Skip to content

Top Navigation

Health.com Health.com
  • Health Conditions A-Z
  • News
  • Coronavirus
  • Diet & Nutrition
  • Fitness
  • Beauty
  • Mind & Body
  • Lifestyle
  • Weight Loss
  • Newsletter
  • Promo

Profile Menu

Your Account

Account

  • Join Now
  • Email Preferences this link opens in a new tab
  • Newsletters
  • Manage Your Subscription this link opens in a new tab
  • Help
  • Logout

More

  • Give a Gift Subscription this link opens in a new tab
Login
Subscribe
Pin FB

Explore Health.com

Health.com Health.com
  • Explore

    Explore

    • Is Your Doctor Gaslighting You? Here's What to Do

      How to handle a physician who doubts or dismisses your symptoms. Read More Next
    • 9 Signs It's More Serious Than the Common Cold

      Doctors explain how to tell if you have a head cold or something more serious that requires medical attention, such as the flu, strep throat, meningitis, or mono. Read More Next
    • How Your Period Changes During Your 20s, 30s, and 40s

      From easier cramps to a heavier flow, here's a guide on what to expect decade by decade. Read More Next
  • Health Conditions A-Z

    Health Conditions A-Z

    See all Health Conditions A-Z

    12 Anxiety Symptoms That Might Point to a Disorder

    The symptoms of anxiety can be hard to detect. Here are the ones you need to pay attention to, and how to know if you may have an anxiety disorder.
    • Allergies
    • Anxiety
    • Birth Control
    • Breast Cancer
    • Coronavirus
    • Chronic Pain
    • Cold, Flu, and Sinus
    • Depression
    • Digestive Health
    • Diabetes (Type 2)
    • Eczema
    • Eye Health
    • Fibromyalgia
    • Heart Disease
    • Headaches and Migraines
    • Oral Health
    • Pregnancy
    • Psoriasis
    • Sexual Health
    • Skin Conditions
    • Sleep
    • Thyroid
  • News

    News

    See all News

    Shannen Doherty Reveals Stage 4 Breast Cancer Diagnosis—Here's What It Means

    "I'm petrified," the actress said when she shared the news that her breast cancer came back. Here's why a stage 4 breast cancer diagnosis can be so frightening.
    • Celebrities
  • Coronavirus
  • Diet & Nutrition

    Diet & Nutrition

    The Best (and Worst) Diets of 2020, According to Experts

    FYI: The keto diet is not number one.
    • Food
    • Nutrition
    • Vitamins and Supplements
    • Groceries
    • Restaurants
    • Diets
    • Keto Diet
    • Mediterranean Diet
    • Whole30
    • Recipes
  • Fitness

    Fitness

    See all Fitness

    10 Moves for a Cardio Workout at Home—No Equipment Required

    Stay in your living room and still spike your heart rate.
    • Cardio Workouts
    • Strength Training
    • Yoga
    • Ab Workouts
    • Arm Workouts
    • Leg Workouts
    • Butt Workouts
    • Fitness Gear
  • Beauty

    Beauty

    See all Beauty

    These 13 Women Prove Every Body Is a Bikini Body

    We're loving their inspirational, body-positive messages.
    • Skincare
    • Makeup
    • Hair
    • Nails
  • Mind & Body

    Mind & Body

    See all Mind & Body

    Why Do People Lie? We Asked an Expert

    Here's the truth about lying.
    • Body Positivity
    • Self-Care
    • Misdiagnosed
    • Invisible Illness
    • LGBTQ+ Health
    • Health Diversity and Inclusion
    • Resolution Reboot
  • Lifestyle

    Lifestyle

    20 Things You Should Throw Away for Better Health

    Clean out expired products and clutter to make way for a healthier you.
    • Healthy Home
    • Pets
    • Family
    • Relationships
    • Style
    • Holidays
    • Sex
    • Gifts
    • Money
    • Tech
    • Medicare
    • Best Life Now
  • Weight Loss
  • Newsletter
  • Promo

Profile Menu

Subscribe this link opens in a new tab
Your Account

Account

  • Join Now
  • Email Preferences this link opens in a new tab
  • Newsletters
  • Manage Your Subscription this link opens in a new tab
  • Help
  • Logout

More

  • Give a Gift Subscription this link opens in a new tab
Login
Sweepstakes

Follow us

  1. Home Chevron Right
  2. Healthy Home Chevron Right
  3. 17 Key Facts About the Affordable Care Act

17 Key Facts About the Affordable Care Act

By Karen Pallarito
May 07, 2014
Skip gallery slides
Save Pin
Credit: Getty Images
Don't have health insurance? Here's how the Affordable Care Act (aka Obamacare) will change that.
Start Slideshow

1 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Affordable Care Act

Credit: Getty Images

Baffled by "Obamacare"? You’re not alone. Polls show few Americans understand the health reform law. And many uninsured adults say they’ve heard nothing at all about the law’s key feature: health insurance marketplaces that opened for business in every state on October 1.

