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The ObamaCare Health Insurance Marketplace Explained

Getting ObamaCare

Getting ObamaCare

I said this would be the simple guide to the ObamaCare Marketplace, but I did not say it would be a very short guide. Actually, you can understand the basics of how health reform, known as the Affordable Care Act, impact you and your family rather quickly. But things are slightly different in each state, so a guide aimed at the Unites States cannot be that brief.



Also, this is not really for people who are already on Medicare, but it is for people who need individual health insurance because they are not old enough for Medicare coverage. This includes early retirees, small business owners, contract workers, employees of small companies without group medical benefits, or even the unemployed. You can turn to this page on Medicare.gov to learn how ObamaCare affects Medicare if you have concerns. Also, health reform does not really impact long term care either.

Before plunging in to explain the practicalities of how you can get ObamaCare health insurance, or how it might impact you and your family, these are some things you should know about health reform:

  • Medicaid expansion: There are 25 (26 if you include DC) states that expanded Medicaid in 2014, 19 that did not, and 6 that are still actively debating this issue. You can track the progress on this guide to Medicaid expansion from the Kaiser Family Foundation. This is important, and it will be explained in the Medicaid coverage gap section.
  • Where do you get ObamaCare? You can use a health insurance marketplace to enroll in qualified marketplace health insurance. In a little over half the states, like Texas, New Jersey, and Florida, you must go to HealthCare.gov to register and apply. The rest of the states, like California, Colorado, and New York, you will need to visit your own state’s marketplace.
  • How do you find out if you qualify for subsidies? The application process will let you know if you qualify for marketplace medical plans and subsidies for these private plans. It will also let you know if any members of your family qualify for Medicaid or CHIP (Children’s Health Insurance Program).
  • Do you have to get ObamaCare online? If you do not care to get ObamaCare by applying online, you can also enroll by phone (1-800-318-2596), submit a paper health insurance marketplace application, or find a local health insurance navigator or insurance agent to help you (LocalHelp.HealthCare.gov).

ObamaCare Health Insurance Subsidies, Medicaid, and CHIP

Health Insurance Subsidies: The Affordable Care Act, or ACA, allows subsidies for people who earn between 100 and 400 percent of the federal poverty level. If people have access to other affordable private or public health insurance, they may not qualify for subsidies. Some examples of this might be group health insurance from work, Medicare, Medicaid, or CHIP.


Subsidies are tax credits, and they can be applied to the cost of private marketplace health insurance plans right away. For example, if your family is entitled to a $200 tax credit, and the monthly premium for an insurance plan that you select is $500, you would only need to pay $300.

Medicaid and the Medicaid Coverage Gap: Qualification for Medicaid might depends upon income and family size for adults who live in states that expanded Medicaid. The original idea behind the ACA was that people who made less than 100 percent of the federal poverty level, or about $11,670 for an individual, would get Medicaid instead of a subsidy. In states that did not expand Medicaid, it is very tough to qualify for adults who are not disabled, parents, etc.

This creates a coverage gap for people who do not earn enough to qualify for tax credits, but earn too much (or do not have other qualifications) to qualify for Medicaid. Qualification by income, family size, etc. is different in each state. You can see if your state expanded Medicaid here, and you can check with your state’s Medicaid website to find out if you qualify. Again, the marketplace application will also let you know what you qualify for.

The Children’s Health Insurance Program (CHIP): Children from low to moderate income families may qualify for health insurance under CHIP. In every state, children from families who do not earn enough to qualify for subsidies, and even form some families who do, can qualify for CHIP. Income requirements are different in each state.

You can check with your own state’s CHIP website to see if your kids qualify. Of course, you can simply apply for ObamaCare health insurance to see if your kid’s qualify for CHIP.

What are Health Insurance Marketplace Plans?

These are private policies from insurers like Blue Cross, Aetna, Humana, etc. They are not public or government health insurance at all. However, they have to conform to certain guidelines that the ACA enforces. The companies vary by state and even ZIP code. Not all companies offer all plans or any plans in all states, and some health insurance companies only work in certain regions of certain states.

What to Know About ObamaCare Health Insurance Marketplace Plans:

  • Plans come in “metal” levels, and these are Platinum, Gold, Silver, and Bronze. There are also catastrophic plans for some applicants.
  • Plans must provide “essential health benefits,” and these include preventative care, immunizations, treatment for chronic conditions, and even maternity care. Plans for kids under 19 years old have to include dental and vision benefits too.
  • Insurers are not allowed to decline applicants because of pre-existing medical conditions, and this includes pregnancy.
  • Rates are only set by age, location, and tobacco use.

How do You Get ObamaCare?

By now, you should have a pretty good idea of how the health insurance marketplaces work. If you are still confused about where to begin, you might want to go back to the page on HealthCare.gov that offers local help. Otherwise, you can get started by finding the right website, registering, and applying.

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