Updated: 2021-05-04 by
- What is Obamacare and the Affordable Care Act?
- Is Obamacare different from the Affordable Care Act?
- What do Obamacare health insurance plans cover?
- Will I be penalized if I don't have health insurance?
- What if I already have health insurance?
- Where can I get in-person help with my application?
- What does "open enrollment" mean?
- What if I live in more than one state?
- Information & Documents to Have on Hand
- Glossary of Obamacare and Affordable Care Act Terms
- About This Website
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What is Obamacare and the Affordable Care Act?
Obamacare is the shorthand name for the federal Affordable Care Act (ACA), which was signed into law by President Barack Obama in 2010.
This wide-reaching law does many things, but most significantly it:
- protects consumers -- for example, by requiring insurance companies to cover people with pre-existing conditions and preventing them from arbitrarily canceling your coverage
- allows states to expand Medicaid coverage
- creates marketplaces (also called "exchanges") for health insurance plans that meet the requirements of the ACA, and
- establishes new funding for public health and prevention.
Until 2019, the law also required most U.S. citizens and legal residents to have health insurance or, if they didn't, to pay a tax penalty. Beginning in 2019, however, the penalty goes away in all states except those that have enacted their own penalties. Currently, the list of states with health insurance requirements includes California, D.C., Massachusetts, New Jersey, Rhode Island, and Vermont.
At ObamacareByZipCode, we focus on helping you understand how the Affordable Care Act works in California, to help you get the coverage you need.
Here are some topics that answer frequently asked questions about Obamacare.
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Is Obamacare different from the Affordable Care Act?
They are identical. Obamacare is just a nickname for the Affordable Care Act (ACA).
Here are some articles that answer frequently asked questions about Obamacare and the ACA.
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What do Obamacare health insurance plans cover?
All health plans purchased through Covered California, the health insurance marketplace for California, must include the following benefits whether or not you have a pre-existing health condition.
These are known under the Affordable Care Act as “essential health benefits”:
- Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
- Emergency services
- Hospitalization (including surgery)
- Maternity and newborn care
- Mental health and substance use disorder services (including counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services (including oral and vision care)
Companies that offer plans through Covered California will compete on price and quality of service in delivering these benefits.
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Will I Be Penalized If I Don't Have Health Insurance in California?
In California, unless you qualify for an exemption, you will be required to pay a tax penalty if you go without health insurance. Even though the federal tax penalty for being uninsured has gone away, California passed its own law imposing a tax penalty for state residents. The California law took effect on January 1, 2020.
For more information, see Do I Have to Get Health Insurance in California?
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What if I already have health insurance?
If you used the marketplace to purchase a plan last year. Most people who purchased their 2020 insurance plan from an online marketplace will be able to automatically renew their coverage for 2021. While automatic renewal sounds convenient, it has serious downsides:
- If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.
- Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.
- You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.
While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.
If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets California’s coverage requirements, you can keep it. Or, you may use Covered California to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.
Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.
If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under the Affordable Care Act. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through Covered California.
Keep in mind that if you buy a plan through the exchange:
- Your employer will not have to pay a portion of your monthly premiums.
- You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through Covered California.
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Where can I get in-person help with my application?
In California, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a navigator (often called a "certified enrollment counselor" in California) or from a licensed health insurance agent or broker.
Navigators can explain your options, answer your questions, and help you apply for the plan you choose -- but they can't recommend a specific plan for you.
Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators and counselors, they are allowed to suggest the best plan for you.
Talk to a licensed broker. To directly connect with a California insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)
For more information, see How To Sign Up for Obamacare California.
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What does "open enrollment" mean?
"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year.
For the dates of the next open enrollment period, see What You Need to Know About Obamacare in California.
Choose your health care plan carefully, because after you make your choice, you must usually live with it until the next open enrollment period.
"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:
- moving to a new state
- having a baby or adopting a child
- getting married or divorced
- leaving a job and losing your insurance
- losing coverage under your parents’ plan
- losing coverage because someone on your plan has died
- losing other types of health insurance
- gaining status as a member of an Indian tribe
- becoming an American citizen, or
- getting out of prison.
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What if I live in more than one state?
Purchasing a new individual insurance plan under the Affordable Care Act can be complicated if you spend a significant amount of time in more than one state or travel frequently. Here’s an overview of points to consider.
