The Affordable Care Act (ACA), informally known as Obamacare, stands as a transformative milestone in American healthcare, signed into law by President Barack Obama in 2010.
Guided Solutions also had a recent milestone — we just added health insurance to the list of coverages our insurance experts can help you navigate.
We’re hoping that this guide will help clear up some of the confusion surrounding Obamacare, and give you a deeper dive so you can make informed decisions about your healthcare options. Let’s get started.
What is Obamacare?
Obamacare was designed to address long-standing issues within the U.S. healthcare system. It’s based on three core principles: expanding access to healthcare, enhancing the quality of care, and controlling the soaring costs associated with medical services.
To meet these goals, the ACA introduced the following:
- Health insurance marketplaces – The heart of Obamacare is the health insurance marketplaces, aka exchanges, which encourages competition between insurance companies to reduce costs and improve the quality of services. These exchanges let individuals and families compare a range of private insurance plans with varying levels of coverage and cost and purchase one that makes the most sense for them.
- Medicaid expansion – Obamacare expanded the income thresholds for Medicaid eligibility in order to cover more low-income individuals who may not have qualified for Medicaid previously. This has helped reduce the number of Americans without access to affordable healthcare.
- New standards – Redefining what insurance plans must cover, Obamacare’s benefits include access to prescription drugs, maternity care, mental health services, and preventive care — which is believed to lead to better health outcomes and lower long-term costs. Under the ACA, certain preventive services are available without out-of-pocket costs, a big hurdle for many when it comes to being proactive about healthcare.
- Consumer protection – This Obamacare provision provides peace of mind to individuals with chronic health issues as it prohibits charging higher premiums or the outright denial of coverage based on pre-existing conditions.
Is Obamacare Still in Effect?
As of this writing, Obamacare remains in effect. It continues to make gains in expanding access to healthcare and protecting individuals from discriminatory insurance practices.
Efforts to repeal or replace the ACA faced various legal challenges, but the U.S. Supreme Court upheld key components of the law. Some aspects were revised, however. For example, the individual mandate — which requires most Americans to maintain health coverage — still exists. But starting with the 2019 tax year, there is no longer a U.S. federal penalty if you don’t carry health insurance (although some state penalties remain in effect).
Who Qualifies for Obamacare?
Inclusivity is a defining feature of Obamacare, as it’s main purpose is to provide healthcare options for a wide and diverse range of Americans. While, eligibility often depends on income, the Medicaid expansion extends access to vital healthcare services to more low-income individuals, families and vulnerable populations, including pregnant women and children.
An important aspect of Obamacare is the protection it affords to individuals regardless of their health history. Before the ACA, many found it difficult to get affordable insurance, if they could get coverage at all.
There’s also the extension of coverage for young adults, allowing them to stay on their parents’ insurance plans until the age of 26. This has helped a lot of individuals who are transitioning into the workforce or continuing their education.
How Much is Obamacare?
Choosing the right level of healthcare depends on your needs and budget preferences. It’s about finding the sweet spot that aligns with your health priorities and financial situation.
Obamacare health plans are categorized into four tiers: Bronze, Silver, Gold, and Platinum. These tiers don’t refer to quality of care, they just represent the different ranges of monthly premiums and out-of-pocket costs.
- Bronze: With lower monthly premiums, but higher out-of-pocket costs this tier is ideal if you’re expecting fewer medical expenses.
- Silver: This is a balanced option with moderate premiums and costs. It would make perfect sense if you’re seeking a middle-ground coverage.
- Gold: This is the opposite of the Bronze tier, with higher monthly premiums and lower out-of-pocket costs. It’s best if you’re anticipating regular healthcare needs.
- Platinum: This tier has the highest premiums and lowest out-of-pocket costs. It’s right if you’re looking for extensive coverage with minimal co-pays.
While Obamacare health insurance rates are not influenced by your overall health or gender, the following factors can affect costs:
- Age
- Location
- Smoking status
- Number of family members seeking coverage
- Chosen plan tier (Bronze, Silver, Gold, or Platinum)
- Selected health insurance company
- Household income
According to Forbes magazine, the average Obamacare plan costs in 2024 are:
- $469 per month for a 40-year-old individual
- $937 for a couple age 40
- $1,214 for a 40-year-old couple with one child
- $1,491 for a 40-year-old couple with two children
This, of course, is an average and your personal considerations will change the rate that you’re quoted.
It’s important to note that the cost of Obamacare is not static; it can change annually based on factors like inflation, changes in the cost of healthcare services, and updates to subsidy calculations and tax credits that can reduce plan costs if your household income qualifies.
How Does Obamacare Work?
You may be asking yourself “How do I apply for Obamacare?” It’s not difficult. Let’s look at how the Affordable Care Act works and the steps a plan member typically takes. Here’s a simplified breakdown:
- Health Insurance Marketplace Enrollment:
- The marketplace serves as a central hub, allowing individuals and families to compare various plans, coverage levels, and costs.
- For most states, the annual open enrollment period for ACA-compliant health insurance runs from early November to mid January. However, the exact dates may vary slightly depending on the plan you choose.
- Enrollment can also be triggered by qualifying life events like marriage, divorce, the birth of a child, or losing other health coverage.
- Selecting a Plan:
- When selecting a health plan, you can pick from the four categories listed above: Bronze, Silver, Gold, and Platinum. The choice depends on how you and the plan share the costs of your healthcare.
- Remember, these categories mainly revolve around monthly premiums and out-of-pocket expenses, with no impact on the quality of care provided.
- Applying for Financial Assistance:
- Applicants with lower incomes may be eligible for subsidies or tax credits to help reduce the overall cost of getting insured.
- To see if you qualify for financial assistance — speak with one of our seasoned health insurance experts who quickly can help you determine if there are subsidies available to lower the cost of your healthcare coverage.
We understand – getting healthcare is a big deal.
All that may seem like a lot of effort, but you’ve already taken the first step by reading this blog. No worries, we can take it from here.
At Guided Solutions, we do the legwork for you to find the best health insurance options and present the plans that meet your needs and budget.
Get started with an online quote, or give us a call at 248-717-1423.