The Affordable Care Act (ACA)—also known as Obamacare—is a comprehensive health care reform law that was enacted in March 2010. Its full name is the Patient Protection and Affordable Care Act. The ACA was designed to expand access to health insurance, reduce health care costs, and improve the quality of care in the United States.

Key Goals of the ACA:

1. Increase access to affordable health coverage
2. Protect consumers from insurance company abuses
3. Improve quality and lower health care costs

Major Provisions of the ACA:

1. Health Insurance Marketplaces

• Online platforms where individuals and families can shop for and enroll in health insurance plans.
• Plans are categorized by metal levels: Bronze, Silver, Gold, and Platinum.
• Consumers can compare coverage options and prices.

2. Premium Subsidies

• Many people qualify for financial help (premium tax credits and cost-sharing reductions) to make coverage more affordable, based on household income and size.

3. Medicaid Expansion

• Allowed states to expand Medicaid to cover more low-income adults (up to 138% of the federal poverty level).
• As of 2025, not all states have adopted this expansion.

4. Protections for People with Preexisting Conditions

• Insurers cannot deny coverage or charge more based on health history.

5. Essential Health Benefits

All ACA-compliant plans must cover a standard set of benefits, including:

• Doctor visits
• Hospitalization
• Prescription drugs
• Maternity and newborn care
• Mental health services
• Preventive services (like vaccines and screenings)

6. Individual Mandate (Repealed Penalty)

• Originally required most people to have health insurance or pay a penalty.
• The federal penalty was reduced to $0 starting in 2019, though some states (like California and New Jersey) have their own mandates.

Who Can Use the ACA Marketplace?

• U.S. citizens and lawfully present immigrants
• People who don’t have affordable employer-based coverage or qualify for Medicaid/Medicare

Open Enrollment is the annual period when individuals can sign up for a health insurance plan through the federally mandated Health Insurance Marketplace.
It runs from November 1 to December 15, and any plan selected during this time will take effect on January 1 of the following year.

To enroll in an Affordable Care Act (ACA) health insurance plan outside of the Open Enrollment Period in 2025, you must qualify for a Special Enrollment Period (SEP). SEPs allow you to sign up for coverage due to specific life changes or special circumstances. These include:

 

Common Life Events That Trigger a SEP:

• • Losing health coverage, including job-based, individual, Medicaid, or COBRA coverage
  • Getting married or divorced
  • Having a baby, adopting a child, or placing a child for adoption or foster care
  • Moving to a new ZIP code or county (if you had prior qualifying coverage)
  • Aging off a parent’s plan at age 26
  • Gaining U.S. citizenship or lawful presence
  • Leaving incarceration
  • Change in immigration status
  • Change in income or household size
  • Domestic abuse or spousal abandonment
  • Enrollment errors made by the Marketplace or assister
  • Exceptional circumstances, such as natural disasters or public health emergencies

• Starting or ending AmeriCorps, VISTA, or NCCC service

Ongoing SEP for Low-Income Individuals (150% FPL SEP):

If your estimated annual income is at or below 150% of the Federal Poverty Level, you may qualify for a continuous SEP throughout the year. This means you can apply for coverage any time in 2025 if you:

• Are not eligible for Medicaid or other minimum essential coverage
• Are eligible for premium tax credits

This SEP is designed to increase access to $0-premium plans for low-income individuals through enhanced subsidies under the American Rescue Plan and extended by the Inflation Reduction Act.

When to Act:

• Most SEPs give you 60 days before or after the qualifying event to enroll.
• Documentation may be required to confirm eligibility.