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:
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 Pennsylvania, to help you get the coverage you need.
Here are some topics that answer frequently asked questions about Obamacare.
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.
All health plans purchased through Pennie, the health insurance marketplace for Pennsylvania, 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”:
Companies that offer plans through Pennie will compete on price and quality of service in delivering these benefits.
Prior to 2019, if you didn't have health insurance and didn't qualify for an exemption, you would owe a penalty when you filed your federal tax return. For now, at least, that penalty has gone away. You must still report your coverage status on your federal tax return, but you won't have to pay a penalty if you aren't covered.
For more health insurance basics, see What Pennsylvania Residents Need to Know About Obamacare.
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:
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 Pennsylvania’s coverage requirements, you can keep it. Or, you may use Pennie 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 Pennie.
Keep in mind that if you buy a plan through the exchange:
In Pennsylvania, if you need help understanding your options for coverage under the Affordable Care Act (Obamacare) or signing up for a plan, you can get assistance from a trained enrollment assistant or from a health insurance broker or agent.
An enrollment assistant (sometimes called a navigator, enrollment counselor, or something similar) 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.
To find an enrollment assistant in Pennsylvania, visit the Connect page at Pennie. Scroll down to search for a certified helper in your area.
Talk to a licensed broker. To directly connect with a Pennsylvania insurance broker who can help you evaluate Affordable Care Act 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 in Pennsylvania.
"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 Pennsylvania.
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:
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.
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 Pennsylvania Residents Need to Know About Obamacare.
Here's the information to gather before you visit Pennie to apply for health insurance:
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 Pennsylvania?
Glossary source: HealthCare.gov
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.
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.
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.
Contact Albin Renauer.