Obamacare: Where To Apply?

Obamacare aims to provide affordable health insurance coverage for all American citizens and protects consumers from insurance company tactics that could increase costs for patients or restrict care.

The Affordable Care Act (ACA), officially known as the Patient Protection and Affordable Care Act, and casually known as Obamacare, is a United States government law enacted by the 111th United States Congress and endorsed into law by President Barack Obama on March 23, 2010. When it comes to Obamacare, where to apply is one of the many questions one asks. For the vast majority, you will have the option to apply for Obamacare during the yearly Open Enrollment Period (OEP). Open Enrollment is a six-week period each fall when anybody can join up with an Obamacare plan for the upcoming year. On the off chance that you have missed the Open Enrollment Period for a calendar year, you might still have the option to apply for Obamacare if you fit the bill for a Special Enrollment Period (SEP). A Special Enrollment Period is triggered by what is known as a Qualifying Life Event (QLE).

What is Obamacare?

Obamacare is another name for the Affordable Care Act and also alludes to the subset of health care coverage plans that require state and federal checks. You might meet all requirements for subsidies for these health plans in the event that you have a low-pay household.

Obamacare health care coverage plans may likewise be alluded to as marketplace plans, as the health insurance marketplace on the healthcare.gov site is the main way that people apply for and buy these plans. Nonetheless, there are alternate ways to purchase marketplace inclusion, including directly from an insurance organization, or an online health insurance dealer, that allows you to analyze and compare various plans.

Individuals regularly apply for Obamacare when they do not have group medical coverage through their employer or another organization, like a freelancers union. On the off chance that you need to purchase a health plan, you can just do this during the Open Enrollment period (from November 1, 2020, through December 15, 2020) or during a Special Enrollment period in the event that you have a qualifying life event (QLE). QLEs come in three general classes: Loss of inclusion, changes in your household, and changes in residence.

Open Enrollment Period

The application process for Obamacare opens during a certain time period known as the Open Enrollment. It is a 45-day window designated for purchasing health insurance. Open Enrollment starts on November 1, for plans that take effect on January 1, of the upcoming year. So for coverage that started on 1st January, 2021, the open enrollment period begins on 1st November, 2020. The deadline to apply for coverage during Open Enrollment is December 15 (so for the example just stated, it would be 15th December), except for some states. These states are:

  • California: January 15
  • Colorado: January 1
  • Massachusetts: January 23
  • Minnesota: December 22
  • Nevada: January 15
  • New Jersey: January 31
  • New York: January 31
  • Pennsylvania: January 15
  • Washington D.C: January 21

Outside of this window, you will only have a chance to purchase a marketplace plan during a Special Enrollment period. The Special Enrollment Period is accessible to you only after you experience a qualifying life event, such as, losing your current health coverage or gaining a family member.

Special Enrollment Period

Special Enrollment permits you to purchase an individual health care coverage plan after you experience a qualifying life event (QLE), which is a significant change in your life. The following section will give more examples of what can be classified as a qualifying life event. If we quickly skim through what these events could be, they could be changing jobs (regardless of whether you resign or are fired) or a change in your marital status. After your qualifying event, you will be allowed a brief period of time to purchase medical coverage. This time period is known as a Special Enrollment Period (SEP). You normally have 30 to 60 days to sign up for a health plan after a qualifying event. On the off chance that you expect to lose health care coverage inclusion within the next 60 days, as in if you know you will find employment elsewhere, you might even have access to a Special Enrollment Period before your qualifying event. You can check with your state or federal exchange for the exact time span.

Qualifying Life Events

A qualifying life event (QLE) is an event that changes your family or medical coverage circumstance and qualifies you for a Special Enrollment Period. Normal qualifying life events are the loss of health care inclusion when you leave your job and find employment elsewhere, get married, have a kid, move houses, or lose existing inclusion under a parent’s plan because you turned 26. You additionally fit the bill for Special Enrollment on the off chance that you lost your employer-supported health care coverage due to the Covid pandemic (COVID-19).

