What is Obamacare and how does it work?
Obamacare and the ACA Marketplace are the same thing. Here is what it actually is, who it is for, and what it changed.
Obamacare, the Affordable Care Act, and the Health Insurance Marketplace all refer to the same system. The nickname stuck and the official names never quite replaced it.
It is not a government insurance plan. It is a marketplace where private insurance companies sell individual health plans under a common set of rules, with financial help available based on your income.
What it changed
- Insurers cannot deny you coverage or charge you more for a pre-existing condition
- Every plan must cover a defined set of essential health benefits
- There are no annual or lifetime limits on essential benefits
- Preventive care is covered with no cost sharing
- Young adults can stay on a parent's plan until age 26
- Premium subsidies are available based on household income
Before the ACA, an individual plan could refuse you for a diagnosis or exclude a condition entirely. That is the change most people notice.
Who it is for
People who do not have coverage through an employer, Medicare or Medicaid. That includes:
- Self employed people and independent contractors
- Early retirees not yet 65
- People between jobs
- Workers whose employer does not offer coverage, or whose coverage is unaffordable
- Part time and seasonal workers
- Small business owners
The subsidy, which is the whole point
Most people who buy through the Marketplace qualify for a premium tax credit that lowers the monthly cost, sometimes substantially. The amount depends on household income and household size.
Because the credit is calculated against a benchmark plan, a lot of people are surprised by how affordable a plan is once it is applied. See whether you qualify for a subsidy.
We cannot tell you your subsidy amount on a public page, because it depends entirely on your household income, size and the plans available at your address. Anyone quoting you a figure without asking those questions is guessing.
The metal levels
Plans are sorted into bronze, silver, gold and platinum. The metal does not describe quality of care. It describes how costs are split between you and the plan.
Silver plans matter more than the rest for one specific reason involving extra savings. See how the metal levels work.
When you can enroll
Open enrollment runs from November 1 through January 15 for coverage the following year. Outside that window you need a qualifying life event.
See open enrollment in South Texas and special enrollment periods.
Where to apply
Texas uses the federal marketplace, so you apply at HealthCare.gov, by phone, or through a licensed agent or certified assister. There is no separate Texas exchange.
We are an independent agency, not a government office and not HealthCare.gov. Using an agent does not change your premium, which is set by the insurer and filed with the state. See whether a broker costs extra.
Common follow-up questions
Is Obamacare the same as the ACA Marketplace?
Yes. Obamacare is the nickname for the Affordable Care Act, and the Marketplace is where you buy the plans it created.
Is it government insurance?
No. Private insurance companies sell the plans under federal rules. The government provides the marketplace and the subsidies.
Can I be turned down for a health condition?
No. Marketplace plans cannot deny you or charge more because of a pre-existing condition.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
ACA Marketplace open enrollment in McAllen: what to know before November
Health and ACA