Tuesday, October 29, 2019

The Affordable Care Act 2020 - Are You Eligible for the ACA?

Many middle-age adults who are not quite old enough for Medicare are currently being charged outrageous prices for their private medical insurance.  However, in some cases, they may be eligible for subsidies to help pay for their health insurance through the Affordable Care Act.  Yes, the ACA, sometimes called Obamacare, is still around, although it does not get as much of an advertising budget as it did in the past, so people are not as aware of it.  As a result, a large number of people are paying more than they need to for insurance coverage. How can you apply and find out if you are eligible for an Obamacare healthcare subsidy?

Apply During the ACA Open Enrollment Period

The 2020 Open Enrollment Period runs from Friday, November 1, 2019, until Sunday, December 15, 2019.  That window is just slightly over six weeks long, so it is important you act quickly.  If you do not act by December 15, 2019, you cannot get coverage for 2020 unless you qualify for a Special Enrollment Period.  Once you have been approved for medical insurance with subsidies through the Affordable Care Act, your healthcare plan will be effective starting January 1, 2020.

Special Enrollment Periods Provide Some Exceptions

In the event you have had a change in your situation, such as losing your prior medical coverage, getting married, or becoming a new parent, it may be possible for you to get insurance through the ACA after the Open Enrollment Period has ended.  You can also apply at any time of the year if you already qualify for Medicaid or the Children's Health Insurance Program.

Apply Even if You Have Pre-Existing Conditions

Under the current law, health insurers under the Affordable Care Act cannot charge you more or deny you coverage if you have a pre-existing health condition such as asthma, diabetes, heart disease or cancer.  In addition, they cannot limit the benefits you receive for that condition.  Once you have obtained health insurance, they cannot refuse to cover the treatment of your pre-existing condition. (However, this may not be true if you continue to have an older, private insurance policy which you purchased prior to March 23, 2010.  Those old policies are still allowed to put limits on your care.)

How Do You Apply for Insurance through the Affordable Care Act?

In some communities, you may see special pop-up stores in malls where agents will be available to walk you through the process of completing an application.  If you do not have one of these businesses near you, and you have access to a computer, you can go to the government website to apply.  The website is:


On the site, you will be asked to give your zip code, so they can help you sign up for a plan which will work in your state.   You will be able to apply right on the website.  Your premiums will be based on your income, as well as other factors, such as the size of your family and whether or not you are disabled.  In order to make it quicker and easier for you to apply, be sure to have proof of your household income and other financial information on hand while you are completing the application.

You can also get help from health insurance agents and brokers on the website by clicking on the button which says "Get Contacted."  Fill-in your contact information, and they will contact you to help you personally with the application process.  In some areas, a local agent may even be able to meet with you in person. 

Which ACA Plan is Best for You?

The plans which you can purchase through HealthCare.gov are available at three levels:  Bronze, Silver and Gold.  The Bronze plans are the least comprehensive and least expensive.  Silver is the moderate choice and Gold is the top-of-the-line plan.  The figures used below are for the typical Silver plan.  However, when you apply, you may want to check out the pros and cons of all three plans.

In addition to the option to choose plans which offer different levels of care, beginning this year you can also find out how the plans are rated.  The Star rating system which has been available for years for Medicare and Medicaid plans has now been extended to policies sold through the Affordable Care Act.  The health care plans which are listed on the healthcare exchanges will have a rating of 1 to 5 stars, with 5 representing plans of the highest quality. 

How Much Does the ACA or Obamacare Cost?

The amount you will pay depends on the size of the subsidy you are eligible to receive.  Currently, your portion of the cost of health insurance premiums through the ACA is capped at 9.5% of your income.

In addition, your maximum out-of-pocket expenses, excluding your premium, can range from $6,350 a year for a single person, up to $12,700 for a family of four.   While these out-of-pocket expenses may seem high, at least there is a cap and you cannot be hit with a huge, unexpected medical bill should someone in your family develop a major illness or require surgery.  The good news is that you may never come close to actually hitting the limits for your out-of-pocket costs.  Those fortunate families which remain healthy will rarely spend much more than their basic premiums and a few co-pays.

The actual amount you will be expected to pay in premiums will vary depending on the number of people in your family and your total household income. 

For example, assume you are a married couple with no children, which is common for many of my readers who have retired, but are still too young for Medicare. If you opt for the popular Silver insurance plan, you will receive a health insurance subsidy to reduce the cost of your premiums, as long as your household income in 2019 is under $65,840 for a married couple

If you are single, you can receive a subsidy if your income in 2019 is under $48,560

If you are a couple with a child you are supporting, you will receive a subsidy if your income is as much as $83,120.  If you have more than one child you are still supporting, your income limit can be even higher.

The exact amount of the subsidy you will receive will vary, and depends on your income and the size of your family.  If you think you are close to the income levels, it is still worth it to apply and see if you qualify for a reduction in your health insurance premiums.

Take Advantage of the Affordable Care Act if You are Eligible

Many people retire earlier than they planned, which means they often retire before they are eligible for Medicare.  In fact, the average American retires at age 63, and they cannot apply for Medicare until they are 65. In other cases, people become disabled and need to stop working at a much younger age.  Sometimes people are unemployed for an extended period of time, and COBRA coverage can be very expensive.  Purchasing health insurance through the ACA healthcare exchanges is a good alternative until you are working again.  One of our daughters obtained insurance through the ACA for herself and her two children when she obtained her teaching credential and it was several months before she found her first teaching job.  It was a relief to her to know that she and her children had health insurance until she was employed again and covered by her school district's group plan.

Regardless of your personal situation, you may be able to save a substantial amount of money if you apply for a health insurance subsidy through the Affordable Care Act.  It certainly will not hurt to apply and see if it can save you money.  After all, you have paid for these benefits through your taxes, so you should certainly feel comfortable using them when you are eligible.

If you want to learn more about Medicare, Social Security, financial planning, common health problems as you age, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

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  1. Thanks for posting this. One of the things I don't understand is why I have to put ALL of my personal information into the website before I can get a quote. That seems like a huge violation of my privacy, especially since there are agents who seem ready to call me even if I haven't decided yet.
    It seems like they should let me get a quote based on my income, age, and zipcode without having to enter everything else.

    Thanks for posting this article, it has given me a starting place.

    I can't wait until I'm eligible for Medicare!

    1. Thank you very much for your comments. I agree with your complaint. I also think you should be able to get a quote without giving them so much information. I hope that is something which changes in the future. If you are given the opportunity to leave comments on the site about your experience with it, I hope you will mention this to them. By the way, you will love Medicare, I'm sure!


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