If You Live in More Than One State
If you truly split your time between two states, the federal regulations covering plans offered through an ACA marketplace say that you can purchase health insurance in one or both places. This is true as long you spend “an entire season or other long period of time” in your second home.
Keeping insurance in just one state. It’s undoubtedly easier and less expensive to buy and keep health insurance in only one state. If you go this route, you’ll be covered only for emergency care when you are outside of that state. And even in an emergency, charges may swell beyond your insurer’s limits for “reasonable and customary” care, leaving you at risk for a big medical bill in the event of a medical crisis.
Getting insured in two states. If you want to establish residency in both of the states where you live, you can buy a new insurance policy every time you move. That’s possible because your move is considered “permanent” under federal regulations. As long as you were insured in the first state, you’ll qualify for a special enrollment period to buy a new policy in the second state.
However, in addition to giving you a paperwork headache, buying insurance twice each year could turn out to be a very expensive arrangement. For example, your deductible and out-of-pocket max will restart every time you move—and maybe even a third time, if your stay in one state crosses into the month of January, when all plans restart for the calendar year.
Carefully consider your situation and talk with potential insurers—then read policies carefully—to be sure you understand your options, potential expenses, and the true extent of your coverage as you move from state to state.
If You Travel Frequently
An insurance plan that meets the requirements of the ACA should cover you if you have to get emergency care out of state. For other types of care, your coverage will depend on the particulars of your plan.
You may want to read the article, Don't Forget to Pack Health Insurance, from HealthInsurance.org for a deep dive into options for travel health insurance.
For more health insurance basics, see What California Residents Need to Know About Obamacare.
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Information & Documents to Have on Hand
Here's the information to gather before you visit Covered California to apply for health insurance:
- Your household size. HealthCare.gov offers a tool to help you figure out who to include in your household.
- Birth dates, Social Security numbers, and addresses for everyone in your household applying for coverage.
- Proof that you are a U.S. citizen, U.S. national, or "lawfully present" in the United States.
- Employer and income information for each member of your household. Include all income sources, such as your earnings from work, pensions, alimony, rental property, and other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.
- Your estimated household income for the coverage year. (For example, if you're applying in November of 2020 for coverage the next year, estimate your household income for 2021.)
- Policy numbers and any Plan ID numbers for current health insurance plans covering you or other members of your household.
- If you or anyone in your household is eligible for job-based health insurance, information about the plan costs and coverage for each available plan. (The Employer Coverage Tool offered by HealthCare.gov can help with this step.)
- A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.
Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to many basic questions or for information on signing up for a plan, see How Do I Sign Up for Obamacare in California?
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Glossary of Obamacare and Affordable Care Act Terms
- Accountable Care Organization
- Actuarial Value
- Advanced Premium Tax Credit
- Affordable Care Act
- Affordable Insurance Exchange
- Affordable coverage (as it relates to APTC)
- Allowed Amount
- Annual Deductible Combined
- Annual Limit
- Authorized Representative
- Cancelled Debts
- Capital Gains
- Care Coordination
- Catastrophic Health Plan
- Centers for Medicare & Medicaid Services (CMS)
- Certified Applicant Counselor
- Children's Health Insurance Program (CHIP)
- Chronic Disease Management
- Community Rating
- Competitive Bidding
- Complication of Pregnancy
- Coordination of Benefits
- Cost Sharing
- Cost Sharing Reduction
- Court Awards
- Creditable Coverage
- Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)
- Eligibility Assessment
- Eligible Immigration Status
- Emergency Medical Condition
- Emergency Medical Transportation
- Emergency Room Care
- Emergency Services
- Employer Shared Responsibility Payment (ESRP)
- Employer or Union Retiree Plans
- Essential Health Benefits
- Excluded Services
- Exclusive Provider Organization (EPO) Plan
- External Review
- HIPAA Eligible Individual
- Habilitative/Habilitation Services
