When Does Obamacare Start?

Obamacare Enrollment Starts November 1, Are You Ready?

••• Photo: malerapaso/Getty Images

When most people ask, "When does Obamacare start?" they're referring to the mandate that everyone must get health insurance or pay a tax. But the Patient Protection and Affordable Care Act is so complex that different portions start at different times. Find out what's happening now, what's coming up next, and what's already begun. Also find out how this changes under Trump's plan to repeal and replace Obamacare.

November 1, 2018: Open enrollment for Obamacare coverage for 2019 began on the health insurance exchanges. The exchanges are always available to compare plans and see if you qualify for subsidies. If you qualify for expanded Medicare, you can get it anytime. 

December 15, 2018: Open enrollment for health insurance closes. If you haven't signed up for insurance by then, the Obamacare tax is 2.5 percent of adjusted gross income. The maximum payment equals the average cost of a Bronze plan. The minimum flat tax will be $695 per adult, and $347.50 per child, capped at $2,085 per family. But President Trump's tax act repealed this tax effective for the tax year 2019.

Small business owners with 100 or more workers must pay $2,000 per employee (except for the first 30) if they don't provide insurance, or if employees can find a lower-cost plan with the same benefits on the exchange. They may waive the fines if they provide insurance to 70 percent of all full-time employees. Companies will receive a tax credit of 50 percent of the cost of providing insurance. Small businesses can search for plans on the SHOP Marketplace

January 1, 2019: Health insurance coverage bought through the exchanges begins for 2019. All plans will offer services in each of the 10 essential health benefits, as well as offer all other Obamacare benefits.

Plans are in four different categories, arranged by how much they cost you versus how much coverage they provide. Bronze plans only pay 60 percent of your total health care costs but have the lowest monthly premiums. Plans in the other three categories have higher premiums but cover more costs: Silver plans cover 70 percent, Gold plans cover 80 percent, and Platinum plans cover 90 percent of costs. The type of plan is one of five factors that determine how much Obamacare will cost you.

2022: Businesses must pay a 40 percent excise tax on "Cadillac" health insurance plans. These are plans that offer specialized coverage, and their premiums are $10,200 (individuals) or $27,500 (families) or more. They offer low copayments or provide unusual benefits, such as marriage counseling. Businesses also offer Cadillac plans if most of their employees are older, live in an area with expensive health costs, or have dangerous jobs.

2020: The Medicare "doughnut hole" is eliminated.

Obamacare Changes That Already Began

March 23, 2010: President Obama signed the ACA legislation. Here's what immediately went into effect.

  • Small businesses received a tax credit of 35 percent of their premium payments for workers. 
  • Indoor tanning services paid a 10 percent excise tax.
  • Businesses that provided early retiree health insurance were reimbursed until December 31, 2011. 
  • Those who had to pay part of the gap in Medicare Part D Prescription Drug coverage (the "donut hole") received a $250 rebate.
  • Parents can keep their children on their insurance until age 26.
  • Insurance companies could no longer drop people when they got sick, create lifetime coverage limits, or deny coverage to children with pre-existing conditions. They were required to cover 100 percent of preventive services.

June 17, 2010: Federal regulations "grandfathered in" health plans that were in existence on March 23, 2010.

2011: These additional benefits started in 2011:

  • Medicare paid 100 percent of the costs of preventive services, and negotiated a 50 percent discount on brand name drugs.
  • Insurance companies had to prove they spent at least 80 percent of premium payments on medical services or send rebates to policyholders. They had to submit justification to Federally-funded state boards for all rate hikes
  • Federal funds increased the number of doctors, nurses, and community health centers.

June 28, 2012: The Supreme Court ruled that Obamacare was legal. 

January 1, 2013: Individual taxpayers could only deduct medical expenses that were at least 10 percentof income. It was 7.5 percent before. If their income was $200,000 or more ($250,000 for families), they paid a 2.35 percent income tax on earnings above the threshold. They also paid a 3.8 percent tax on the lesser of (a)dividends, capital gains, rent and royalties or (b)income above the threshold.

Medicaid paid 100 percent of preventive services, and CHIP was extended two years. States received Federal funds for this. Medicare launched a pilot program to help hospitals bundle services before submitting them for payment. Medicare also paid 100 percent of primary care physicians' fees.

Insurance companies can no longer deny coverage to anyone with pre-existing conditions. Small businesses will receive tax credits to cover up to 50 percent of their total employee premium payments.

If you hadn't signed up for insurance by the time the open enrollment closed on February 15, 2014, you were assessed an income tax that's roughly 2 percent of your Adjusted Gross Income. You will pay no more than the average cost of the Bronze plan. You will pay no less than a flat rate of $325 per adult and $162.50 per child, capped at $975 per family. (Source: Healthcare.gov.) 

In Depth: How It Affects You | The Truth About Obamacare | Why Reform Health | How Much Obamacare Adds to the DebtObama's Health Care Campaign Promises

For more on how to save money on the ACA, see the author's book, "The Ultimate Obamacare Handbook."