How It Works
What is Obamacare insurance?
The ACA brings some uniformity to healthcare. Even though specific benefits may vary, core requirements are now the same for all qualified health plans.
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Be guaranteed coverage
You can’t be denied coverage or charged more based on factors such as your health history and gender.
Cover specified preventive care at no additional cost
These “free” preventive services come in three categories (all adults, women, children) and include certain screenings, vaccinations, and condition-related counseling. You can’t be charged a copay or coinsurance for these preventive services, even if you haven’t met your plan’s deductible.
Includes, at a minimum, these 10 essential health benefits:
- Ambulatory patient services (outpatient hospital care)
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drug coverage
- Rehabilitative and habilitation services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Know the ACA Health Insurance Basics
While Obamacare plans have to comply with the guidelines mentioned above, they do come in a few different forms to accommodate where you are in life. After all, your healthcare needs will change along with you. For example: As you make career moves, your finances shrink or expand, when you turn 26 and age off your parent’s health insurance, if you decide to start a family, or as your health status stays strong or enters periods that require more medical attention.
In general, the lower the premium, the higher the deductible, and vice versa. That means your household budget and typical healthcare needs come into play. Maybe you’re relatively healthy and want to keep your monthly premium costs low, then a bronze plan may feel like the right choice. Or perhaps you have ongoing health concerns that require more frequent care and prescription medications, then a gold plan with a lower deductible may feel more comfortable. If you qualify for cost-sharing reductions, you’ll want to choose a silver plan that can have an actuarial value as high as 94%.
There are also catastrophic plans, which are available to individuals under 30 or those who have a hardship or affordability exemption, regardless of age. These plans offer a lower monthly premium but come with a higher deductible ($8,550 in 2021). They don’t qualify for ACA subsidies, though. That means you may want to consider a plan in one of the metal categories if you’re eligible for a subsidy—your premium and deductible could potentially be less.
ACA health insurance plans are categorized into what are known as the metal levels according to their actuarial values. On average, it works out as follows:
Frequently asked questions
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