The Affordable Care Act (or Obamacare) was put into effect in March of 2010 and has been the way individuals and families get access to affordable healthcare ever since. In this article by Cuspide we will go in-depth into Obamacare insurance and how it works. From the enrollment and requirements to the plans and prices, everything will be covered here in this easy to follow guide!
Your guide to Obamacare
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Are Obamacare and the ACA the same?
Obamacare and the Affordable Care Act are the same thing, just different names. The ACA law was put in place back in 2010 and introduced the health insurance marketplace. This is where individuals and families can shop for health insurance through the many budget-friendly plans available. The ACA law also expanded Medicaid eligibility, making sure that everyone could get the coverage they needed.
FUN FACT: 4/5 applicants qualify for a $10 a month or less plan!
How to enroll in Obamacare in 3 steps
So, assuming you meet the requirements for ACA coverage (read about that later in this article), then the enrollment process is easy. After you contact an agent or agency, they will enroll you through the health insurance marketplace. Here’s how easy it is to apply for ACA plans with us at Cuspide:
1. We will quote you for free and find the best plan.
2. We get the information needed and begin your application.
3. You receive confirmation of your new plan.
It is that easy to enroll. But like stated earlier, you need to see if you are eligible for ACA plans. The main thing you should know is that your qualification is based on your income. If you don’t meet the minimum required then, you can’t qualify. So, what is the minimum and maximum? Let’s find out.
The Obamacare subsidy income limits for 2024
Below are the income limits for Obamacare subsidies. On the left is the household size; you determine this by how many people are going to be on your tax returns. Next is where you rank on the Federal Poverty Level. The closer you are to 100%, the cheaper your health plan will be, and the closer you are to 400%, the more expensive your plan will be.
Note: This is all based on your after-tax income. Whatever is left after all deductions have been made is what counts. This is called your “adjusted gross income”. Do not make the mistake of applying for health coverage with pre-tax income. This error causes people to overpay.
For example: You make $75,000 a year getting paid as a 1099 contractor. After deductions are done, let’s say you are left with $40,000. That $40K is what you apply for coverage with. That is the correct way, and guess what? You saved money. With that new information, look at the chart and see where you land (and your family if more people are applying.)
| Household # | 100% | 400% |
|---|---|---|
1 person | $14,580 | $58,320 |
2 people | $19,720 | $78,880 |
3 people | $24,860 | $99,440 |
4 people | $30,000 | $120,000 |
5 people | $35,140 | $140,560 |
6 people | $40,280 | $161,120 |
7 people | $45,420 | $181,580 |
8 people | $50,560 | $202,240 |
Usually, most people qualify for some kind of subsidy to get an affordable plan. Other factors affect your price, like location, age, etc. It’s important to know that making money is not the only qualification condition. There are more. So, what are they?
What are the Obamacare insurance requirements?
Before you enroll in the health insurance plans through the ACA, you must meet the requirements. But what are they? Let’s get into it. Here is what is needed to qualify for Obamacare plans:
• Legal residency or citizenship in the U.S. (Work Visa, Residency card, etc)
• You can’t have health coverage through your job, Medicare, or Medicaid
• Must declare taxes and meet the minimum income requirement
• Have a social security number
Also, you can’t be claimed as a dependent on someone else’s tax return if you want to apply yourself. For example, if your parents or someone else claims you on their taxes, you might not be eligible. In this case, you would have to be a part of their health plan and go under them as a dependent.
Now, one of the main problems people face with their ACA plans is that the premium is simply too much. The good news is that there are a couple reasons for that. Some of which are under your control. Let’s tackle one of the most asked questions in the health insurance industry.
Enroll in Obamacare plans with Cuspide
Call (305) 970-8583 to speak to an insurance agent. (We also speak spanish!) You will be in contact with us here at Cuspide. Our focus is to find the most affordable plans in the marketplace for you.
Why is my ACA plan so expensive?
There are many reasons as to why you could be overpaying for your Obamacare plan. After reading this maybe you can walk away and learn how you can save money in your policy. From errors in the application to bad agents and brokers, let’s dive in. (#3 is shocking and the most common) Reasons include:
– Incorrect income reporting (For example: You were quoted based on your pre-tax income)
– Didn’t claim dependents (It lowers your monthly premium)
– Your broker/agent (They can only sell you a certain company)
Incorrect income reporting
It’s crucial to apply with your correct income because doing so can save you money. Some people tell the agents their pre-tax income and not their “adjusted gross income”. Or maybe they simply didn’t ask you how you get paid, and it resulted in a bad reporting which leads to overpaying.
