No matter which side of the aisle you sit on, the Affordable Care Act has been an important part of America’s healthcare scene since 2010. Though it comes under seemingly continuous fire from its opponents, it’s still here in 2022, and probably at least through 2023.
In this 2022 guide to the Affordable Care Act (ACA), we’ll look at how the ACA works, who qualifies, how much it costs to have coverage, and how to sign up.
But first, let’s clarify what the ACA is (and isn’t).
What is the Affordable Care Act?
The Affordable Care Act, also known as Obamacare, was passed in 2010 under President Barack Obama. The act aimed to provide affordable health insurance coverage for all Americans while keeping patient costs reasonable without restricting care.
So, what did the Affordable Care Act do?
The ACA expanded Medicaid eligibility, created a Health Insurance Marketplace, required plans to cover a list of essential health benefits, and prevented insurance companies from denying anyone coverage due to pre-existing health conditions.
Whether the goal has been achieved is a topic of debate. ACA proponents believe that millions of Americans who can’t work because of a disability or have family obligations that keep them out of the workplace are finally able to get health insurance coverage, as are people with pre-existing medical conditions that keep them from being approved for coverage.
ACA critics believe that Obamacare has led to tax increases and higher insurance premiums for Americans with private health insurance. In addition, some people in the healthcare industry have been critical of the ACA because they believe it has caused doctors and hospitals to be overworked and has lessened the overall quality of care.
It should also be noted that Obamacare was never intended to replace group health insurance where you work. If your employer offers group health coverage as an employee benefit, it is to your benefit to enroll in that coverage. At the very least, compare it to an ACA plan you’re interested in and make an informed decision about which plan best meets your needs.
How does the Affordable Care Act work?
Under Obamacare, when you enroll in one of the health insurance plans (there are several to choose from), you pay a monthly premium to keep the plan active. Depending on your income, the program provides a subsidy, also known as a tax credit, to help cover a portion of your premiums.
The specific coverage you have depends on the plan you chose, but the ACA requires that all plans sold through the Marketplace cover “essential health benefits,” which include:
- Wellness services
- Chronic disease management
- Emergency care
- Outpatient care when you’re not admitted to the hospital
- Prescription drugs
- Pregnancy and newborn care
- Pediatric care
- Services for mental health and substance abuse disorders
- Rehabilitative services
- Laboratory services
In addition, Obamacare requires plans sold on the Marketplace to cover at no cost to policyholders a list of preventive services. These include checkups, patient counseling, immunizations, and numerous health screenings.
The ACA also allowed states that opted-in to extend Medicaid coverage to a broader range of people. As of April 2022, 38 states and the District of Columbia had exercised that option and have accepted federal funding.
Who qualifies for Obamacare?
Eligibility for Obamacare is fairly far-reaching. You must live in the United States, be uninsured, not be incarcerated, not be covered by Medicare, and be a U.S. citizen or national.
If you’re not a U.S. citizen or national, you may also qualify for Obamacare if your immigration status is:
- Lawful permanent resident or green card holder
- Cuban or Haitian entrant
- Immigrant paroled into the U.S.
- Immigrants granted conditional entrance before 1980
- Battered spouse, child, or parent
- Victim of trafficking, along with a spouse, child, sibling, or parent
- Those granted withholding of deportation or withholding of removal, under the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment, or Punishment (CAT), or immigration laws
- Non-immigrant status, including those with worker visas and student visas
- Temporary protected status (TPS)
- Deferred enforced departure (DED)
- Deferred action status, excluding Deferred Action for Childhood Arrivals (DACA)
- Lawful temporary resident
- Those with an administrative order issued by the U.S. Department of Homeland Security that stays their removal
- Member of a federally recognized Indian tribe, or an American Indian born in Canada
- Resident of American Samoa
[ Related: Who should buy supplemental health insurance? ]
How much is Obamacare?
While anyone meeting the criteria listed above can buy a health insurance plan under Obamacare, if you have a household income between 100% and 400% of the federal poverty level (FPL), you may qualify for a financial subsidy that reduces your premiums and out-of-pocket costs.
According to a Kaiser Family Foundation analysis of marketplace plans nationwide for a 40-year-old person, the average premium in the U.S. (without subsidies) for a silver plan (considered the “benchmark” plan )in 2022 is $438. The price ranges from a low of $309 in New Hampshire to a high of $762 in Wyoming.
Monthly premiums will vary by:
- Where you live
- Your income
- Your household size
- The plan you choose
- The tax credit you receive
The ACA is more affordable in 2022 than ever because of the American Rescue Plan Act of 2021. Because of this plan enacted to help those hardest hit financially by the pandemic, 80% of people eligible for Obamacare can find a plan for $10 or less per month.
How to signup for Obamacare
There are several ways to sign up for Obamacare. You can use:
- A Navigator. This is an individual or organization trained to help consumers, small businesses, and their employees look at plans available through the Marketplace, and complete eligibility and enrollment forms. These individuals and organizations are required to be unbiased, and there is no charge to consumers to use their services.
- An agent or broker. This is a licensed insurance agent or broker who will explain the different plans to you and help you enroll. Agents and brokers are paid a commission by the insurer for assisting you.
You can also sign up on your own using the healthcare.gov website, through a participating insurance company’s website, by calling the Marketplace Call Center 24/7 (except holidays) at (800) 318-2596, or by mailing in an application.
If you missed the 2022 open enrollment period but now need coverage, you may qualify for a special enrollment period if you have a qualifying life event, like:
- Losing your health insurance coverage
- Getting married
- Having a baby
- Adopting a child
- Moving to a new state
What if you change jobs while on Obamacare?
If you have an Obamacare plan and get a new job offering health insurance, you’ll no longer be eligible for an ACA subsidy. In that case, you’ll want to cancel the plan you got through the Marketplace and switch to your employer's plan.
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