Simple Steps Towards Getting Obamacare

How to Get Obamacare
••• Photo: Joe Raedle/ Getty Images

You are still able to get Obamacare, the informal name for the Patient Protection and Affordable Care Act. That's despite President Donald Trump's efforts to dismantle or repeal it. Here are four steps you can take to get Obamacare now.

STEP 1 - Find Out If You Want To Get Obamacare (When: Now)

Anyone can get Obamacare, and you might be better off, depending on your circumstances. The enrollment period is between November 1 and December 15. But you can always use the exchanges now to compare plans and find out how much of a subsidy you would get. Anyone can also use the exchanges to compare local physicians, hospitals, nursing homes, home health agencies, and dialysis services. Compare providers now.

If you don't have insurance, Obamacare affects you the most. If you've been without insurance this year, you'll no longer be hit with a tax. President Trump's tax act repeals this tax effective 2019. But you could get hit with high medical costs. For example, treatment for a broken leg can cost $7,500, and three days in the hospital can cost $30,000.

Even if you're young and healthy, you're taking a financial risk by not getting insurance. The average cost of an emergency room visit was $1,389 in 2017, a 176% increase from the previous 10 years. If you can easily afford this, then it's worth the risk. If not, you might face bankruptcy. In fact, one of the top causes of bankruptcy in this country is healthcare-related costs. That's just one of the many reasons why you should have health coverage.

If your household income is between 100% and 400% of the federal poverty level, the government will subsidize some or all of your premium in the form of a premium tax credit. In that case, Obamacare will most definitely be cheaper. Healthcare.gov helps you figure this out.

If your income is low enough (for example, less than $12,760 for an individual or $26,200 for a family of four), you may qualify for free insurance through Medicaid if your state expanded coverage. Healthcare.gov helps you determine if you are eligible for Medicaid.

In some states, you can't get expanded Medicaid but at least you won't have to pay the tax. Healthcare.gov lists whether your state has expanded Medicaid coverage.

Instead of getting Obamacare, you could find low-cost community health centers in your area.

If you are under 30, you have two additional options. First, you can go on your parents' plans until you are 26. Second, you can buy a less-expensive catastrophic plan. It covers emergency room visits and hospital stays, but only three regular doctor visits. 

If you have insurance, you can keep it whether it's a company plan or one you bought yourself. That's true even if it's catastrophic insurance, a retiree plan, COBRA or any other qualifying health plan. Keep in mind that a Discount Plan, Vision Care or Dental Discount Plan, or Worker's Comp does not qualify as insurance.

Even if you have insurance, go ahead and compare it to Obamacare plans. You may be able to get better coverage at a lower cost.

There are three ways this could happen:

  1. Your plan was "grandfathered in." That means it was in existence before March 23, 2010, and, therefore, doesn't have to offer the Obamacare benefits. These include the 10 essential benefits and protection from being dropped due to a preexisting condition.
  2. You qualify for a subsidy or free health care. For example, if you live in Alabama, and you make less than $51,040 for an individual or $104,800 for a family of four, the government may pay for all or part of your insurance.
  3. Your company drops your insurance plan. In 2012, the Congressional Budget Office and the Joint Committee on Taxation estimated that about 3 to 5 million fewer people will obtain employer-based coverage each year from 2019 through 2022 than would have been the case before the Affordable Care Act.

You Have Medicare or Medicaid - You already have Obamacare.

You're a Small Business Owner - You must provide health insurance or pay a tax penalty, called the Employer Shared Responsibility Payment, if you are a small business owner with 50 or more full-time employees.

STEP 2 - Compare Plans (When: Now)

If you've decided to take advantage of Obamacare, then go to the health insurance marketplace. You'll be prompted to enter your state since some of them have their own marketplaces. You'll then create an account using your name and email address. You'll then create a user name, password and answer three security questions. You will receive an email to authenticate your account. In addition to shopping for plans, you can find out how much in subsidies you qualify for. To do that, you'll need your Social Security number, and your most recent W2, 1099, or other income information. 

Compare the premiums, deductibles, and copays between the plans. All plans will offer services in each of the 10 essential benefit categories, as well as the other Obamacare benefits. Plans are grouped into four different categories, arranged by the amount of coverage. Those with the least coverage have the lowest premiums. Here's how much you'll pay in total health care costs for the plans in each category:

  1. Bronze - 40%
  2. Silver - 30%
  3. Gold - 20%
  4. Platinum - 10%

STEP 3 - Purchase the Plan You Want (When: November 1 - December 15)

Starting November 1, you can buy the plan you want. There are five factors that predict how much Obamacare will cost you. One is the type of plan. The other four are your age, income, family size, and location.

STEP 4 - Coverage Begins (When: January 1)

You must pay your premium before your coverage can begin. It is advisable to do so by the enrollment deadline of December 15.

In Depth: The Truth About Obamacare | Pros and Cons | Obamacare Summary | How the ACA Affects You

To save money on Obamacare, check out the author's book, "The Ultimate Obamacare Handbook."

Article Sources

  1. U.S. Centers for Medicare & Medicaid Services. "Dates and Deadlines for 2021 Health Insurance." Accessed Nov. 12, 2020.

  2. IRS. "Individual Shared Responsibility Provision." Accessed Nov. 12, 2020.

  3. U.S. Centers for Medicare & Medicaid Services. "Why Bother With Health Insurance?" Accessed Nov. 12, 2020.

  4. Health Care Cost Institute. "10 Years of Emergency Room Spending for the Commercially Insured." Accessed Nov. 12, 2020.

  5. American Journal of Public Health. "Medical Bankruptcy: Still Common Despite the Affordable Care Act." Accessed Nov. 12, 2020.

  6. U.S. Centers for Medicare & Medicaid Services. "Subsidized Coverage." Accessed Nov. 12, 2020.

  7. U.S. Department of Health and Human Services. "HHS Poverty Guidelines for 2020." Accessed Nov. 12, 2020.

  8. U.S. Centers for Medicare & Medicaid. "Medicaid Expansion & What It Means for You." Accessed Nov. 12, 2020.

  9. U.S. Centers for Medicare & Medicaid Services. "How to Get or Stay on a Parent’s Plan." Accessed Nov. 12, 2020.

  10. U.S. Centers for Medicare & Medicaid Services. "Catastrophic Health Plans." Accessed Nov. 12, 2020.

  11. U.S. Centers for Medicare & Medicaid Services. "Types of Health Insurance That Count as Coverage." Accessed Nov. 12, 2020.

  12. U.S. Centers for Medicare & Medicaid Services. "Grandfathered Health Insurance Plans." Accessed Nov. 12, 2020.

  13. U.S. Centers for Medicare & Medicaid Services. "Income Levels & Savings." Accessed Nov. 12, 2020.

  14. Congressional Budget Office. "The Effects of the Affordable Care Act on Employment-Based Health Insurance." Accessed Nov. 12, 2020.

  15. U.S. Centers for Medicare & Medicaid Services. "How the Affordable Care Act Affects Small Businesses." Accessed Nov. 12, 2020.

  16. U.S. Centers for Medicare & Medicaid Services. "The 'Metal' Categories: Bronze, Silver, Gold & Platinum." Accessed Nov. 12, 2020.

  17. U.S. Centers for Medicare & Medicaid Services. "Complete Your Enrollment & Pay Your First Premium." Accessed Nov. 12, 2020.