Didn't claim dependents
Happens time and time again, when a parent is applying for coverage and when I ask for their child’s info they say, “They aren’t applying, it is just me.” Which means that there are thousands of applications out there that are wrong. First, you should know that having dependents on your policy makes it cheaper. Also, if you have kids, parents, or anyone that relies on your financially and is in your tax return they must be included in the policy even if they aren’t getting coverage. This will save you money so make sure everyone that needs to be in the application is in it!
Your broker/agent
Now this leads to the most common and likely fact and that is that is that the insurance agent you called can only sell you a certain company and not all the ones in the health insurance marketplace. There are 2 mistakes that you can make when getting help to apply for coverage. Let’s go into them so you can avoid them.
Mistake #1: You called XYZ company directly and not an agency. Never do this because that means they will only sell you their own plans (which is most likely more expensive than the many other companies in the marketplace.)
Mistake #2: Now, instead of calling XYZ company directly, you called an agent/agency. Good, you are now on the right track. However, you called one that can’t sell EVERY company in the marketplace. (Maybe it’s even a friend of yours that is an insurance agent, so you want to help them out.) To be able to sell every carrier you must have a contract with them. So, if the agent you called doesn’t, then you are stuck with only what they can sell you (which means the more expensive plan.)
That’s why it is important to speak to an insurance agent/agency who can sell EVERY company in the marketplace. Here at Cuspide we are partnered with every carrier so you will not run into this problem.
(More info on every company coming up soon.) For now, you must know how ACA coverage works.
What does Obamacare insurance cover?
Affordable Care Act plans makes sure that they provide what are called “Essential Health Benefits.”
These benefits include things like doctor visits, hospital stays, prescription drugs, preventive and mental health services, maternity care, and more.
The ACA also prevents companies from denying coverage or charging higher rates for people with pre-existing conditions. So, if you have any health issues, you can still get the coverage you need.
You must know that each health plan is unique and has different co-pays, deductibles, out-of-pocket maximums, etc. You can have a $0 deductible plan while your friend has a $400 deductible plan. We go in-depth about how a plan works and what you need to know here. So, what you pay will differ.
Also, these plans have different networks of providers. For example, HMOs and EPOs. HMOs (Health Maintenance Organizations) are usually cheaper than EPOs (Exclusive Provider Organizations) but tend to be a bit stricter. EPOs usually have a larger network. They also provide more flexibility, like not needing a referral from your primary doctor (PCP) to see a specialist.
So, while plans do cover you and provide you with benefits, they all differ in co-payments, networks, etc. But how much is an ACA plan? Let’s find out how much your plan will cost and how different factors will affect how much you end up paying.
How much does Obamacare insurance cost monthly?
Obamacare plans start at $0 and have an average monthly cost of $52 with subsidies and $408 without subsidies! This is based on the average across the whole United States so, most likely you will qualify for this. However, these plans will vary in price, and it depends on many factors. These factors include things like:
- Age
- Location
- Household size
- Income
- Type of plan you choose
There are two categories into which individuals and families fall in when getting health coverage. Those with Premium Tax Credit and those without Premium Tax Credit. Let’s compare the two.
Without Premium Tax Credit
On average, without any subsidy, the monthly premium for an individual trying to get a health plan can range from around $300 to $600 or more. Family plans can be higher, sometimes going over $1,000 per month! But don’t worry; there is a high chance that this won’t be you. You will fall into the other category.
With Premium Tax Credit
With a subsidy, the average monthly premium can drop to around $50, depending on your circumstances. In some cases, individuals and families with low incomes may even qualify for health plans with $0 premiums! Remember, these are just estimates, and it’s not what you will pay. We suggest using our ACA Subsidy Calculator to get an estimate on how much credit you will get!
Did you know: Our clients here at Cuspide on average, pay only $30 a month for their health plan? Compare that to the average medical insurance cost.
So how do you get free health coverage? You need to receive a subsidy through what is called a “Premium Tax Credit.” The more tax credits you receive, the less you will pay for your insurance plan. The less an individual declares in their taxes, the more tax credit they will get when buying ACA insurance.
