Who Is Eligible for Obamacare (Affordable Care Act) Coverage?

Health insurance can be costly — especially if you don’t have a job that offers health insurance as a benefit.

The Patient Protection and Affordable Care Act is a 2010 health-reform law better known as the Affordable Care Act, ACA, and, often, Obamacare

The comprehensive ACA law has three main goals:

  1. Make affordable health insurance available to more people.
  2. Expand the Medicaid program.
  3. Support medical care delivery that reduces costs.

Obamacare offers many consumer protections. The law protects you by offering coverage for people who have pre-existing conditions. The law also requires health plans to offer preventive care without out-of-pocket costs and allow adults under the age of 26 to stay on a parent’s health insurance plan. 

Who is Obamacare for?

Obamacare is designed to make healthcare affordable for people regardless of income. Individuals at all income levels can sign up for health insurance under Obamacare. 

Suppose you have a household income between 100% and 400% of the federal poverty level (FPL). You may qualify for a premium tax credit or special subsidies to reduce health insurance costs.   

Who is not eligible for Obamacare?

Most people who live in the U.S. are eligible for healthcare coverage under Obamacare. However, there are exceptions. 

You are not eligible for Obamacare if:

  • You do not live in the U.S.
  • You are incarcerated.
  • You are not a U.S. citizen, U.S. national, or lawfully present in the U.S.
  • Medicare covers you.

If you are not a U.S. citizen or national but lawfully present in the U.S., you also may qualify for Obamacare if your immigration status is one of the following:

  • Lawful permanent resident or green card holder
  • Refugee
  • Asylee
  • Cuban or Haitian entrant
  • Immigrant paroled into the U.S.
  • Immigrants granted conditional entrance before 1980
  • Battered spouse, child, and parent
  • Victim of trafficking, along with a spouse, child, sibling, or parent
  • Those granted withholding of deportation or withholding of removal, under the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment, or Punishment (CAT), or immigration laws
  • Non-immigrant status, including those with worker visas and student visas
  • Temporary protected status (TPS)
  • Deferred enforced departure (DED)
  • Deferred action status, excluding Deferred Action for Childhood Arrivals (DACA)
  • Lawful temporary resident
  • Those with an administrative order issued by the U.S. Department of Homeland Security that stays their removal 
  • Member of a federally recognized Indian tribe or an American Indian born in Canada
  • A resident of American Samoa

What is the income level to qualify for Obamacare?

While anyone can buy health insurance under Obamacare, those with household incomes between 100% and 400% of the federal poverty level (FPL) may qualify for financial assistance that reduces premiums and out-of-pocket costs.   

Using the 2022 federal poverty levels, a family of four would qualify for subsidies with a household income of $27,750 to $111,000. A single person would qualify for subsidies if they made $13,590 to $54,360. (Federal poverty level amounts are higher in Alaska and Hawaii.)

What are the requirements to qualify for Obamacare?

You qualify for Obamacare if you:

  • Live in the U.S.
  • Are you a U.S. citizen, or U.S. national, or are you lawfully present in the U.S?
  • Are not incarcerated
  • Are not covered by Medicare

How do I apply for Obamacare?

There are several ways to sign up for Obamacare on your own, with an ACA navigator and an agent or broker. You can:

  • Enroll online at healthcare.gov.
  • Use the “find local help” tool to locate in-person assistance in your area with a navigator, agent, or broker. All are trained to walk you through the marketplace process, and services are free.
  • Apply through the website of a certified enrollment partner, such as a private health insurance company.
  • Enroll by phone by contacting the marketplace call center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays.
  • Complete and mail an application.  

How much does Obamacare cost monthly?

The Affordable Care Act will reach record affordability during the 2023 coverage year because of the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022. New financial assistance with premiums means that 4 out of 5 people will be able to find a plan for $10 or less per month.

Your premium, or the amount you might pay monthly for Obamacare, will vary depending on where you live, your income, your household size, your plan, and the amount of your premium tax credit.

Generally, ACA plans are organized into “metal tiers,” which determine how you and your plan split the cost of care. The tiers and their characteristics are listed in the chart below.

