Simple Steps Towards Getting Obamacare

How to Get Obamacare
Getting Obamacare is easier than you think. Photo: Joe Raedle/ Getty Images

The opportunity to get Obamacare, the informal name for the Patient Protection and Affordable Care Act, is here. You will be protected for at least a year even if Donald Trump repeals it. What can you do 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, 2016, and January 31, 2017.

 You can use the exchanges now to compare plans and find out how much of a subsidy you will 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 be hit with a tax. For most of you, the tax is 2.5 percent of your adjusted gross income (AGI). The AGI is your gross income minus your deductions. For example, if your AGI is $30,000, your Obamacare tax is $615. For more, see Obamacare Taxes. You may not have to pay the tax if you qualify for the ACA exemptions.

Would this be cheaper than Obamacare? It depends on the number of people in your household. For example, if you live alone, then a $300 annual tax might be cheaper than the $200 monthly premium. However, if your income is below $45,000, the government will subsidize some or all of your premium.

In that case, Obamacare could be cheaper. Find out how much at Will I Qualify to Save on Monthly Premiums?

If your income is low enough (for example, less than $16,104 for an individual or $32,913 for family of four), you qualify for free insurance through Medicaid if your state expanded coverage. Find out 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. Find out if your state has expanded Medicaid coverage.

If you decide to pay the tax instead of getting Obamacare, here's where to find low-cost community health centers in your area. The tax is 2.5 percent of your adjusted gross income. Furthermore, you're taking a financial risk by not getting insurance. If you go to the emergency room, you pay about $1,265 on average. If you get cancer, you'll face a $30,000 bill. If you an easily afford this, then it's worth the risk. If not, you might face bankruptcy. In fact, the number one cause of bankruptcy in this country is healthcare-related costs. See Why Should I Have Health Coverage?

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 less-expensive "catastrophic" insurance. That covers emergency room visits and hospital stays, but only three regular doctor visits. Find out more in Can I Buy a Catastrophic Plan?.

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 in case you can 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 ten essential benefits, protection from being dropped if you get sick, and the ability to put your adult children on your plan. Find out what benefits you should have in How Does the ACA Protect Me?
  1. You qualify for a subsidy or free health care. If you make less than $45,960 for an individual/$94,200 for a family of four, the government will pay for part or all of your insurance. Find out more.
  2. Your company drops your insurance plan. That could happen to 3-5 million employees.Your company's plan might not meet all the 100 essential benefits required by the ACA. (Source: CBO, The Effects of the Affordable Care Act on Employment-Based Health Insurance, March 15, 2012)

You Have Medicare or Medicaid - You already have Obamacare.

You're a Small Business Owner - You must provide health insurance or pay a fine. For more, see How Does Obamacare Work?

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 ten 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 - 60 percent
  2. Silver - 30 percent
  3. Gold - 20 percent
  4. Platinum - 10 percent.

STEP 3 - Purchase the Plan You Want (When: November 1, 2016 - January 31, 2017)

 Starting November 1, you can buy the plan you want. Find out How Much Will Obamacare Cost Me?

STEP 4 - Coverage Begins (When: January 1, 2017)

You must submit payment 15 days before coverage will begin. As long as you're signed up for insurance by the January 31, 2017 deadline, you won't have to pay the tax.  In addition, you'll be covered for at least a year if Trump repeals and replaces Obamacare.

Obamacare In Depth

To save money on Obamacare, see my book The Ultimate Obamacare Handbook (2015 - 2016).