"That’s why we’re working overtime to make sure folks across the country know what’s to come," said Jessica Barba Brown, national communications director for

Enroll America, a Washington, D.C.-based nonprofit coalition dedicated to ensuring that eligible Americans get coverage. If you’re uninsured or lack adequate health insurance, now’s the time to do something about it. Here’s what you need to know to get started:

1 of 18

Advertisement
Advertisement

2 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You must have health insurance

Credit: Getty Images

The health reform law requires most U.S. citizens and legal residents to have health insurance in 2014 and beyond or pay a fine. In 2014, the penalty is $95 for an adult or 1% of income, whichever is greater. It’s half of that—$47.50—for uninsured kids, and up to $285 for a family. Fines increase every year. In 2016, it’s $695 per adult, $347.50 for kids, and up to $2,085 per family, or 2.5% of income.

Tip: If you have a religious objection to having health insurance or are experiencing a hardship that prevents you from buying insurance, you may qualify for an exemption from the coverage mandate.

2 of 18

3 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You can shop online

Credit: Getty Images

As of October 1, every state will have a health insurance marketplace, or exchange, offering one-stop shopping for health plans in your area. If you’re web-savvy, simply visit your marketplace web site to compare health plans and prices and apply for coverage.

You can go to

Healthcare.gov to find your health exchange and get started. (If the federal government is running the marketplace in your state, you will use healthcare.gov to enroll.)

Tip: For help, try the toll-free hotline: 1-800-318-2596 (TTY: 1-855-889-4325) or click on the "Live Chat" button at Healthcare.gov.

3 of 18

Advertisement

4 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You can enroll "old school"

Credit: Getty Images

Don’t worry if you don’t have a computer. You can apply for coverage by mail or in person with the help of a health "navigator," or other individual trained and certified to help you wade through your options and enroll in a health plan.

Tip: Many health clinics, community centers, churches and libraries will have people on hand to assist you. Check with your state marketplace to find a location near you. Go to localhelp.healthcare.gov to find help in your area.

4 of 18

5 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You have a choice of plans

Credit: Getty Images

If you buy coverage through the state marketplace, you can choose among health plans in four categories: Bronze, silver, gold and platinum. Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs. With a bronze plan, premiums are lower but you’ll shell out more when you need care. "People can choose the plan that best fits their family’s needs and budget," Brown said.

People who are under 30 and can't find a plan for less than 8% of their income may be eligible for a

catastrophic plan.

Tip: If you visit the doctor often or take prescription drugs, consider a gold or platinum plan. If you qualify to receive help paying your out-of-pocket costs, you must choose a silver plan.

5 of 18

6 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Cost-sharing subsidies are available, too

Credit: Getty Images

You can get help paying your out-of-pocket costs, like your deductible and copayments or coinsurance, if you make less than 250% of the federal poverty level. That’s $28,725 for a single person and $58,875 for a family of four, based on 2013 data.

Tip: You must buy a silver plan to get help paying your out-of-pocket expenses.

6 of 18

Advertisement
Advertisement
Advertisement

7 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You may qualify for free or low-cost care

Credit: Getty Images

Twenty-four states and the District of Columbia are expanding Medicaid, the public health program for the poor, in 2014. Eligibility is based solely on your income and family size, not whether you are pregnant, disabled, or have dependent children. People making up to $15,856 a year, or $32,499 for a family of four, in 2013, may be eligible for free or low-cost care.

Tip: Not sure if you qualify? Just fill out an application with your state health marketplace to find out what coverage you and your family may be eligible for.

7 of 18

8 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Young adults have more options

Credit: Getty Images

Since 2010, health reform has allowed young adults to stay on their parents’ health plan up until age 26, as long as the plan offers dependent coverage. In 2014, young people will have even more options. Many will qualify for federal subsidies to reduce the cost of private health insurance on the marketplace, while others may be eligible for Medicaid.

