Many people are familiar with Obamacare but might not realize that it refers to the Affordable Care Act (ACA). In 2017, NPR conducted a survey asking 2,000 Americans around the country the question, “Is ACA the same as Obamacare?” They found that around 35% of Americans did not realize they were the same policy. Obamacare is simply an informal name for the Affordable Care Act, a landmark healthcare law signed in 2010.
Before the ACA, health insurance in the United States was characterized by high rates of uninsured populations, steep out-of-pocket costs, and restrictive coverage limits. Insurance companies often deny coverage to those with pre-existing conditions, including serious illnesses like heart disease, cancer, and mental health disorders, as well as conditions like pregnancy. The ACA was designed to enhance the accessibility and affordability of health insurance for many Americans.
The ACA broadly impacts the healthcare system, influencing providers, insurers, employers, taxpayers, and consumers. It also introduced modifications to Medicare, Medicaid, and employer-sponsored plans. One of its key features was the establishment of health insurance marketplaces, which provide federal financial assistance to help individuals obtain ACA-compliant coverage, particularly for those lacking traditional health insurance options like employer-sponsored plans.
The Affordable Care Act (ACA) changed the health insurance system, expanding access to millions of uninsured Americans. It expanded Medicaid eligibility, prohibited companies from denying coverage due to preexisting conditions, and increased consumer protection. Additionally, the ACA mandated employer-sponsored coverage, offered financial aid, established a health insurance marketplace with plans that met essential health coverage standards, and required the provision of preventive services.
Over the years, the American Care Act has seen some updates since its original Obamacare days, including removing penalties for individuals not having health insurance with the Tax Cuts and Jobs Act (TCJA) in 2017. The Inflation Reduction Act in 2022 extended financial assistance for individuals enrolled in the ACA through 2025 instead of 2022. As the ACA continues to evolve, healthcare coverage has expanded to millions of previously uninsured Americans, with more than 13 million enrolled in coverage offered by the ACA’s Marketplace as of 2021.
What Are 5 Different Types of Government Plans Under the Affordable Care Act?
Health Insurance Marketplace plans are categorized into four distinct “metallic” tiers: Bronze, Silver, Gold, and Platinum, along with an additional Catastrophic option. Levels are based on how the plan shares costs with the individual, with Bronze representing the lowest coverage and Platinum offering the highest coverage. All plans, regardless of their tier, include the same essential health benefits.
Four of the five different types of ACA government plans are differentiated based on their actuarial value, which is the average percentage of healthcare expenses that will be paid by the plan. Higher levels, like Gold and Platinum, pay more towards healthcare bills, lowering out-of-pocket costs for copayments, coinsurance, and deductibles. However, this increased coverage comes with higher monthly premiums. For any plan, monthly premiums are based on several factors, including age, number of family members enrolling, where the person lives, and the insurance company.
Actuarial values for each plan are as follows:
Bronze – 60%
Silver – 70%
Gold – 80%
Platinum – 90%
Catastrophic health plans have low monthly premiums and very high deductibles, making them affordable ways to protect oneself from worst-case scenarios, like getting seriously injured or sick. These plans are available to individuals under 30 or with specific hardship or affordability exemptions.
Who Is ACA Eligible?
The Affordable Care Act (ACA, commonly referred to as Obamacare, is designed to make healthcare affordable for all individuals, regardless of their income. To be eligible for the ACA, individuals must meet certain criteria:
Be a U.S. citizen or national, or be lawfully present in the U.S.
Live in the United States
Not be enrolled in Medicare
Not be currently incarcerated
As noted by GoodRx, while anyone can purchase health insurance through the ACA, those whose incomes fall between 100% and 400% of the federal poverty level (FPL) may be eligible for financial aid to help lower their out-of-pocket expenses and premiums. For example, a family of four can receive subsidies if their household income ranges from $31,200 to $124,800. A single individual qualifies for assistance if their income is between $15,060 and $60,240 or higher, based on the 2024 federal poverty guidelines.
Individuals who are not U.S. citizens or nationals but are lawfully present may also be eligible for Obamacare if they meet specific immigration criteria, including:
Lawful permanent residents or green-card holders
Asylum seekers or refugees
DACA recipients
Those with nonimmigrant status, such as student or work visa holders
Lawful temporary residents
Cuban/Haitian entrants
Victims of Trafficking and their immediate family members
And many others, with the full list of qualifying statuses on the HealthCare.gov website.
What Are the ACA Minimum Requirements?
Obamacare health insurance operates on the principle that qualified health plans (QHPs) must adhere to essential health coverage standards, which include no annual or lifetime limits on benefits. To qualify, major medical insurance and QHPs must meet specific criteria, such as having an actuarial value of at least 60% and covering ten essential health benefits. These mandatory benefits include:
Laboratory services
Emergency services, including visits to the emergency room.
Prescription drugs for both acute and chronic medications.
Mental health and addiction services, which encompass treatment for anxiety and depression, as well as inpatient care for substance use or mental health disorders.
Maternity and newborn care, covering prenatal expenses, costs of labor and delivery, and newborn care expenses.
Pediatric services provide not only routine medical care but also dental and vision care for children.
Ambulatory patient services refer to routine outpatient care and urgent care visits.
Preventive and wellness services, such as routine physicals.
Hospitalization includes surgical procedures, intensive care units, and inpatient hospital stays.
It is important to note that there are many non-ACA-compliant health insurance plans outside the Marketplace, which may not cover essential benefits and may have annual or lifetime caps on covered benefits. However, all qualified plans from the ACA Marketplace should provide individuals with all the coverage needed. All qualified plans available through the ACA Marketplace are designed to offer comprehensive coverage. While shopping for health insurance can be daunting, a reliable insurance agency can assist individuals in navigating the complexities and selecting a plan that meets their needs.
Is ACA the Same as Obamacare? Let HealthLifePlus Help You Find the Best Health Insurance Plan
Navigating the health insurance world can be challenging and knowing is ACA the same as Obamacare can help dispel myths. Many are still not aware that the ACA is the same as Obamacare, which can make it even more difficult to find the right insurance plan for themselves and their families. At HealthLifePlus, our mission is to assist everyone in securing the appropriate health insurance plan and maximizing their benefits through comprehensive education and dedicated customer support. All plans available through HealthPluseLife comply with the Affordable Care Act, guaranteeing all necessary health benefits.
Whether you’re enrolling for the first time, renewing your existing plan, or trying to understand your benefits, our knowledgeable insurance agents are ready to provide expert guidance and support throughout the entire process. Contact HealthPlusLife today at 888-828-5064 to speak with a licensed insurance agent.
Johanna Karlsson Johanna Karlsson is a veteran health and life insurance professional licensed in 50 states. She relocated from the countryside in the south of Sweden and has not looked back. After coming to the United States to attend university, she gained her degree in Public Relations. She brought her public relations skills to a local international health insurance where she discovered a new passion in insurance. After years with that company, Johanna now joins HealthPlusLife to help build a team of licensed insurance agents ready to meet your insurance needs.
