For millions of Americans, the Patient Protection and Affordable Care Act of 2010 has been life-changing. Call it Obamacare, the Affordable Care Act, or ACA; today, 31 million Americans have health insurance because of it.
With open enrollment running from November 1, 2022 to January 15, 2023, now is the time to consider your Obamacare options. Here’s what Obamacare is, how it works, and what you need to do.
Changing the healthcare landscape
Prior to 2010, when then-President Barack Obama signed the act into law, nearly 50 million Americans lacked health insurance. That’s roughly 1 in 6 Americans. Today, over 91% of All Americans have some form of health insurance, and the ACA is a major reason for that.
Besides making health insurance more available, the act also mandates different levels of coverage to ensure adequate coverage and help consumers compare plans.
| Level | Insurance Pays | You Pay |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Bronze
- Lowest monthly premium
- Highest costs when you need care
- Highest deductibles
Good choice if: You want protection from worst-case medical scenarios, such as serious accidents or illness, at the lowest possible cost. Your monthly premium will be low, but you’ll have to pay for most routine care.
Silver
- Moderate monthly premium
- Moderate costs when you need care
- Lower deductibles than Bronze plan
Good choice if: You qualify for cost-sharing reductions, which requires a Silver plan. This can save hundreds or even thousands of dollars per year if you go to the doctor a lot. (Silver plans may also be available if you’re eligible for a premium tax credit and can enroll through a Special Enrollment Period based on estimated household income. More on that below.)
Gold
- High monthly premium
- Low costs when you need care
- Deductibles are usually low
Good choice if: You’re willing to pay more each month in return for having more costs covered when you get medical treatment. If you use a lot of care, this could be a good value.
Platinum
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low
Good choice if: You use a lot of care and want to know that the majority of your costs will be covered.
Required coverage
Regardless of coverage level, all plans must include some coverage for:
- Preventative care
- Emergency care
- Outpatient care when you are not admitted to the hospital
- Hospitalization
- Pregnancy and newborn care
- Services for mental health and substance use disorders
- Rehabilitative services
- Pediatric care
- Laboratory services
Under the Affordable Care Act, you cannot be denied coverage or be charged extra for a pre-existing condition. A pre-existing condition is one that was diagnosed before your new insurance coverage began; you can’t just say, “Oh, I had that before.”
How to qualify for lower premiums
Not everyone in the same state with the same plan from the same provider will pay the same premium. Individuals and families with lower income may qualify for tax credits and other savings.
Generally, if your household income is 100% to 400% of the federal poverty level, you may qualify for a premium subsidy. This means a single eligible person can earn from $12,880 to $51,520 and qualify for the tax credit. A family of three would qualify with income from $21,960 to $87,840. This amount changes every year; find out more here.
Certain life events, including losing health coverage, moving, getting married, having a baby, adopting a child, or if your household income is below a certain amount, may also enable you to apply for health insurance outside the usual open enrollment period.
Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan.
Note: some other medical insurance programs, such as Medicaid or the Children’s Health Insurance Program (CHIP), accept enrollees at any time.
How to enroll
There are several ways to begin the application process:
Before applying, you can check plans and prices for your state and find answers to the most common questions from the federal government.
One thing to keep in mind: some states may have slightly different requirements and a special marketplace just for state residents. Currently, 18 states manage the ACA for their own residents.
Healthcare is an important part of ongoing financial planning. Choosing healthcare coverage can be a complex process without the help of a specialist. A CFP® Professional from Facet can help you choose the right plan for your needs.