- Hardship Exemption
- Health Care Workforce Incentive
- Health Coverage
- Health Insurance
- Health Insurance Marketplace
- Health Maintenance Organization (HMO)
- Health Plan Categories
- Health Reimbursement Account (HRA)
- Health Savings Account (HSA)
- Health Status
- High Deductible Health Plan (HDHP)
- High Risk Pool Plan (State)
- High-Cost Excise Tax
- Home Health Care
- Home and Community-Based Services (HCBS)
- Hospice Services
- Hospital Outpatient Care
- Hospital Readmissions
- Medical Loss Ratio (MLR)
- Medical Underwriting
- Medically Necessary
- Medicare Advantage (Medicare Part C)
- Medicare Hospital Insurance Tax
- Medicare Part D
- Medicare Prescription Drug Donut Hole
- Member Survey Results
- Minimum Essential Coverage
- Minimum value
- Modified Adjusted Gross Income (MAGI)
- Multi-Employer Plan
- Patient Protection and Affordable Care Act
- Patient-Centered Outcomes Research
- Payment Bundling
- Pension (Retirement Benefit)
- Physician Services
- Plan Year
- Platinum Health Plan
- Point of Service (POS) Plans
- Policy Year
- Pre-Existing Condition
- Pre-Existing Condition (Job-based Coverage)
- Pre-Existing Condition Exclusion Period (Individual Policy)
- Pre-Existing Condition Exclusion Period (Job-based Coverage)
- Pre-existing Condition Insurance Plan (PCIP)
- Preferred Provider
- Preferred Provider Organization (PPO)
- Premium Tax Credit
- Prescription Drug Coverage
- Prescription Drugs
- Preventive Services
- Primary Care
- Primary Care Physician
- Primary Care Provider
- Prior Authorization
- Public Health
- Self-Employment Income
- Self-Insured Plan
- Service Area
- Silver Health Plan
- Skilled Nursing Care
- Skilled Nursing Facility Care
- Social Security
- Social Security Benefits
- Social Security Survivors Benefits
- Special Enrollment Period
- Special Health Care Need
- State Continuation Coverage
- State Health Insurance Assistance Program (SHIP)
- State Insurance Department
- State Medical Assistance Office
- Subsidized Coverage
- Summary of Benefits and Coverage (SBC)
- Supplemental Security Income (SSI)
Glossary source: HealthCare.gov
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About This Website
We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.
When you choose your state or enter your zip code here, you will quickly learn:
whether or not you're required to get health insurance
what the available plans cover
how much coverage will cost, and
how to sign up in your state.
For those concerned about cost, we show you how to determine whether you qualify for subsidies.
Why We Care
This site was created by Albin Renauer, founder of LegalConsumer.com, and is coauthored by Renauer and legal editor and writer Shae Irving. LegalConsumer, which originally concentrated on consumer bankruptcy, began in 2005, when Congress overhauled federal bankruptcy laws.
“When politicians tried to make it harder to file bankruptcy, I vowed to make it easier. When I read about politicians making it hard to get information about Obamacare, it got my blood boiling -- and I realized I could help folks find that information the same way I do with bankruptcy.”
Some states hide the ball when it comes to options for health care coverage under the Affordable Care Act. We want to guide you to all the official local resources you need to make sure you get the maximum benefits under the law.
Who We Are
LegalConsumer.com has helped more than a million consumers navigate the bankruptcy process by providing a free online “means test calculator,” which shows people whether or not they’re eligible to file for bankruptcy.
Albin Renauer is an independent web and database developer and Webby Award judge. He created LegalConsumer.com as an online companion to his book, How to File for Chapter 7 Bankruptcy, to help people file for bankruptcy.
After receiving his J.D. from the University of Michigan Law School in 1985, Albin Renauer worked for various public-interest law firms in the Bay Area and as a staff attorney for Chief Justice Rose Bird of the California Supreme Court. He spent 17 years as an editor at leading do-it-yourself legal publisher Nolo, where he helped create numerous books and software programs, including the bestselling Quicken WillMaker. He also edited Law on the Net, the first online directory of legal resources, and was the architect of Nolo's Webby Award winning website.
Shae Irving has been a legal editor and writer since 1994, when she joined Nolo, specializing in estate planning, health care, and family law issues. For almost a decade, she was the managing editor of Nolo’s bestselling Quicken WillMaker software. Her books include Living Wills and Powers of Attorney for California and Prenuptial Agreements: How to Write a Fair and Lasting Contract. Shae graduated from Berkeley Law and briefly practiced at a large San Francisco law firm before becoming an editor and author.
For More Information
Contact Albin Renauer.