There are four main kinds of qualifying events as per Healthcare.gov, which deals with the health insurance marketplace — life events that result in a loss of your health coverage, changes in your family, changes in your house, and other special conditions. Beneath you can see a list of common qualifying life events that you might go through:

  • Becoming a U.S. citizen
  • Birth or adoption of a child
  • COBRA coverage ends (you don’t qualify if you prematurely end COBRA by either cancelling it or not paying the premiums)
  • Death of a family member, resulting in your loss of coverage
  • Divorce or legal separation
  • Gaining an eligible dependent, like through child support, a court order, by caring for an elderly parent
  • Gaining other “lawful presence in the U.S.” such as permanent residence or a green card
  • Joining a federally recognized tribe
  • Leaving active duty or otherwise losing TRICARE coverage
  • Leaving incarceration (prison or jail)
  • Leaving your current employment, whether you resign, get fired, or are otherwise let go
  • Losing an eligible dependent, such as through placing a child into adoption or foster care
  • Losing coverage or being denied coverage for Medicare, Medicaid, or CHIP (Children’s Health Insurance Plan) eligibility. (Find your local eligibility requirements in our state by state guide to Medicaid.)
  • Marriage (usually including a common-law marriage or domestic partnership)
  • Moving to a new zip code or county where your current insurance coverage is not offered
  • Moving to or from the place where you attend school, if you’re a student
  • Moving your home for seasonal work
  • Spousal abandonment, including situations where you can’t locate your spouse after attempting to find them or if you’re a survivor of domestic abuse and need to enroll in your own plan
  • Turning 26 and losing health coverage under a parent’s plan

In the event that you can’t get health inclusion during either of the enrollment periods, you might need to think about other options, for instance, a short-term insurance plan. This adaptable plan normally lasts for a couple of months and can be renewed. However, a short-term plan does not meet the minimum fundamental inclusion needed by the government, so you might end up with inclusion that is inadequate for your requirements. Americans age 65 or more can get health care coverage through Medicare while lower pay families may fit the bill for Medicaid.

Preparing to apply for Obamacare

In case you are waiting for an enrollment period, you can set aside some time to acquaint yourself with health care coverage and the amount you can bear. Monthly premiums can go from $150 to $600 for people, yet that retail cost does not represent other out-of-pocket costs you may need to pay.

The marketplace will offer many plans that might sound similar or even confusing if you do not get them. You can read any guide to health insurance coverage, which includes key parts of a health plan, such as deductibles, coinsurance, and out-of-pocket maximums.

On the off chance that finding affordable care is a need, you may meet all requirements for a subsidy depending on your projected pay levels. To appraise your pay, you should begin with your adjusted gross income (AGI) from your last tax return and adjust for any changes (like an expected raise, for instance). Collecting this data beforehand can help you get a better comprehension of your options with regards to plans and subsidies and what you can afford.

Healthcare.gov will be able to tell you what sorts of subsidies you may fit the bill for, similar to the premium tax credit, however you will not have a clue about the exact subsidy amounts and plan costs until you round out the actual application.

Obamacare: Where to apply?

Marketplace plans are fundamentally offered through healthcare.gov, and frequently, other strategies might redirect you there. Remember that while marketplace plans are often purchased on the marketplace, this is not the best way to purchase an Obamacare plan. You will have to give basic data like name, address, family size, and projected family income.

In case you are qualified for any premium tax credits, you can only utilize them through healthcare.gov or a certified enrollment partner. At the point when you sign up, you can decide to claim the tax credits on your tax return the next year, or have the credits applied monthly — this is known as the advanced premium tax credit. Note that you can only get health care coverage through healthcare.gov. For other kinds of insurance, like life insurance, you might have to go through a broker.

Health insurance marketplace

The easiest way to get a marketplace plan is on the marketplace itself. While you can apply via mail or telephone, these techniques take any longer than if you somehow managed to apply online. You can make an account at healthcare.gov and see all the commercial center plans accessible to you. Contingent upon what state you live in, you may be redirected to a different site. The accompanying states have their own health care coverage trade:

  • California: Covered California
  • Colorado: Connect for Health Colorado
  • Connecticut: Access Health CT
  • Idaho: Your Health Idaho
  • Maryland: Maryland Health Connection
  • Massachusetts: Health Connector
  • Minnesota: MNsure
  • Nevada: Nevada Health Link
  • New York: NY State of Health
  • Rhode Island: Health Source RI
  • Vermont: Vermont Health Connect
  • Washington: Washington Healthplanfinder
  • Washington, D.C.: DC Health Link

You will still be getting marketplace health insurance — these states just operate their own exchange and sites.

