Introduction

The Affordable Care Act (ACA), also known as Obamacare, reshaped the U.S. healthcare system by making health insurance more accessible and affordable for millions of Americans. Since its introduction in 2010, the ACA has provided essential protections, expanded Medicaid, and introduced the Health Insurance Marketplace. In this guide, you’ll learn everything you need to know about the ACA—how it works, who qualifies, what’s covered, and how to enroll.

What is the Affordable Care Act (ACA)?

The Affordable Care Act was signed into law by President Barack Obama in March 2010. Its main goals are to:

• Make health insurance more affordable.
• Expand Medicaid coverage to more low-income adults.
• Support innovative medical care to reduce overall healthcare costs.

The ACA remains one of the most significant reforms in U.S. healthcare history, ensuring that millions of uninsured Americans gained access to health coverage.

Key Features of the ACA

The ACA introduced several landmark changes to how health insurance works in the United States. Here are its most important provisions:

1. Health Insurance Marketplace

   The ACA established the Health Insurance Marketplace (HealthCare.gov) where individuals and families can compare and purchase insurance plans. Many states also operate their own exchanges, like Covered California or New York State of Health. Plans are categorized into four “metal” tiers: Bronze, Silver, Gold, and Platinum, which reflect how costs are shared between you and your insurer.

2. Subsidies and Tax Credits

   To make coverage affordable, the ACA provides two types of financial assistance:
   • Premium Tax Credits – Reduce your monthly insurance cost based on your income.
   • Cost-Sharing Reductions (CSR) – Lower your deductibles, copays, and coinsurance if you qualify.
   These subsidies apply to people earning between 100% and 400% of the Federal Poverty Level (FPL), though temporary expansions have allowed even higher-income households to qualify in some cases.

3. Medicaid Expansion

   One of the ACA’s major achievements was expanding Medicaid eligibility. States that opted into expansion now cover individuals earning up to 138% of the FPL. This has provided insurance to millions of low-income adults who previously did not qualify.

4. Preexisting Condition Protection

   Before the ACA, insurance companies could deny coverage or charge higher premiums for people with preexisting medical conditions. The ACA banned this practice, ensuring everyone has access to coverage regardless of health status.

5. Essential Health Benefits

   All ACA-compliant plans must cover 10 essential health benefits, including:
   • Ambulatory (outpatient) services
   • Emergency care
   • Hospitalization
   • Maternity and newborn care
   • Mental health and substance use services
   • Prescription drugs
   • Rehabilitative and habilitative services
   • Laboratory services
   • Preventive and wellness services
   • Pediatric services (including dental and vision for children)

6. Individual Mandate (Now Repealed)

   Initially, the ACA required everyone to have health insurance or pay a tax penalty. However, this individual mandate was repealed at the federal level in 2019. Some states, like California, Massachusetts, and New Jersey, still have their own mandates.

7. Young Adult Coverage

   The ACA allows children to stay on their parents’ health insurance plan until age 26, even if they’re married or financially independent.

8. Preventive Care Without Extra Cost

   
All ACA plans must include preventive services (like annual checkups, vaccines, and screenings) at no additional cost to the insured.