Bronze Has the lowest monthly premium but also the highest costs when you need care

Silver This is known as the “benchmark” plan, with moderate monthly premiums and moderate costs when you need care. You must choose a silver plan to qualify for cost-sharing reductions. These are also known as extra savings on out-of-pocket expenses such as deductibles, copayments, and coinsurance.

Gold Has high monthly premiums but low costs when you need care

Platinum Has the highest monthly premiums and the lowest costs when you need care

According to a Kaiser Family Foundation analysis of marketplace plans nationwide for a 40-year-old person, the average premium (without subsidies) for a silver plan in 2023 is $456. The price ranges from a low of $323, in New Hampshire, to a high of $841, in Vermont.

What if I cannot afford Obamacare?

If you cannot afford Obamacare, see if you can qualify for the state-based insurance program called Medicaid. Your Obamacare application can help you determine if you qualify for Medicaid.

Every state, the District of Columbia, and all five U.S. territories with permanent populations (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands) have Medicaid programs. You may qualify for Medicaid depending on your household income, family size, and other factors.

Under Obamacare, some states have expanded Medicaid to include a group of people with slightly higher incomes.

If you do not qualify for Medicaid and cannot afford any ACA health plan, you have other free and low-cost options, including free clinics and community health centers.

Can you be denied Obamacare?

As long as you are eligible for Obamacare, you can’t be denied. That means you can enroll in an ACA insurance plan as long as you are living in the U.S. lawfully and are not incarcerated or covered by Medicare. Your plan may not qualify for subsidies depending on your income and other factors.

Your application can only be accepted if you try to sign up within the annual open enrollment period. For 2023 coverage, the open enrollment deadline is January 15, 2023, for most people. In most states, if you want your coverage to begin on January 1, 2023, the deadline to enroll is December 15, 2022.

If you miss the open enrollment deadline, you may qualify for a special enrollment period if you have a qualifying life event such as:

  • Losing health coverage
  • Moving to a new state
  • Getting married
  • Having a baby
  • Adopting a child

What happens if my job circumstance changes while I’m on Obamacare?

If you have an Obamacare plan and get a new job offering health insurance, you will no longer be eligible for ACA subsidies. In that case, you may want to cancel your Obamacare plan and switch to your employer’s plan.

Suppose you have a new job that does not offer health insurance, and your earnings exceed the income estimate on your Obamacare application. You may no longer qualify for the same subsidy amount in that case. In that circumstance, you should update your application by reporting all income and household changes to Healthcare.gov to determine whether your subsidies or other savings will change. If you end up making less than your income estimate, you should also update your application, because you may qualify for more savings under Obamacare.

If you have an employer-based health plan and lose your job, you qualify for a special enrollment period and can apply for Obamacare health insurance outside of open enrollment. You also can sign up to keep your job-based insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA), but you may have to pay the entire premium — including the portion that your employer was paying.

Does Obamacare differ from Medicaid?

Obamacare is the 2010 health-reform law that makes affordable insurance more widely available to everyone, including those who do not qualify for Medicaid. Medicaid is a federal program administered by states that provides health insurance to persons with low incomes.

The Obamacare law also allows states to expand their Medicaid programs to cover people with slightly higher incomes.

However, states have the right to refuse the Medicaid expansion. The Kaiser Family Foundation reported that 12 states had not expanded Medicaid since late September 2022. These states are:

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • North Carolina
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Wisconsin
  • Wyoming

The bottom line

Millions of uninsured people in the U.S. can access health insurance through Obamacare, also known as the Affordable Care Act, or ACA. In fact, the ACA will reach record affordability during the 2023 coverage year because of 2021’s American Rescue Plan Act and the Inflation Reduction Act of 2022. New financial assistance means that 4 out of 5 people will be able to find a plan for $10 or less per month. You are eligible to enroll in an ACA insurance plan as long as you are living in the U.S. lawfully and are not incarcerated or covered by Medicare. You may find out you qualify for Medicaid during the Obamacare application process. If your job does not offer employer-based health insurance, you may be able to afford an Obamacare health plan that meets your needs.

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