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Everything you need to know about applying for Obamacare.
Obamacare plans are also known as ACA (Affordable Care Act) plans or individual marketplace plans
Apply for coverage during Open or Special Enrollment periods
You can enroll on Healthcare.gov or your state health insurance exchange website
Health insurance companies and certified online comparison sites also offer ACA plans
Obamacare is another name for the Affordable Care Act and also refers to the subset of health insurance plans that require state and federal checks. You may qualify for subsidies for these health plans if you have a low-income household.
Obamacare health insurance plans may also be referred to as marketplace plans, as the health insurance marketplace on the healthcare.gov site is the main way that individuals apply for and purchase these plans. However, there are other ways to buy marketplace coverage, including directly from an insurance company, or an online health insurance seller, like Policygenius, that lets you compare different plans.
People typically apply for Obamacare when they don’t have group health insurance through their employer or another organization, such as a freelancers union. If you need to buy a health plan, you can only do so during Open Enrollment period (from November 1, 2019, through December 15, 2019) or during a Special Enrollment period if you have a qualifying life event.
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You can only apply for Obamacare during a certain time period called Open Enrollment, a 45-day window designated for buying health insurance. Open Enrollment begins November 1, 2019, for plans that take effect on January 1, 2020. The deadline to apply for coverage during Open Enrollment is December 15, 2019.
Outside of this window, you’ll only have a chance to buy a marketplace plan during a Special Enrollment period, after you experience a qualifying life event like losing your current health coverage or gaining a family member.
Learn more about qualifying life events that will let you apply for Obamacare.
If you’re waiting for an enrollment period, you can take some time to familiarize yourself with health insurance and how much you can afford. Monthly premiums can range from $150 to $600 for individuals, but that sticker price doesn’t account for other out-of-pocket expenses you might have to pay.
The marketplace will offer up many plans that may sound similar or confusing if you don’t understand them. You can read our guide to health insurance, including key aspects of a health plan, like deductibles, coinsurance, and out-of-pocket maximums.
If finding affordable care is a priority, you might qualify for a health insurance subsidy based on your projected income levels. To estimate your income, you should start with your adjusted gross income (AGI) from your last tax return and adjust for any changes (like a potential raise, for example). Gathering this information ahead can help you gain a better understanding of your options when it comes to plans and subsidies and what you can afford.
Healthcare.gov will be able to tell you what kinds of subsidies you might qualify for, like the premium tax credit, but you won’t know the exact subsidy amounts and plan prices until you fill out the actual application.
Marketplace plans are primary offered through healthcare.gov, and oftentimes other methods may redirect you there. Keep in mind that while marketplace plans are most often bought on the marketplace, this is not the only way to buy an Obamacare plan.
You will need to provide basic information like name, address, household size, and projected household income.
Note that if you’re eligible for any premium tax credits, you can only use them through healthcare.gov or a certified enrollment partner. When you enroll, you can choose to claim the tax credits on your tax return the following year, or have the credits applied on a monthly basis — this is known as the advanced premium tax credit.
The easiest way to get a marketplace plan is on the marketplace itself. While you can apply by mail or phone, these methods take much longer than if you were to apply online. You can create an account at healthcare.gov and see all the marketplace plans available to you.
Depending on what state you live in, you might be redirected to a different site. The following states have their own health insurance exchange:
You’ll still be getting a marketplace health insurance — these states just operate their own exchange and sites.
You can also search for Obamacare plans directly with health insurance companies. This might be an insurer that has been around for decades or a newer company that only exists online. In either case, if you apply online, the insurer may redirect you at some point to the health insurance marketplace — either healthcare.gov or your state exchange — to complete your application. Remember that the insurance company will only show you their health plans. So if you want to comparison-shop for insurance coverage, it may be best to go directly to the marketplace to see all the plans.
Online insurance sellers will show you marketplace plans from more than once insurance company and let you enroll in them. Depending on the site, they may show you some or all of the plans available on the marketplace. These sites are good for comparing different plans, and are sometimes easier to navigate than then federal or state health insurance exchanges.
Agents and brokers are licensed sales people who usually receive a commission when they sell a policy. They typically only offer health plans from a range — not all — insurance providers.
Assisters are certified and trained to help you but find a marketplace plan — or apply for Medicaid or CHIP (the federal Children's Health Insurance Program) — but aren’t associated or paid with an insurance company.
Applying for health insurance is not limited to U.S. citizens. Permanent residents, or Green Card holders, and other people with certain immigration status are also qualified to buy marketplace insurance coverage. This includes refugees, asylum seekers, and anyone with temporary protected status (TPS), individuals with worker visas, student visas, and more.
If you’re not a citizen, you will likely have to provide some documents proving your immigration status. This might be a Green Card, foreign passport, employment authorization, or something else.
Unfortunately undocumented immigrants cannot apply for marketplace health insurance.
Health insurance can help pay for your medical expenses.
Health insurance coverage pays for medical expenses you can't afford out of pocket.
One part of Obamacare is the expansion of Medicaid, a government program that provides health insurance for low income families. You can also get Medicaid if you’re pregnant, elderly, disabled, a parent or caretaker, or a child — through the Children’s Insurance Program (CHIP).
Generally Medicaid covers major medical expenses, but the specifics (like whether or not prescription drug coverage is included) will depend on the state.
Unlike getting health coverage on the marketplace, you don’t need to wait for an enrollment period to get Medicaid. You can apply at any time (either on healthcare.gov or your state Medicaid office or website) so long as you meet the qualifications.
Medicaid rules can be confusing, but you can find out more about the eligibility requirements in our state-by-state guide to Medicaid.
Health insurance and life insurance work together to offer financial protection.
Health insurance can pay your medical expenses. Life insurance keeps your loved ones whole after you die.
Policygenius’ editorial content is not written by a certified financial planner or advisor. It’s intended for informational purposes only and should not be considered legal, financial, or investment advice. Consult a professional to learn what financial products are right for you.
This post contains references to products or services from one or more of Policygenius' advertisers or partners. While these codes earn us a small fee at no additional cost to you, they do not influence editorial content and we only refer products we love.
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