Paul Sanchez
The Affordable Care Act (ACA), also known as Obamacare, was enacted in 2010 to make affordable health insurance available to more people. To apply for ACA, you must complete an application with information about your household, income, employment, and citizenship or immigration status. You can apply online, by phone, or by submitting a paper application. After your application is approved, you will select a plan and pay your first premium. Most people apply during the Open Enrollment period each year, but you may be able to apply during a Special Enrollment Period if you experience a qualifying life event, such as losing coverage or experiencing a natural disaster.
| Characteristics | Values |
|---|---|
| Name of the Act | Affordable Care Act (ACA) or Obamacare |
| Year of enactment | 2010 |
| Enactment Administration | Barack Obama |
| Goals | Make affordable health insurance available to more people |
| Enrollment Requirements | Application with details of household members, income, citizenship or immigration status, and employment |
| Enrollment Period | Open Enrollment (OE) typically from November 1 to December 15; Special Enrollment Periods for qualifying life events like loss of coverage, natural disasters, etc. |
| Enrollment Process | Filling out an application online, via paper, or over the phone; Choosing a plan from metal tiers like Silver, Gold, or Platinum; Paying the first premium |
| Premium Affordability | Financial assistance available; 4 out of 5 people can find a plan for $10 or less per month |
| Catastrophic Health Plan Deductibles | $9,100 in 2023 |
| DACA Recipient Eligibility | Eligible in certain states due to lawsuits and injunctions; Considered "lawfully present" for ACA purposes from November 1, 2024 |
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What You'll Learn
Application methods
The Affordable Care Act (ACA) application process involves several steps. Firstly, you must complete an application form, providing personal information such as your Social Security number, citizenship or immigration status, and details about your household and income. This can be done online, which is the fastest method, or by submitting a paper application or calling the Marketplace call center and applying over the phone.
After submitting the application, you will be informed of your eligibility for financial assistance and whether you qualify for Medicaid or the Children's Health Insurance Program. During the Open Enrollment period, you can then select a plan that suits your needs and budget. These plans are typically organized into ""metal tiers," indicating how costs will be split between you and your plan provider.
The Open Enrollment period for ACA health insurance usually lasts 45 days, from November 1 to December 15, although it has been extended in the past due to COVID-19. Outside of this period, certain life changes, known as "qualifying life events," may allow you to sign up or make changes to your plan during a Special Enrollment Period. These events include losing coverage, experiencing a Marketplace error, or facing various hardships such as eviction, domestic violence, natural disasters, or the death of a family member.
It's important to note that some states run their own marketplaces, so you may be directed to a specific state-based website during the application process. Additionally, members of federally recognized American Indian tribes and Alaska Native Claims Settlement Act shareholders can enroll at any time without enrollment period restrictions.
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Application information
To apply for the Affordable Care Act (ACA), also known as Obamacare, you must complete an application form and choose a plan. You may also need to pay a premium. The application process can be completed online, over the phone, or via a paper form. The online application is the fastest method.
The application will ask for basic information about yourself and any family members applying for coverage with you. This includes your Social Security number, citizenship or immigration status, and employment and income information. You will also be asked about your most recent income tax return.
After submitting the application, you will be informed of your eligibility for Qualified Health Plans and whether you may be covered by Medicaid or the Children's Health Insurance Program.
To complete the application online, you will need to create a secure personal account with a login ID and password. You can also receive free, local, in-person assistance in evaluating your enrollment options.
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Choosing a plan
Once you have completed the application process, the next step is to choose a plan. Generally, ACA plans are organized into "metal tiers", which determine how you and your insurance provider will split the cost of care. The higher the monthly premium, the lower the costs when you need care.
The Silver plan is considered the "benchmark" plan, with moderate monthly premiums and moderate costs when you require care. You must choose a Silver plan to qualify for cost-sharing reductions, also known as "extra savings" on out-of-pocket expenses such as deductibles, copayments, and coinsurance.
The Gold plan has a high monthly premium but lower costs when you need care. The Platinum plan has the highest monthly premium but the lowest costs when you require care.
If you are looking for very low premiums, you could consider a Catastrophic health plan. However, the deductibles for this type of plan are extremely high. As of 2023, all ACA catastrophic health plans have a deductible of $9,100.