If you’re a college student, your university may offer a student health insurance plan. If you work, check with your employer to see what coverage may be available to you.

Tip: For more information on your options, go to health.younginvincibles.org.

8 of 18

9 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You can stick with your employer plan

Credit: Getty Images

If you have good, comprehensive health insurance through your job, chances are you don’t need to use the state health exchanges. But be ready to shell out more for that coverage. As health care costs continue to escalate, employers are shifting a greater share of the health plan premium and out-of-pocket expenses to employees.

Tip: Review your options to make sure you have the best plan for you and your family.

9 of 18

Advertisement
Advertisement
Advertisement

10 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

No more skimpy benefits

Credit: Getty Images

All health plans sold through the health insurance marketplaces must provide, at a minimum, a package of essential health benefits, including basics like emergency services, hospitalization, maternity and newborn care, doctor visits, laboratory services, and prescription drugs.

Tip: Having a standard set of core benefits makes it easier to make apples-to-apples comparisons among health plans and avoids ugly surprises later on when you find the care you received isn’t covered.

10 of 18

11 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

You can get coverage even if you’re sick

Credit: Getty Images

Beginning in 2014, health plans cannot refuse coverage or charge you more if you have a pre-existing health condition, like cancer, diabetes or high blood pressure. The only exception is for individual health plans with "grandfathered" status. (Individual coverage means a health plan you purchased for yourself or your family. A grandfathered plan is one that has been in place since March 23, 2010 and hasn’t made any major changes since then.)

Tip: If you’re stuck in a plan with a pre-existing condition exclusion, shop around. Plans offered through the state marketplaces will cover you regardless of what health conditions you may have.

11 of 18

12 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Your coverage won’t top out

Credit: Getty Images

Health reform ended lifetime limits in 2010, meaning health plans can no longer cap the amount of money spent on essential health benefits during the entire time you are enrolled in the plan. And beginning in 2014, the law prohibits most health plans from imposing annual limits.

Tip: Lifetime and annual limits do apply to non-essential health benefits, such as adult dental care and cosmetic surgery.

12 of 18

Advertisement
Advertisement
Advertisement

13 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Preventive care is free

Credit: Getty Images

Most health plans, including private plans offered through the state health insurance exchanges, must cover many preventive health services at no cost to you. In most cases, you won’t pay anything out-of-pocket for flu shots, cholesterol testing or colon cancer screening, for example.

Tip: For free preventive care, you need to see a provider in your health plan network. If a test reveals a problem, you’ll have to pay for any follow-up care.

13 of 18

14 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Contraception is covered

Credit: Getty Images

You won’t pay a dime out of pocket for Food and Drug Administration-approved methods of birth control prescribed by your physician.

Tip: Group health plans sponsored by religious employers are exempt from this requirement.

14 of 18

15 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

It pays to stay healthy

Credit: Getty Images

Employer wellness programs are getting a boost. The law permits employers to sweeten rewards—and step up penalties—from 20% of the total health plan premium to 30% in 2014 and up to 50% for programs designed to prevent or reduce tobacco.

Employers have some leeway in how wellness programs are designed but cannot make unreasonable demands and must give employees fair notice of opportunities to earn rewards for, say, participating in a health screening or lowering their cholesterol.

Tip: Your employer must give you a chance to qualify for a reward at least once a year.

15 of 18

Advertisement
Advertisement
Advertisement

16 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Smokers can get help quitting

Credit: Getty Images

The health law added a tobacco cessation benefit for pregnant women on Medicaid in 2010. In 2014, Medicaid must cover tobacco cessation medications, and health plans sold on the health exchanges must cover tobacco cessation services at no cost to you.

Tip: The law also allows health plans on the exchange to charge tobacco users up to 50% higher premiums, but that provision is on hold until at least 2015.

16 of 18

17 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Open enrollment begins October 1

Credit: Getty Images

If you buy a health plan on the marketplace by Dec. 15, 2013, your coverage will take effect on Jan. 1, 2014. You can buy coverage up until March 31, 2014, but the effective date will be delayed. If you have a baby, get divorced or lose your job, you can buy coverage after the open enrollment period closes.

For 2015, open enrollment runs October 15 to December 7, 2014.

