The Affordable Care Act has expanded access and affordability of health insurance coverage among more Americans. Furthermore, insurers cannot discriminate based on preexisting conditions; and people can receive regular healthcare while simultaneously lowering overall costs.
To qualify for Obamacare, one must reside in the US as either a citizen, national, or legally present resident; their household income must fall within 400% of poverty threshold.
1. Individuals
Individuals can enroll in Obamacare and access financial assistance through the marketplace to cover their monthly premium costs. Household incomes that fall between 100-400% of federal poverty levels may qualify for subsidies that reduce health insurance costs significantly.
Individuals with higher household incomes are eligible for cost-sharing reductions to assist them in paying out-of-pocket medical costs such as deductibles and copays. To take advantage of this additional financial support, individuals must enroll in a Silver-level plan.
To determine your eligibility for premium subsidies, follow this link and select your state. Enter your projected household income and the 2022 poverty rate into the system to view eligibility. These income levels are adjusted annually to account for inflation, so if any adjustments occur throughout the year it is imperative that this information is reported back immediately in order to receive accurate advance premium tax credits (APTC) every month.
2. Families
Subsidies from government are available for most enrollees of exchange plans to help cover monthly premiums, with amounts determined based on income and plan cost (the lowest-cost plan option available to you). Furthermore, ACA bans health insurers from excluding preexisting conditions from treatment and mandates all plans offer certain essential benefits.
The Affordable Care Act offers two forms of financial support for individuals and families who purchase marketplace plans: premium tax credits that help lower monthly payments, as well as cost sharing reductions that lower out-of-pocket expenses like deductibles and copays. Furthermore, all qualified marketplace plans must include coverage of preventive health services at no additional charge.
ACA has given adults living in states that have not expanded Medicaid the chance to qualify for Marketplace subsidies by maintaining income at 138% or below of poverty levels. In order to do this, however, an eligibility threshold must be reached: for individuals qualifying under this criteria.
3. Small Businesses
Obamacare (or Patient Protection and Affordable Care Act) includes provisions tailored specifically for small businesses. These include an online marketplace allowing individuals to browse commercial insurance options as well as an HCA tax credit for those qualifying.
Small businesses can also utilize the SHOP Marketplace to purchase group coverage for their employees at reduced premium costs than other options. This solution provides businesses with cost savings.
Small businesses do not need to provide health insurance benefits, but doing so may be worth considering as an investment in the health and well-being of their workforce. Studies have demonstrated the positive results from providing these benefits – healthier employees can result in reduced sick days and missed workdays.
The Affordable Care Act incentivizes employers to offer wellness programs as part of their group health insurance plans, which may help reduce premium costs. Furthermore, large employers (with 50 or more full-time equivalent employees) must either offer affordable coverage to their workers or face penalties for doing so.
4. Self-Employed
If you work for yourself, an exchange may provide affordable health insurance in the individual market. Depending on your income and cost assistance eligibility requirements, cost assistance might even be an option for you.
Before the Affordable Care Act was implemented, many self-employed people lacked affordable health coverage; many often went without coverage altogether or settled for subpar plans that did not meet their needs and budget. Thanks to the ACA, everyone now has access to cost-effective health coverage plans that meet both needs and budget considerations.
If your income increases above 138% FPL, an exchange plan with cost assistance throughout the year may be more suitable. An association health plan that meets ACA requirements may also offer comparable coverage; however, these often don’t offer as many benefits.
Some states have not expanded Medicaid, meaning if your income falls below certain thresholds you may not be eligible for marketplace subsidies or low-cost coverage through your marketplace or COBRA. Here you can check on your state’s status; furthermore you can discover alternative solutions such as short-term insurance or COBRA plans.
