Obamacare Eligibility FAQs

Obamacare is the colloquial term for the Patient Protection and Affordable Care Act which is also commonly referred to as the Affordable Care Act (ACA). It was signed into law by President Barack Obama on March 23, 2010.

The Affordable Care Act took effect in October 23 with the first open enrollment running from October 1 to March 31 of the following year. Essentially, an open enrollment is the only time you can apply for health coverage under the ACA.

It’s been two years since the law has been enacted, and since then only the state of Texas has more than 20% uninsured, according to a survey by Gallup which was published on August 2015.

While Obamacare may have been in place since 2013, some may still have lingering questions over eligibility. And that’s what this FAQ is here for: to answer any of those concerns regarding Obamacare eligibility.

Who Is Eligible For Obamacare?

President Barack Obama signed ACA into law for the purpose of improving health insurance coverage in America, as well as expand the Medicaid program which provides cover for low-income citizens. While almost all residents of the US are eligible for Obamacare, there are some exceptions.

There are three main provisions in the ACA:

1. Expansion of the Medicaid program which offers health coverage for Americans with low income.

2. Creation of insurance exchanges which are basically online sites like Healthcare.gov where people can search for coverage, and some come with financial assistance from the federal government.

3. The individual mandate which requires almost all Americans to buy health insurance coverage, otherwise a penalty must be paid. This provision was put into place to encourage those who are unlikely to purchase coverage to sign up. By doing so, economists believe that premiums can be kept low. This isn’t strictly mandatory as some may not find an affordable plan or may have religious reasons for not wanting health coverage.

Since almost every citizen of the US can apply for health insurance under Obamacare, the eligibility requirements kick in when you want to receive subsidies for said insurance. A health insurance subsidy is basically financial assistance from the federal government. The amount which they would give you is based on the family income, where those who are earning less will receive bigger subsidies.

Requirements

  • You must live in the US.
  • You must be a US citizen or national or are lawfully present in the US.
  • You must have a household income between 133% and 400% of the federal poverty level.
  • You must not be currently incarcerated.

All that said, you can still apply for coverage under The Affordable Care Act even if you don’t meet the requirements listed above. But while you can definitely apply for coverage, you cant qualify for government subsidies that can help shoulder the costs of healthcare.

Essentially, it’s quite a misnomer to say that Obamacare makes healthcare accessible for all. Not every American citizen is covered by the act, but everything considered, it can lower the amount of Americans with little to no health insurance coverage.

Can Obamacare Be Purchased Right Now?

The short answer is no. But that doesn’t mean you can’t ever purchase health care moving forward.

If you want to apply for health coverage under The Affordable Care Act, there is a so-called open enrollment period where you can apply. You need to keep yourself up to date on the window for this if you’re interested in getting covered by the ACA.

Obamacare isn’t available all year round, and there is a reason for it being such. If, for example, the enrollment for ACA were to be all year round and at anytime then you would have a scenario where someone could sign up in the most extreme of situations like on an ambulance headed towards the hospital. When this happens, premiums would shoot up because people can buy coverage at the exact moment they are expecting really high medical expenses.

In order to avoid that situation, a specific window is given to Americans to sign up for Obamacare, as well as commit to buying health coverage for the entire year.

Then again, there are exceptions to the “buy on the spot” rule. For instance, a special enrollment period is given to someone whose just had a baby. Also, people who lose their jobs or are moving to a new state can search for a new plan even when the enrollment period has closed. To get a list of all the exceptions to the rule, head over the healthcare.gov.

All that said, the enrollment period for 2016 starts on November 1, 2015 and runs until January 31, 2016.

Do All States Have Obamacare?

Not every one. However, every state in America does have an insurance exchange. Each state also has financial subsidies which assist middle-income US citizens purchase private coverage.

Yes, the Affordable Care Act was written with the intention to require all states to expand their Medicaid programs, but only 28 states are participating. In 2012, the Supreme Court found that it too taxing for states to create a bigger Medicaid program. Since the state helps pay for Medicaid, the Supreme Court ruled that each state can decide whether they want to expand their Medicaid program or not.

The other 17 states have opted out of Obamacare while the other five are still on the fence as legislators and governors continue to debate about the act. The disappointing fact about this is that those who earn less than the poverty line and live in non-expansion states will suffer. When legislators drafted Obamacare, they thought this segment of the population would be able to get Medicaid coverage which is why they didn’t consider them for subsidies. So, while the ACA was meant to provide healthcare to those who can’t afford it, there’s a portion (the poor) who can’t earn subsidies to fund insurance.

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