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Affordable Care Act for Individuals

Health Insurance Medicaid & Medicare

This article tells you about the Affordable Care Act, also known as "Obamacare". It tells you how to enroll, when, and the costs of enrolling. This article was written by Texas RioGrande Legal Aid. 

The Affordable Care Act

The Affordable Care Act (ACA) is a federal law that helps uninsured people get affordable health insurance. It affects how much you’ll pay for insurance and the quality of health insurance that is offered by private insurance companies in the health insurance marketplace.

Higher Standards for Insurance Companies

Health insurance companies must:

  • insure people with pre-existing health conditions,

  • Cover essential health benefits,

  • Offer free preventive health care, and

  • Allow children under age 26 to stay on their parents’ health insurance plan.

Cost of Insurance

Under the ACA, the cost of your health insurance premium is based on your income, not on what the insurance company wants to charge. Most people who enroll under the ACA qualify for tax credits that reduce the cost of their insurance premiums. Cost sharing subsidies lower out-of- pocket costs for Silver plans bought through the Health Insurance Marketplace. If you don’t qualify for these, you may qualify for Medicaid.

Type of Plans

  • Bronze - The lowest cost plan. 60% of medical costs paid by the insurance company; you pay the remaining 40%.

  • Silver - 70% of medical costs paid by the insurance company; you pay the remaining 30%

  • Gold - 80% of medical costs paid by the insurance company; you pay the remaining 20%.

  • Platinum -The most expensive plan. 90% of medical costs are paid by the insurance company, 10% paid by you.

What happens if I don’t enroll?

As of 2019, there is no longer a fine or tax penalty for violating the "individual mandate" or not having insurance.

How do I enroll?

Enrollment is through the Health Insurance Marketplace during the open enrollment period. You can enroll online or with a paper application by going to www.healthcare.gov or calling 800-318-2596. In central Texas, Insure Central Texas provides one-on- one help with enrollment at several drop-in sites. For locations, dates and hours, call 2-1-1.

When can I enroll?

“Open enrollment” is for a specific period of time that varies from year to year. It usually begins in the fall and closes early the in the following year. If you don’t enroll during the open enrollment, period, you’ll have to wait until the next enrollment period. You can qualify for Special Enrollment (outside the enrollment period) if you have experienced a “significant life event” such as marriage, birth of a child, or loss of your current insurance.

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