The Affordable Care Act – also known as health reform or “Obamacare” – introduces significant changes to public and private health insurance. In this resource, we highlight the key changes under health reform.
These changes include new insurance reforms, Health Insurance Marketplaces, Medicaid expansion, and a penalty for being uninsured.
Here are some of the key things to know:
Insurance reforms mean new coverage options for millions of Americans
Health reform is designed to make health care coverage more available, affordable, and adequate for individuals and families. For example, insurers can no longer refuse to cover you or charge higher premiums because of a pre-existing condition, and new plans must cover a minimum set of essential health benefits. Because these changes apply differently based on the type of coverage you have and where you live, it is important to understand your options.
Our fact sheets on health reform can help you learn more about these reforms, when they will be implemented, and whether they affect your coverage.
You can shop for the coverage you need through new Health Insurance Marketplaces
Individuals, families, small employers, and employees can explore their new coverage options and shop for private health insurance through new Health Insurance Marketplaces in every state. Through the online Marketplaces (or by phone or in-person), you can compare new options and learn whether you qualify for financial assistance or coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
You can enroll through the Marketplace in your state from November 15, 2014 through February 15, 2015. If you do not enroll during this time period, you may have to wait until enrollment reopens next year unless you face certain life-changing circumstances. And, you and your family members can enroll in Medicaid and the Children's Health Insurance Program at any time throughout the year.
Need to connect to the Marketplace in your state? Use this link and select your state.
Some states will offer expanded access to Medicaid for low-income adults
Under the Affordable Care Act, states can choose whether to expand Medicaid coverage to adults with annual incomes of up to about $16,105 for an individual (or $32,913 for a family of four). If your state has not expanded Medicaid coverage, you may still qualify for financial assistance to purchase private coverage if your income is more than $11,670 (or $23,850 for a family of four).
You can learn whether your state chose to expand Medicaid coverage and whether you’re eligible for financial assistance here.
Most Americans must have health insurance or pay a penalty
Beginning on January 1, 2014, every individual – with some exceptions – must have health insurance or pay a penalty. Most Americans already have affordable coverage through an employer; if so, you don’t need to change coverage unless you want to. If you are uninsured, or your employer offers coverage that is unaffordable, or you want to check out new options, you can shop for coverage through the Marketplace in your state and may be eligible for financial assistance.
You can learn more about the penalty and what it means for your family here.