The Affordable Care Act (ACA), which is most often referred to as Obamacare, is now the law of the land in the United States. This law allows eligible individuals and families to have access to affordable health insurance.  One of the key components is eligibility for the health insurance is mainly based on income amongst other determining factors.  In this blog, we will talk specifically about what does it mean to be ACA eligible.

To start, the ACA is a law that was enacted in 2010 by the federal government that requires all Americans to have a health insurance plan or else they will be subject to pay a penalty.  The ACA formed a health insurance marketplace online where individuals and families can qualify and enroll in health insurance plans.  The marketplace has a variety of health insurance plan options for each person to choose from.  The ACA has a built in subsidy provision where individuals and families could qualify for a subsidy paid by the government to reduce their health insurance cost.  This is mainly based on the household income.  For those whose income is considered to low the ACA also expanded Medicaid to help cover this group of people.  

The question is what does it mean to be ACA eligible?  ACA eligibility is based mainly on income but also other criteria that includes age and citizenship status. If a households income falls between 100% and 400% of the federal poverty level (FPL), then they would be eligible for a subsidy to reduce their health insurance cost.  The FPL is set each year and can vary from year to year based on family member size and geographic location. For example in 2022, the FPL for a household size of four people would be $30,000.

Besides subsidies, individuals and families that become ACA eligible may also qualify for cost sharing reductions (CSR).  With a CSR you not only get your premium paid for fully or partially but you also get your out of pockets expenses reduced such as deductible and copays.  To qualify for a CSR your income needs to fall between 100% and 250% of the FPL.  It is important to mention that in order to take advantage of a CSR you qualify for you must enroll in a plan through the health insurance marketplace.  Licensed and certified health insurance agents can assist you with this process. 

To qualify for ACA coverage, you must be a US. citizen or a legal resident.  You also must not be incarnated.  If you have access to an affordable health insurance plan through you or your spouses employer then you may not qualify either.  You do not have the option to enroll in a subsidized plan even if you decline the employer sponsored health insurance plan.

ACA eligible also comes with many attractive benefits.  Clearly the most attractive benefit is that individuals and families will be able to enroll in an affordable health insurance plan with a private health insurer of your choice.  The subsidies you qualify for can greatly reduce your health insurance premium cost.  This helps the lower income households to be able to afford a quality health plan.  If you also qualify for a CSR you will have the advantage of lower out of pocket expenses.

ACA eligibility also allows individuals and families to no longer get denied coverage based on pre-existing conditions.  Before the ACA law was enacted health insurance companies could deny covering your pre-existing conditions.  However, with the new ACA law this is no longer allowed.  The ACA is the law of the land in the United States which ensures all Americans have the right to affordable healthcare.

Lastly, if you are ACA eligible you have protection from being financially ruined from high medical costs.  Medical bills are the number one cause of bankruptcy in the United States.  Having a health insurance plan with out of pockets maximum limits through the ACA marketplace protects all who enroll from financial ruin. If you should have any questions contact us at