Let’s give you an easy example for you to understand how this works. In this scenario, we are using a 25-year-old male. We will be using two different yearly incomes as examples so you can see how Premium Tax Credit works.
SCENARIO #1:
Income: $40,000 a year.
Tax Credit: $171 a month
Plan’s original price: $264.20
What he will pay: $93.20/mo
SCENARIO #2:
Income: $20,000 a year.
Tax Credit: $364 a month
Plan’s original price: $374.08
What he will pay: $10.08/mo
So there you have it; it is that simple. Now that you know how to factor in the price of your health insurance, it is important to know when you can apply. Can you apply at any time? Do you have to wait? It is coming up…
Apply for ACA insurance today!
The best way to get help is to contact us at (305) 970-8583. You can call this number to apply for a plan through the health insurance marketplace. When you call, you will speak to us here at Cuspide. Compare health plans, make changes, provide customer service, and more.
Get access to all the benefits and call now!
Open Enrollment Period vs Special Enrollment Period
Obamacare Open enrollment begins on November 1st and ends on January 15th, 2024. This is the official sign-up period for the Affordable Care Act. It is when individuals and families apply and make changes to their Obamacare insurance. You can update your income, change your address, add or remove people from your policy.
Note: If you get a health plan before December 15, 2023, your policy will go into effect on January 1st, 2024. If you get it after that then you will have to wait till February 1st for your policy to be active.
But what if you missed Open Enrollment 2024? In that case, you can still qualify for coverage through something called the SEP, or “Special Enrollment Period.” To qualify, you must experience a certain life event, which includes:
- Getting married
- Having a baby
- Losing health coverage
- Moving
- Migratory status change
There are many more qualifying life events inside the SEP (Special Enrollment Period) so we advise you to contact us to find out how you can still apply for and get coverage. Also, it’s important to note that you typically have a limited time window (60 days) after the qualifying life event to enroll in a marketplace plans. Low-income individuals and families will always qualify and don’t need the SEP. You can go more in-depth about this here.
If you missed the open enrollment dates or have more questions about the Special Enrollment Period, give us a call at (305) 970-8583 and we will be able to help you!
6 key Obamacare health insurance terms explained
Before buying an Obamacare insurance plan, we explain to our clients all the terminology. We like to break it down for you to completely understand what everything means. So, let’s do that here. Here are the 6 key terms that you must know when buying health plans through the marketplace:
Premium
This is a monthly membership that you make to the insurance company. Making these payments is how your policy stays active. You pay the company, and they give you, their services. Pretty basic.
Deductible
If your plan has a deductible then that means you must pay that fee before your insurance starts to help you. For example, if you have a $500 deductible and you need an MRI done. It cost $2,000 so you pay the $500 and the insurance company handles the rest. That’s why we prioritize $0 deductible policies to our clients.
Out-of-pocket maximum
The OOP is the most you will have to pay within the year for services done under your policy. Once you reach this limit, your insurance will pay for everything else. Let’s say your out-of-pocket max is $2,000. If you have a surgery that costs $10,000 you will only pay $2,000 and your plan will cover the rest. After that, every service you may need is free for the remainder of the year.
Copayment
A copay is a fee you a pay for things like doctor visits, prescription drugs, and general care. For example, if you go to see your primary doctor you can have a copay of $5 for the visit. It will usually be a small payment.
In-network
This is just a group of doctors, hospitals, and providers that have contract with whatever insurance company you chose that provides services at lower costs. Staying in-network will always be cheaper. More on this later in this article.
Out-of-network
These are not contracted with your insurance company. These will always be more expensive and sometimes your insurance will not cover the service at all. So, it is important to get in-network care. The only exception is emergencies. You will always be accepted by any network in an emergency.
With your new knowledge about the terminology there comes questions that people naturally want to know. “How can I find a doctor?” and ‘Which doctor accepts my insurance?” and that is all very simple. You don’t want to end up accidentally going out of network when you could have saved so much money.
How do I use my Obamacare insurance?
The first thing to note is that your policy always goes into effect on the first of the following month.
For example, if you applied for coverage on January 15th then you will have to wait till February 1st to use your plan. It is not an effective immediately thing.