Applying for Obamacare via an insurance company

You can likewise look for Obamacare plans directly with health care coverage organizations. This may be an insurance provider that has been around for quite a long time or a newer organization that only exists online. Regardless, in the event that you apply online, the insurer might redirect you eventually to the medical coverage marketplace — either healthcare.gov or your state exchange — to finish your application. Keep in mind that the insurance organization will just show you their health plans. So assuming you need to comparison-shop for insurance coverage, it may be ideal to directly go to the marketplace to see each of the plans.

Online comparison sites besides healthcare.gov

Online insurance sellers will show you marketplace plans from more than one insurance organization and let you sign up for them. Contingent upon the site, they might show you a few or all of the plans available on the marketplace. These websites are useful for comparing different plans, and are sometimes simpler to explore than federal or state health insurance exchanges. If you wish to start or finish the application online yourself, you might directly do it online through HealthCare.gov, through the official website of your state-based exchange, or through any assigned government partner. You will enter your postal division (zip code) and some essential personal data (like your age, gender, number of individuals in your family who need inclusion, and yearly family income) and afterward you will be shown plans available to you and their monthly premium expenses. You will also see any savings you fit the bill for depending on the data you gave.

Agents, brokers, and assisters

Agents and brokers are authorized sales people who typically get a commission when they sell a plan. They commonly only offer health plans from a range of — not all — insurance suppliers. Assisters are licensed and trained to help you find a marketplace plan — or apply for Medicaid or CHIP (the federal Children’s Health Insurance Program) — however are not related to or paid with an insurance organization.

Applying for Obamacare as an immigrant

Applying for medical coverage (health insurance) is not restricted to U.S. residents. Permanent residents, or Green Card holders, and others with certain immigration status are also able to purchase marketplace insurance inclusion. This incorporates refugees, people who are seeking asylum, and anybody with temporary protected status (TPS), people with worker visas, student visas, and more. In case you are not a resident, you will probably need to give a few documents that prove your immigration status. This may be a Green Card, foreign passport, employment approval, or something else. However, undocumented immigrants cannot apply for marketplace health insurance.

Can you apply for Obama care anytime?

You can only apply for Obamacare during a specific time-frame known as the Open Enrollment Period. As mentioned above, it is a 45-day window assigned for buying health insurance. Open Enrollment begins on November 1, for plans that take effect on January 1 of the following year. 15th December is the application deadline. Some states have a different deadline date (they are already mentioned in this article).

How much is Obamacare monthly?

The amount Obamacare costs you relies upon five factors: your age, pay, family size, area, and the sort of plan you pick. The Affordable Care Act gives subsidies to middle-income people, families, and private companies. It additionally expands free Medicaid for low-pay families. It charges higher-pay families and organizations that do not give medical benefits. Firstly, your expense relies upon the plan category you pick. All medical coverage plans can be categorized as one of four classifications which are:

  • Bronze – Has the lowest premiums, but only pays 60% of your health care costs. Choose this plan if you do not expect a lot of medical bills.
  • Silver – Pays 70% of your covered medical costs, but the premiums are higher than the Bronze plan.
  • Gold – Pays 80% of your costs, with higher premiums than the Silver plan.
  • Platinum – Pays 90% of your costs, but has the highest monthly premiums. It will make sense to go for this plan if you have a chronic health condition.

The plans in every category permit you to compare monthly premiums, deductibles, copays, and yearly out-of-pocket maximums. This is where it gets precarious. Indeed, even in the same category, the plan with the most reduced premium might have the largest deductible. You may wind up paying more for health costs in the event that you become sick, than you would with a plan with a higher premium and lower deductible. Therefore, you must gauge how much actual health care costs will be, then decide the insurance plan that helps you with reducing the total expense the most.

Secondly, your expenses rely upon your age. Health insurance organizations are permitted to charge higher premiums for older individuals. In any case, they cannot charge more than three times the premium for younger individuals. Third, is the place where you live. The average cost for basic items, including healthcare, is higher in certain urban areas than in others.

Fourth and fifth are your pay and family size. On the off chance that you make 400% or less of the federal poverty level, you will get a subsidy. Here is how the subsidy works. Let us assume you are a single individual and you earn $47,520 (almost 400% of the poverty level). Obamacare guarantees you will not pay over 9.78% of your income a year, or $4,647.46, for the second-lowest Silver plan. Your subsidy is the cost of the plan, minus $4,647.46. So if the plan is $5,000, your subsidy is $352.44.