Tip: If you are eligible, enrollment in Medicaid or the Children’s Health Insurance Program is open all year round.

17 of 18

18 of 18

Save Pin
Facebook Tweet Mail Email iphone Send Text Message

Scammers are on the loose

Credit: Getty Images

Beware of emails, phone calls or visits from people posing as federal government workers, health "navigators" or insurance agents. Con artists are taking advantage of people's confusion over the Affordable Care Act and trying to get their hands on your personal and financial information.

"When enrolling, people should make sure they are talking to a certified application counselor or a federally certified navigator before giving over sensitive information," said

Enroll America's Brown, whose organization in pointing people in the direction of approved, trusted sources for enrollment help.

Tip: If anyone asks you to wire money or hand over your bank account number, it’s a scam.

18 of 18

Advertisement
Advertisement
Advertisement
Replay gallery

Share the Gallery

Pinterest Facebook

Up Next

By Karen Pallarito

Share the Gallery

Pinterest Facebook
Trending Videos
Advertisement
Skip slide summaries

Everything in This Slideshow

Advertisement

View All

1 of 18 Affordable Care Act
2 of 18 You must have health insurance
3 of 18 You can shop online
4 of 18 You can enroll "old school"
5 of 18 You have a choice of plans
6 of 18 Cost-sharing subsidies are available, too
7 of 18 You may qualify for free or low-cost care
8 of 18 Young adults have more options
9 of 18 You can stick with your employer plan
10 of 18 No more skimpy benefits
11 of 18 You can get coverage even if you’re sick
12 of 18 Your coverage won’t top out
13 of 18 Preventive care is free
14 of 18 Contraception is covered
15 of 18 It pays to stay healthy
16 of 18 Smokers can get help quitting
17 of 18 Open enrollment begins October 1
18 of 18 Scammers are on the loose

Share options

Facebook Tweet Mail Email iphone Send Text Message

Login

Health.com

Magazines & More

Learn More

  • About Us
  • Subscribe this link opens in a new tab
  • Contact us
  • Advertise this link opens in a new tab
  • Content Licensing this link opens in a new tab
  • Sitemap

Connect

Follow Us
Subscribe to Our Newsletter
Other Meredith Sites

Other Meredith Sites

  • 4 Your Health this link opens in a new tab
  • Allrecipes this link opens in a new tab
  • All People Quilt this link opens in a new tab
  • Better Homes & Gardens this link opens in a new tab
  • Bizrate Insights this link opens in a new tab
  • Bizrate Surveys this link opens in a new tab
  • Cooking Light this link opens in a new tab
  • Daily Paws this link opens in a new tab
  • EatingWell this link opens in a new tab
  • Eat This, Not That this link opens in a new tab
  • Entertainment Weekly this link opens in a new tab
  • Food & Wine this link opens in a new tab
  • Hello Giggles this link opens in a new tab
  • Instyle this link opens in a new tab
  • Martha Stewart this link opens in a new tab
  • Midwest Living this link opens in a new tab
  • More this link opens in a new tab
  • MyRecipes this link opens in a new tab
  • MyWedding this link opens in a new tab
  • My Food and Family this link opens in a new tab
  • MyLife this link opens in a new tab
  • Parenting this link opens in a new tab
  • Parents this link opens in a new tab
  • People this link opens in a new tab
  • People en Español this link opens in a new tab
  • Rachael Ray Magazine this link opens in a new tab
  • Real Simple this link opens in a new tab
  • Ser Padres this link opens in a new tab
  • Shape this link opens in a new tab
  • Siempre Mujer this link opens in a new tab
  • Southern Living this link opens in a new tab
  • SwearBy this link opens in a new tab
  • Travel & Leisure this link opens in a new tab
Health.com is part of the Meredith Health Group. © Copyright 2021 Meredith Corporation. All rights reserved. The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments. All products and services featured are selected by our editors. Health.com may receive compensation for some links to products and services on this website. Offers may be subject to change without notice. Privacy Policythis link opens in a new tab Terms of Servicethis link opens in a new tab Ad Choicesthis link opens in a new tab California Do Not Sellthis link opens a modal window Web Accessibilitythis link opens in a new tab
© Copyright . All rights reserved. Printed from https://www.health.com

View image

17 Key Facts About the Affordable Care Act
this link is to an external site that may or may not meet accessibility guidelines.