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ACA

The Affordable Care Act (ACA), commonly known as Obamacare, was designed to provide affordable health coverage to more Americans. The ACA created health insurance marketplaces where individuals and families can compare and purchase health insurance plans. It also introduced important protections to ensure that health insurance is available to people with pre-existing conditions and makes health insurance more affordable for those who qualify.

How the ACA Works

Under the ACA, individuals can purchase health insurance through the Health Insurance Marketplace. There are two primary ways you can get coverage through the ACA:

Marketplace Plans

These plans are offered by private insurance companies but regulated by the ACA. They must cover a comprehensive set of health benefits, including:

These plans are grouped into four categories: Bronze, Silver, Gold, and Platinum, each with different levels of monthly premium and out-of-pocket costs. The choice depends on your healthcare needs and financial situation.

Medicaid and the Children’s Health Insurance Program (CHIP):

The ACA expanded eligibility for Medicaid in some states to cover more low-income individuals and families. CHIP offers free or low-cost coverage to children in families that earn too much to qualify for Medicaid but can't afford private coverage.

How to Get Help Paying for Health Insurance

If you’re finding health insurance unaffordable, the ACA offers ways to help lower your premium and out-of-pocket costs. Premium Tax Credits (PTC) or Advance Premium Tax Credits (APTC) are subsidies available to help make health insurance more affordable, and they depend on several factors, including:

Income

To qualify for subsidies, your household income must fall between 100% and 400% of the federal poverty level (FPL). In 2025, you may qualify for subsidies if your income is below 400% of FPL and if the cost of the second-lowest-cost silver plan (the "benchmark plan") exceeds 8.5% of your

Household Income

This will lower your monthly premiums

Household Size and Location

Your household size and location (state and county) are also taken into consideration when calculating your subsidy eligibility

Age

Your age can affect the price of your premiums. Younger individuals may have lower premiums than older individuals, though the ACA ensures that age-based premium differences are limited

Subsidies can lower your monthly premium, making health coverage more affordable. They are available only through the ACA marketplace, so if you qualify, it’s important to apply for coverage during the open enrollment period

What is the Benchmark Plan?

The benchmark plan is the second-lowest-cost Silver plan available in your area. The cost of this plan is used to calculate your eligibility for subsidies. If the cost of the benchmark plan exceeds 8.5% of your household income, you may qualify for Premium Tax Credits (PTC) or Advance Premium Tax Credits (APTC). These subsidies will reduce your monthly premiums, making coverage more affordable.

Important ACA Protections

The ACA provides key protections for all health insurance plan members, including

Pre-existing Condition Protection

Insurers cannot deny you coverage or charge higher premiums due to pre-existing health conditions.

Essential Health Benefits

All ACA-compliant plans cover a set of essential health benefits, ensuring that you have access to a comprehensive range of services.

No Lifetime Limits

The ACA prohibits insurers from placing lifetime or annual limits on essential benefits.

Open Enrollment and Special Enrollment Periods

You can apply for or change your ACA health insurance coverage during the open enrollment period, which typically runs annually from November 1 to December 15. If you miss the open enrollment period, you may still qualify for a Special Enrollment Period (SEP) if you experience certain qualifying life events such as:

How to Apply for ACA Health Insurance

Applying for ACA coverage is simple and can be done through your state’s Health Insurance Marketplace or the federal marketplace at HealthCare.gov. The application process will involve

  • Reporting your household income and size.
  • Choosing a plan: After assessing your eligibility for subsidies, you can compare plans based on your medical needs and budget.

You can apply online, by phone, or with the help of a licensed insurance agent who can guide you through the process

Important Disclaimer

HealthInsuranceQuotes.co offers assistance in navigating the ACA marketplace, providing expert guidance to help you understand your options and enroll in a health plan that meets your needs. However, we do not offer all plans available through the marketplace, and the final selection and enrollment must be done through the official Health Insurance Marketplace or HealthCare.gov.

Eligibility for subsidies is based on your income, household size, and location, and subsidies may not be available if your income exceeds certain thresholds.