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What is the Affordable Care Act? | How to Apply, Every Qualification & More

What is the Affordable Care Act? How can I apply for the Affordable Care Act? Who qualifies for the Affordable Care Act? We’ve dug deep and found all the answers you might have about the Affordable Care Act (ACA) — including the benefits that the ACA covers and the ACA Open Enrollment period.

If you’re looking for the best coverage you can grab under ACA, give one of our agents a call at (855) 968-5736 for the most accurate information, or use our free quoting tool to get an estimate based on your state and income.

What is the Affordable Care Act (ACA) or Obamacare?

The Affordable Care Act, also known as Obamacare, was enacted on March 23, 2010, and has created baseline standards for health coverage to make health insurance affordable to all citizens of the United States.

Main Goals of the Affordable Care Act

According to HealthCare.gov, there are three main goals for the Affordable Care Act:

Make affordable health insurance available to more people.
Expand Medicaid to cover all adults with an income below 138% of the Federal Poverty Line (FPL).
Decrease the cost of health care.

Besides those main goals, the Affordable Care Act included several additional benefits.

Every Essential Health Benefit ACA Covers

Under the ACA, insurance companies that offer a Marketplace plan are required to provide these ten essential health benefits:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services (i.e. counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness service and chronic disease management
Pediatric services (including oral and vision care)

Unfortunately, adult dental and vision care are not included in the essential health benefits, but Marketplace offers dental and vision insurance as an addition.

Pre-Existing Conditions Under ACA

According to the ACA, health insurers can no longer charge you more or deny you or your child coverage based on any pre-existing health conditions. These pre-existing health conditions include asthma, diabetes, cancer, and pregnancy.

The only exception to this rule is if your plan is a “grandfathered” health plan, a health insurance policy purchased before March 23, 2010, and hasn’t had any significant changes since the date of purchase.

Young Adult Coverage Under ACA

The ACA also states that children under 26 can be covered under your health insurance plan until their 26th birthday. They can even remain on your plan if they are…

Not living with you
Going to school
Eligible to enroll in their employer’s plan
Married
A parent
Not financially dependent on you

When children lose their coverage on their 26th birthday, they can qualify for the Special Enrollment Period on the Marketplace for 60 days before and after their birthday. Here are a few things that your child can do when they turn 26:

Have them enroll in their own Marketplace plan.
If you are currently on a Marketplace plan, your child can stay on your Marketplace plan until December 31st of the year they turn 26.
Have them enroll in their job-based plan.

What About “Grandfathered” Health Plans?

A “Grandfathered” Health Plan is a health plan purchased before March 23, 2010, by an insurance company, agent, or broker. With a Grandfathered Health Plan, many of the rights and protections covered under the ACA aren’t included. Here’s a list of benefits that aren’t required to be covered under a Grandfathered Health Plan according to HealthCare.gov:

Free preventive care
Right to appeal a coverage decision
Right to choose your doctors and access to emergency care
Be held accountable through Rate Review for excessive premium increases
End yearly limits on coverage
Coverage with pre-existing conditions

Double-check with your insurance provider to see if your plan is a Grandfathered Health Plan and if these benefits are covered under your insurance.

If your Grandfathered Health Plan has undergone significant changes, such as a reduction of benefits or a price increase, your plan could lose its “grandfathered” status.

What is the Federal Poverty Level (FPL)?

The Federal Poverty Level is a scale that the Department of Health and Human Services uses to determine different benefits including savings on Marketplace health insurance, Medicaid, and CHIP coverage.

Here are the Federal Poverty Levels for 2024:

Family Size	2024 Income Numbers
Individual	$15,060
Family of 2	$20,440
Family of 3	$25,820
Family of 4	$31,200
Family of 5	$36,580
Family of 6	$41,960
Family of 7	$47,340
Family of 8	$52,720
Family of 9+	Add $5,380 for each additional person

*Numbers came from HealthCare.gov. FPL levels are higher in Alaska and Hawaii.

How Can I Get $0 Health Insurance?

Depending on your FPL, your tax subsidy, a tax credit that can lower your insurance premium, can affect how much you’ll spend on health insurance through Marketplace. If your FPL is below 150%, you might be able to cover your health insurance fully.