You can also receive financial assistance with your premiums. Due to new legislation, 4 out of 5 people will be able to find a plan for $10 or less per month.
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Paying premiums
Understanding ACA Premiums
ACA premiums refer to the monthly or periodic payments made to maintain health insurance coverage under the Affordable Care Act. These premiums vary based on the type of plan selected and the individual's income and family size. The ACA plans are typically organized into "metal tiers," with different cost-sharing structures. For instance, the Silver plan is considered the "benchmark" option, with moderate monthly premiums and out-of-pocket costs. In contrast, the Gold plan features higher premiums but lower costs when healthcare services are needed.
Applying for Premium Tax Credits
The ACA offers Premium Tax Credits to help individuals and families with low to moderate incomes afford health insurance. These credits are refundable and based on a sliding scale, providing larger credits to those with lower incomes. When applying for ACA coverage, individuals can choose to have the Marketplace estimate their Premium Tax Credit and decide how much of the estimated credit they want to be paid in advance to their insurance company to lower their monthly premiums. This advance credit payment option is beneficial for reducing the out-of-pocket cost of premiums.
Paying the First Premium
After completing the ACA application and selecting a plan, individuals will need to pay their first premium to the insurance company for their coverage to begin. This initial payment is an essential step in securing their chosen health insurance plan. The amount of the first premium will depend on the selected plan and any applicable financial assistance or subsidies.
Annual Open Enrollment and Special Periods
Most people apply for ACA coverage during the annual open enrollment period. For the 2023 coverage year, the open enrollment period ran from November 1, 2022, through January 15, 2023, in most states. If individuals miss the open enrollment deadline, they may still have the opportunity to choose a plan during a special enrollment period, which is typically triggered by specific life events or qualifying circumstances.
Enhanced Subsidies and Premium Payments
Enhanced ACA subsidies, first enacted in 2021 under the American Rescue Plan Act and extended through 2025 by the Inflation Reduction Act, have significantly lowered premium payments for enrollees. These subsidies boost existing subsidies and make more individuals eligible for financial assistance. For example, low-income enrollees (up to 150% of the poverty level) may qualify for free or nearly free coverage. Additionally, individuals earning over four times the poverty level saw their premium payments capped at a certain percentage of their income.
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Enrollment periods
During the OEP, individuals and families can compare various health plans, select the one that best fits their needs, and make their first premium payment to activate their chosen plan. It is important to note that the OEP provides a limited window of opportunity for enrollment or plan adjustments.
Outside of the OEP, individuals can only enroll in ACA-compliant health insurance if they qualify for a Special Enrollment Period (SEP). SEPs are triggered by specific "qualifying life events," such as marriage, the birth of a child, losing existing health coverage, moving to a new state, or income changes. The period typically lasts for 60 days from the date of the qualifying life event.
While the OEP is the ideal time to make changes to your health insurance plan, it is important to remember that you may still have options outside of this period through a SEP. However, in most cases, you will need to demonstrate that you have experienced a qualifying life event to take advantage of this special enrollment opportunity.
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Frequently asked questions
ACA stands for the Affordable Care Act, also known as Obamacare. It was enacted in 2010 during Barack Obama's presidency and has three main goals: making affordable health insurance available to more people, expanding Medicaid, and supporting innovative medical care delivery methods.
You can apply for ACA by completing an application form online, via paper, or over the phone. The application will ask for basic information about yourself and any family members applying with you, including your Social Security number, citizenship or immigration status, employment, and income information. After submitting the application, you will need to choose a plan and pay your first premium.
The Open Enrollment (OE) period for ACA typically lasts 45 days, from November 1 to December 15 each year. However, certain life changes, known as "qualifying life events," may allow you to sign up outside of this period during a Special Enrollment Period. These events include losing coverage, experiencing a Marketplace error, or facing a natural disaster.
Most people in the United States can apply for ACA coverage during the Open Enrollment period. DACA recipients' eligibility varies by state due to an ongoing lawsuit. As of November 1, 2024, DACA recipients are considered “lawfully present” for ACA purposes, and they can access coverage in states not implicated in the lawsuit.