So, let’s say your policy is now active. What now? How do you use it? If you want to use your health insurance plan, then you must make an account through your provider portal. Through this portal, you can select a primary doctor and make appointments. This is also the place where you can make your premium payments. (Different companies have different portals and interfaces.)
If you don’t want to make an account and you want care then you can call up whoever you want to see (doctor, facility, hospital, etc) and ask if they accept your insurance company. Lastly you can call up your insurance agent and they will be able to help with finding you a doctor, making payments, and all that. Some don’t provide that service, but we do!
What are the 4 tiers of Obamacare?
Plans in the ACA marketplace have 4 different tiers: Bronze, Silver, Gold, and Platinum. These tiers differ in price and coverage, so it is important to know how they each work. But what does that mean? Which one should you get? Let’s compare all the tiers.
Bronze
Lowest monthly premium but highest cost when you need health care.
Best for: Want something on a “just in case” basis. A little bit of something is better than nothing.
Silver *
Most popular. Average monthly premiums and moderate costs when you need health care. Usually provides an “extra savings” option and reduces premiums. This is also called “Cost Sharing Reductions”
Best for: Individuals and families who want to pay less for getting care while not breaking their wallet.
Gold
High monthly premiums. Low cost when you need care.
Best for: Those willing to pay more monthly for the best co-payments and fees when you need care. It is great if you are going to use the plan a lot.
Platinum
Highest monthly premiums. Lowest costs when you need care.
Best for: Individuals and families who require frequent care and don’t mind paying high premiums because of the low co-payments.
To find out which tier is best for you, we suggest estimating the level of care that you may need in the year. If you don’t think you are going to use it much, then go for a Bronze or Silver. If you use it frequently due to certain conditions, then a Gold might suit you. Now that you know the metal tiers, you must know that all the Obamacare insurance companies in the marketplace work like this.
What companies does Obamacare offer?
We will start by stating that one company is not better than the other. A company that is good for your friend may not be good for you and vice versa. It depends on many factors (income, location, age, etc.) All the carriers in the marketplace are good and made for every different type of need. We are partnered with all of them but for this list we will only go into the more popular ones. Here is list in no order:
The best affordable health insurance plans are Ambetter, Oscar, Aetna, Molina Healthcare, BlueCross & BlueShield, UnitedHealthcare, Cigna, AvMed, and Kaiser Permanente.
With whichever you pick just know that you made a good choice as all of these have large networks for care. As always to find out which one provides the most affordable coverage you should contact an agent/agency that can sell all these carriers. That way you can find which one is best for your wallet.
What is better Medicaid or Obamacare insurance?
Medicaid and Obamacare (ACA) are two different healthcare programs in the United States. Both are designed to help individuals and families get affordable coverage. Medicaid is mainly for low-income individuals, offering free health services but it has strict income and eligibility requirements.
On the other hand, the ACA is designed to offer more options. It has a marketplace where individuals, and families (no matter their income level), can shop for health insurance that fits their specific needs and budget. This means that even if you don’t meet the income criteria for Medicaid, you can still access low-cost coverage through the marketplace. The ACA is a great choice for those who didn’t qualify for Medicaid.
Were you denied Medicaid? Here's what you can do:
If you were denied Medicaid you can apply for an ACA plan through the marketplace. Also, most likely you will qualify for a $0 a month plan. With ACA insurance you can get the same benefits that Medicaid provides (doctor visits, emergencies, prescription drugs, etc) and even more. Switch to the Affordable Care Act plans and get all the benefits you need! It’s important that you do not stay without coverage.
A little bit about us at Cuspide
Now that you know a bit more about Obamacare and how the Affordable Care Act works, we invite you to learn more about us here at Cuspide. We are an insurance agency based in Miami, FL. We offer health plans in states like Florida, Texas, Georgia, South Carolina, North Carolina, Tennessee, and more! So, when you look for agents near you, then you can bet on Cuspide being there.
We offer the best possible plans to individuals and families under the ACA to give you the benefits you deserve. Using the health insurance marketplace, we let you compare and choose the right health plan. Cuspide will be with you even after the sale, answering questions you may have and offering you 24/7 quality customer service.
We hope you learned a bit more about the Affordable Care Act (ACA) from this guide. Choosing the right plan is easy if you do it with us.
Here at Cuspide you can count on us to help you with your Obamacare insurance.
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