Here’s what you can expect to pay for premium contributions under ACA depending on your FPL:

Annual Household Income (FPL %)	Expected Premium Contribution (% of Income)
Up to 150%	0%
200%	2%
250%	4%
300%	6%
400%	8.5%

Need some more information on how much you’ll pay for a Marketplace plan? Call us at (855) 968-5738 or use our free quoting tool for the most accurate information regarding your plan.

Where to Apply for ACA Insurance

There are plenty of ways you can apply for Marketplace health coverage. Here’s what’s available to you:

Apply for a Marketplace plan through HealthCare.gov
Enroll over the phone
Search for help in your area to find in-person assistance
Fill out a paper application to send in the mail

However, we recommend contacting one of our talented agents at (855) 968-5738 for the most accurate information or using our free quoting tool to find estimated prices for your Marketplace plan.

When Are the ACA Open Enrollment Dates?

What is ACA Open Enrollment? The Open Enrollment period is when new or existing applicants with a plan with Marketplace can enroll in, renew, or change their health plan through their portal. Enrollment dates start on November 1 and last until January 15.

Here are a few Open Enrollment dates that you should know:

November 1: Open Enrollment starts
December 15: The last day to enroll in or change coverage for Marketplace plans starting January 1.
January 1: Coverage begins for those who enrolled before December 15 and paid their first premium.
January 15: Open Enrollment ends. After this date, you can enroll or change plans if you qualify for a Special Enrollment Period.
February 1: Coverage begins for those who enrolled from December 16 to January 15 and paid their first premium.

Do I Qualify for the ACA Special Enrollment Periods?

Special Enrollment Periods are exceptions to the strict Open Enrollment dates of the Affordable Care Act. Generally, you’ll qualify for a Special Enrollment Period if you experience a significant life change such as getting married, having a child, or if someone on your Marketplace plan dies.

There are so many reasons why you could or could not be accepted into a Special Enrollment period, so we have all the information you need to know to see what qualifies you for a Special Enrollment Period.

What is Medicaid Expansion & How Can I Qualify?

Medicaid qualifications are generally based on income, household size, disability, family status, or other factors that differ from state to state. However, if your state has adopted Medicaid Expansion, you can qualify for Medicaid based on income alone.

Medicaid Expansion states that if your income is lower than 138%, you should qualify for Medicaid in your state. However, if your state has not adopted Medicaid Expansion, HealthCare.gov suggests you apply for a Marketplace plan to see what is available.

Here are the states that haven’t adopted Medicaid Expansion: WY, KS, TX, WI, MS, TN, AL, GA, SC, and FL.

If you want more about your Marketplace plan, call us at (855) 968-5738 or use our free quoting tool for the most accurate information.

Conclusion

The Affordable Care Act has created baseline qualifications for health insurance providers through Marketplace and it is estimated that 21.3 million Americans enrolled in an ACA Marketplace plan in 2024.

If you’re looking for an affordable healthcare plan, the ACA has given baseline qualifications that all Marketplace providers must follow and the government gives a tax subsidy that makes plans more affordable. Give one of our agents a call at (855) 968-5738 or use our free quoting tool to see how you might qualify for a Marketplace healthcare plan.

Frequently Asked Questions

What is the Affordable Care Act?

The Affordable Care Act is a set of standards for healthcare providers on Marketplace that was passed on March 23, 2010.

How Much Does the Affordable Care Act Cost?

The plans found on Marketplace costs differ depending on your income and the state you live in but for the most accurate and updated information, call us at (855) 968-5738 to see how much you’ll need to pay.

Who Qualifies for the Affordable Care Act?

Everyone qualifies for a plan on Marketplace under the Affordable Care Act. However, the amount the plan will cost will depend on the state you live in and your income.

When is Open Enrollment for the Affordable Care Act?

Open Enrollment for Marketplace plans under the Affordable Care Act will start on November 1 and last until January 15.

Does the Affordable Care Act Cover Dental and Vision?

The Affordable Care Act states that plans under Marketplace must include dental and vision for children; however, adult dental and vision are not considered essential health benefits and will cost you an additional charge.