Care Act, commonly referred to as Obamacare, has enabled millions of Americans to gain access to health insurance coverage – even if you have a pre-existing condition.
By 2023, ACA plans will reach unprecedented affordability thanks to the American Rescue Plan Act and Inflation Reduction Act of 2022. New financial assistance with premiums will allow four out of every five people to find a plan at or below $10 per month during that coverage year.
Open Enrollment Period
During open enrollment, individuals and families can shop for a new health insurance plan, as well as change or cancel your existing one.
Most people rely on the annual open enrollment period as their only opportunity to enroll in health coverage. However, certain circumstances may allow for enrollment outside this window.
Special Enrollment Periods (SEPs) are available for certain life events like losing other coverage, getting married, having a baby or based on estimated household income.
The Special Enrollment Period (SEP) is a 60-day window in which you can enroll or make changes to your coverage. Find out if you qualify for a SEP here.
In Pennsylvania, all adults and children can purchase health insurance through Pennie, our online health insurance marketplace. Furthermore, we provide year-round enrollment in Medicaid and the Children’s Health Insurance Program (CHIP).
Special Enrollment Period
On and off exchanges, open enrollment for ACA-compliant individual health insurance (both on and off exchanges) typically runs from November 1 through January 15 in most states. Please be aware that some state-run exchanges have different deadlines.
Outside of the annual open enrollment period, Americans can enroll in an ACA-compliant plan if they experience a qualifying life event. Examples include losing other coverage, becoming dependent on someone else, or moving to a different state.
Losing Other Coverage: Individuals who lose their employer-sponsored or other minimum essential coverage must apply for a new ACA-compliant plan as soon as they know it’s about to expire, in order to prevent an insurance gap. Depending on your state, this process may occur automatically.
Marriage: When you and your spouse tie the knot, you have 60 days to enroll in an ACA-compliant plan. However, new regulations issued in 2017 restrict this special enrollment period somewhat.
Other qualifying events that trigger a special enrollment period can include becoming pregnant, moving to another state, and becoming a parent. These milestones also enable people to qualify for financial assistance through an Marketplace plan.
Eligibility
Most Americans can access health insurance coverage through Obamacare, which is part of the Patient Protection and Affordable Care Act (ACA). This law offers financial assistance that lowers premiums and out-of-pocket expenses for most.
The Affordable Care Act (ACA) prevents insurance companies from denying coverage to people with preexisting conditions. Furthermore, it expands Medicaid – a government program that helps low-income Americans access medical care – into an expanded version.
If you don’t have insurance yet, you can apply for coverage through the Marketplace or a private insurer. Additionally, short-term plans are available if you require temporary medical protection.
Individuals and families with incomes between 100% and 400% of the federal poverty level may qualify for federal subsidies to cover the cost of their ACA plans.
To determine if you qualify for an ACA subsidy, estimate your household income and 2021 federal poverty level using the chart below. Afterward, use that projected income in 2022 to determine your subsidy eligibility.
Costs
Obamacare costs vary based on your age, income, family size and the plan you select. Your deductible also plays a significant role in how much out of pocket you pay each year for health care services.
If you qualify for premium tax credits under the Affordable Care Act (ACA), your healthcare costs tend to be lower than if you paid all of the premiums yourself. These credits are calculated based on your income level.
Individuals making less than 4 times the Federal poverty level (about $45,000 in 2012) can save on premiums with these subsidies. Those who make up to 133% of FPL will also qualify for tax credits that reduce their net payment to only 2% of their income.
Uninsured individuals who lack coverage may face financial penalties; however, this penalty will no longer apply from the 2020 tax year onwards.