Imagine a scenario where you need a more costly plan. Obamacare puts together all subsidies on the expense of the second-lowest Silver plan. So your subsidy is still $485 per year, which you can apply to any plan. You pay the difference. Luckily, healthcare.gov sorts this out for you. It allows you to pick whether you need your subsidy every month, or the year’s end as a tax break. It even calculates the premium of the plan you pick depending on your subsidy.

10 Essential Health Benefits

The 10 categories are:

  1. Emergency room services. Most plans already included this. Some cost more if you go to a hospital that is out of their network or go without pre-authorization. Obamacare plans do not charge extra.
  2. Hospitalization. Not all plans cover enough of this tremendous cost. Most people do not realize that a day in the hospital can cost between $2,000 and $20,000. If you have a high-deductible plan or one with a low maximum, you may be surprised by how much you wind up paying out-of-pocket.
  3. Lab tests. Plans must pay 100% of the expense of tests if doctors use them to diagnose an illness. Otherwise, regular copays and deductibles apply.
  4. Maternity and newborn care. That must be provided without any expenses since it is preventive care. Most young people who do not have insurance will find that this is a required benefit if they become pregnant.
  5. Mental and behavioral health treatment. It includes treatment for alcohol, drug and other substance abuse and addiction. Insurance companies avoid paying for these diseases, which need a long-term commitment. They increase co-pays to as high as $40 a session and restrict the number of therapist visits.
  6. Outpatient care. Most health insurance plans covered this already.
  7. Pediatric care: Dental and vision care should be covered.
  8. Preventive and wellness visits, including chronic disease management. Preventive care visits do not have a copay. The ACA requires that all 50 procedures recommended by the United States Preventive Services Task Force be covered as preventive services. These include well-woman visits, domestic violence screening, and support for breastfeeding equipment and contraception.
  9. Prescription drugs. Plans need to cover at least one drug in every category in the U.S. Pharmacopeia. Your out-of-pocket drug costs count toward your deductible. That was not true for all insurance plans before the ACA. They also usually offered this at an expense.
  10. Services and devices to help people with injuries, disabilities, or chronic conditions. Most plans cover services and equipment that help you recover from temporary injuries, like a broken leg. The ACA needs coverage for equipment required to treat a chronic disease, like multiple sclerosis.

This Obamacare mandate applies to all plans made after March 23, 2010. Prior to that, under 2% of plans gave all of the 10 advantages. In the event that you had your plan before 2010, it very well may be grandfathered in, and not have the necessary advantages. Numerous insurance organizations have dropped these plans. They will ask you to change to plans that do give this inclusion on the exchanges.

Audit these advantages and contrast them with the advantages your plan currently gives you. You might find that you can get a better plan for less cash on the health care coverage exchanges. The premiums might be higher, but the inclusion might end up costing you less.

Obamacare permits each state to make a “benchmark” plan that will be the model for any remaining plans in its jurisdiction. This is to ensure that the plan is not excessively costly for small businesses to offer. The plans should cover the state’s benchmark services without forcing a lifetime maximum, or yearly limits, on costs.

Impact of these benefits on the U.S. economy

By setting this standard of advantages, the Affordable Care Act holds insurers back from reducing advantages to decrease expenses. Will they raise premiums instead? No, in light of the fact that a large number of presently uninsured Americans will begin paying premiums. Obamacare’s preventive care benefits diminish the growth rate of the country’s health care costs. Doctors can pinpoint and treat illnesses before they require costly emergency room visits. A huge number of families can avoid bankruptcy by getting treated early, or by having the insurance to cover these costs.

Because of the Bankruptcy Prevention Act, individuals lost their entire savings and homes to meet medical expenses. In the wake of losing everything, they went bankrupt. Medical care costs rose to make up for these neglected bills. As more individuals have insurance, it should bring down healthcare expenses and bankruptcies. Young and healthy individuals will get insurance, because of maternity, infant and pediatric care. That will diminish health care coverage costs in general. Obamacare’s extended behavioral medical advantages help drug addicts, heavy drinkers, and the mentally ill. The development of Medicaid ensures that low-pay individuals have inclusion. That lessens costly emergency room visits.


The Obamacare mandate is subject to changes every year. The legislation can be changed, and budget decisions can have an impact on how it is implemented. Adjustments in the healthcare field, along with changes to the political makeup of future presidential services and Congress, make it likely that Obamacare will continue to change for years to come.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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