More than 20 million Americans are publicly or privately insured under the Affordable Care Act (ACA), commonly referred to as “Obamacare.” The act was signed into law by President Barack Obama as a way to give more Americans access to affordable healthcare.
This act also offers protections for people with pre-existing conditions who might otherwise encounter expensive premiums and gaps in coverage. After applying to the program, one can browse available insurance plans and coverage options through the online Health Insurance Marketplace.
Who Can Use the Health Insurance Marketplace?
In order to access private health insurance through the Health Insurance Marketplace created under the ACA, you must be a U.S. citizen or have lawful status in the U.S. Additionally, you cannot be currently incarcerated. The marketplace offers private health and dental plans.
Healthcare plans fall into one of four categories: bronze, silver, gold, or platinum-based on how you and your insurance will split the costs. Depending on how much coverage you need or how much you’re able to afford, you can find a plan that best suits you and your family’s needs.
Open Enrollment Periods
Enrollment for Affordable Care Act coverage opens for a limited time each year, typically from November 1st to December 15th for insurance plans beginning in the new year. However, some states extend their marketplace’s open enrollment periods to give more people time to sign up.
You will be able to browse the marketplace and explore coverage options before hearing back about your eligibility. After a year, you have the option to re-enroll or apply to keep or upgrade the coverage you received from open enrollment insurance.
Special Enrollment Periods (SEP)
If you need coverage but missed the deadline due to a special circumstance, you can still apply for coverage, assuming that your circumstances qualify you for a special enrollment period. These circumstances might include having a baby, getting married, losing a spouse, getting divorced, moving, or becoming unemployed.
People moving from transitional housing or coming into the U.S. from abroad may also qualify for a special enrollment period. When you apply, you may need to submit documentation of your situation. You’ll have 30 days to submit this proof to confirm your eligibility, although you can browse the marketplace and pick your plan in advance before waiting for approval.
Health Plan Categories
The majority of health plans on the marketplace are divided into four categories, which are bronze, silver, gold, and platinum. These categories are based on how you and your insurer will split the costs of care. The categories and general breakdowns are as follows:
- Bronze – Insurance pays 60% and you pay 40%.
- Silver – Insurance pays 70% and you pay 30%.
- Gold – Insurance pays 80% and you pay 20%.
- Platinum – Insurance pays 90% and you pay 10%.
Determining which category is right for you depends on what your needs are and how much you are able to pay monthly for your insurance.
The bronze plan offers the lowest premiums of all the plans, and is best for people looking for a cost-effective solution to healthcare coverage. However, silver plans often have lower deductibles than that of bronze plans, making it an attractive option for people looking for moderate healthcare coverage with less upfront costs.
The gold and platinum plans come with higher premiums but also feature significantly lower deductibles. These plans are ideal for people seeking a significant amount of healthcare coverage or would rather have more of their health care costs paid upfront.
Regardless of which category you choose, you may qualify for a premium tax break based on your income level. When you submit your application, you can also find out if you qualify for any of these tax breaks.
How to Apply for Health Insurance on the Marketplace
You have several methods to apply for health insurance in the marketplace. They include:
- Applying online on Healthcare.gov.
- Having an agent contact you.
- Using a certified enrollment partner.
- Calling the marketplace by phone.
- Using a mail-in application.
The most common application method is the online option. From there, you can use the online form to provide your basic information, including your Social Security Number, tax identification number, proof of legal residence, or income levels.
Visiting an agent or broker is a great option for people new to the insurance marketplace, or who are unsure where to start. An agent can work with you to find a plan that best suits your needs, and determine whether a bronze, silver, gold, or platinum plan is best for you. There are hundreds of open enrollment health insurance plans to choose from, as well as catastrophic plans.
Eligibility for Catastrophic Plans
The only two initial criteria to enroll in a catastrophic plan are being under the age 30 or being of any age with a hardship exemption during enrollment.
Hardship exemptions are given to people in a variety of circumstances, including homelessness, foreclosure, bankruptcy, victims of domestic violence, and people with outstanding medical debt that they are unable to pay.
There are pros and cons to enrolling in a plan under a catastrophic exemption. The first major con is that deductibles are very high.
As of 2020, the deductible for any catastrophic plan is $8,700 — a steep price if you’ve been recently evicted or have an outstanding debt. After this deductible, however, your insurance will pay in full for every covered service without a copayment. If you’re expecting a major life event, such as having a baby or going through major surgery, this plan might be your best option.
Coverage for Those Who Need It Most
Of course, picking a plan all depends on your eligibility and acceptance into the program. If you get turned down (which, based on the criteria, isn’t likely to happen to most people), there is always the option to appeal the decision.
Apply early in the open enrollment period to ensure adequate time to submit additional documentation and discuss picking the right plan with your partner. You can also qualify for coverage under the ACA if you didn’t qualify for Medicaid in your state (depending on whether they extended their guidelines for eligibility when the ACA was passed).
Your health is important, and the Affordable Care Act was designed to give Americans the coverage they need without being exploited by insurance companies. Take time to talk to an agent or representative and learn about Obamacare and open enrollment to get the coverage you and your family deserve.