Not having health insurance comes with several risks, including high out-of-pocket medical bills and limited access to care. Despite these risks, cost is the number one cited barrier to health insurance coverage for uninsured people. Thankfully, the Affordable Care Act (ACA) offers financial assistance to individuals and families.
What is the Affordable Care Act?
President Obama signed the ACA, also known as Obamacare, into law in 2010. The ACA has three primary goals:
- increase health insurance coverage to uninsured people by making it more affordable
- protect consumers from exploitive insurance company practices
- reform the health insurance market
The ACA created new health insurance exchange markets through which individuals can purchase coverage and receive financial help through Advanced Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSR). The ACA also permitted states to expand Medicaid to adults with household incomes up to 138% of the federal poverty level.
According to a 2024 report from the Center on Budget and Policy Priorities, the ACA’s coverage expansions, which took effect in 2014, have resulted in a historic decline in the number of uninsured people, dropping from 45.2 million in 2013 to 26.4 million in 2022.
How Does the Affordable Care Act Help the Uninsured?
Lower-income individuals and families without access to employer-sponsored health insurance should check the ACA Health Insurance Marketplace. The ACA authorizes the creation of Health Insurance Exchanges, or Health Insurance Marketplaces, for individuals and small employers, allowing them to shop for affordable yet high-quality private health plans. The ACA Health Insurance Marketplace includes a tool for families to search for plans and see reduced premiums based on their income.
Families previously unable to afford health insurance coverage now have options. Factors like state, age, income level, and family size dictate eligibility for financial ACA financial assistance, Medicaid and the Children’s Health Insurance Program (CHIP). Also, note that there are rules and guidelines for when individuals and families can enroll in plans.
Advance Premium Tax Credits and Cost-Sharing Reductions
An Advance Premium Tax Credit acts as a tax credit that an individual can use in advance to decrease monthly premiums for marketplace health insurance plans. These tax credits can cover part or the entire premium for lower-cost plans, e.g., bronze or silver. To qualify, the individual must demonstrate a modified adjusted gross income between 100% and 400% of the federal poverty level. When applying for coverage through the Marketplace, it has tools that can estimate their tax credit.
A cost-sharing reduction is a type of financial assistance that helps reduce out-of-pocket costs, such as deductibles and co-pays, for individuals and families earning between 100% and 250% of the federal poverty level. These cost-shares are only available to those enrolled in silver-tier plans. For individuals and families that meet federal poverty level requirements, these can make a sliver plan’s cost-sharing more akin to gold or platinum plans, reducing deductibles significantly.
Find Out if You are Eligible Today
Besides cost, another common reason people are uninsured is that signing up is too difficult. America’s health insurance system is complicated and confusing. Navigating the terms and stipulations can be daunting. Contact Antidote Health today, and we can help answer your questions about qualifying for the ACA.
