Everything You Need to Know About ObamaCare for 2019: Information on Subsidies, Rates, Dates, Enrollment, and More

We cover everything you need to know about ObamaCare in 2019 including information on enrollmentassistancebenefitsplan types, and more.

ObamaCare in 2019

ObamaCare still offers the same benefits, rights, and protections here in 2019. For example it offers protections for pre-existing conditions and benefits like cost assistance. However, there are some changes for 2019. For example, for 2019 forward the fee for not having health coverage has been reduced to $0 in most states.[/cite][1][2] Here are some key facts for Obamacare in 2019:

  1. There is no fee for not having coverage in 2019 in most states, but some states have their own state based mandate and fee for 2019 forward. See a list of states with their own mandate for 2019.
  2. Obamacare alternatives are expanded this year, so individuals and families who want limited benefit coverage have more options (like short term coverage).
  3. For those who want it, the ACA’s benefits and protections apply to major medical plans (they don’t apply to short term coverage). So if you have a marketplace plan, you still can get assistance, and are still protected.
  4. Medicaid and CHIP are still expanded in many states, and more states continue to expand.
  5. Open enrollment is still in place, so you’ll have to enroll in a plan Nov 1 2019 – Dec 15 2019 for 2020 coverage. For 2019 coverage you already need to have it in place or you have to qualify via special enrollment unless you qualify for another insurance type like employer coverage, Medicare, or Medicaid/CHIP.
  6. There are some healthcare tax requirements to deal with each year, if you get assistance for example you’ll need to file form 8962.
  7. Unfortunately for those who rely on the ACA’s protections and assistance, there is a court case in the works that declared the ACA illegal. For now the judge issued a stay, but this one is still unresolved. See details below

STATE BASED MANDATES FOR 2019: States that have their own mandate for 2019 include: the District of Columbia, Massachusetts, and New Jersey. States considering a mandate for the future: California, Connecticut, Hawaii, Maryland, Minnesota Rhode Island, Washington, and Vermont (starting 2020).

IMPORTANT DETAILS ON THE COURT CASE: Currently the fate of the ACA is somewhat uncertain as a Texas federal judge ruled the Affordable Care Act (Obamacare) unconstitutional on Dec 14 2018. In late March the DOJ then affirmed their support for the ruling. For now nothing changes as the appeals process plays out. However, there could be real consequences down the road if the ACA is struck down in courts. We will let you know if anything changes. For now, despite the changes, ObamaCare is still “the law of the land.” Learn more about the 2018 ObamaCare ruling.

Open Enrollment 2019 – 2020

Open enrollment is still in place for 2020 plans. To get covered for 2020, enroll in coverage offered on the marketplace between November 1st and December 15th. The only other way to get covered is to qualify for another coverage type like employer-based coverage, Medicare, or Medicaid/CHIP. Outside of open enrollment options are limited to short term plans and special enrollment. Remember, there is no penalty for not signing up in most states this year. However, unless you have access to another coverage type like employer coverage, only plans sold on the health insurance marketplace comply with the ACA’s benefits, rights, and protections. Meaning, unless you qualify for another coverage type you have to sign up during open enrollment to get the protections and cost assistance. Short term plans sold year round don’t have to offer the same benefits, rights, and protections. TIP: Got to HealthCare.Gov during open enrollment or find a qualifying broker who can help you sign up for a marketplace plan and show you your other options.

Getting Cost Assistance in 2019

There are three types of cost assistance based on income, family size, and access to other coverage:

  1. Medicaid/CHIP: Offers free or low cost coverage to single adults in many states and families in all states; Offered 365 days a year.
  2. Premium Tax Credits: Lowers premiums; only offered during open enrollment / special enrollment on marketplace plans.
  3. Cost Sharing Reduction Subsidies: Lowers out-of-pocket assistance; only offered during open enrollment / special enrollment on marketplace silver plans.

Aside from these you can lower costs using an HSA. NOTE: Employer’s subsidize a portion of coverage and Medicare has assistance options for low income seniors. Also, some charities provide assistance.

Penalty For Not Getting Covered in 2019 (the Individual Mandate For 2019 Forward)

The fee for not having coverage was reduced to $0 for 2019 and beyond. States that have their own mandate for 2019 include: the District of Columbia, Massachusetts, New Jersey, and Vermont (starting 2020). States considering a mandate for the future: California, Connecticut, Hawaii, Maryland, Minnesota Rhode Island, and Washington. In a state with a mandate there is also a fee for not having coverage. This fee is paid to the state, not the federal government.

What is ObamaCare?

ObamaCare is a nickname for The Patient Protection and Affordable Care Act (sometimes called the Affordable Care Act, ACA, or PPACA for short), a health reform law signed on March 23, 2010, by President Barack Obama.

What is TrumpCare?

TrumpCare is just a nickname for changes to healthcare under Trump, especially changes to the Affordable Care Act (ObamaCare).

What Does ObamaCare Do?

The ACA was signed into law to reform the healthcare industry by President Barack Obama on March 23, 2010, the and upheld by the Supreme Court on June 28, 2012. The aim of the ACA was to address the “healthcare crisis” the nation was experiencing before the law was enacted. In other words, the ACA was meant to address the fact that premiums were rising faster than inflation, that healthcare spending was raising as a percentage of GDP, and that the uninsured rate was increasing because of this.[3][4][5][6] An overview of the Affordable Care Act’s purpose can be stated as:

More specifically, the Affordable Care Act aims to accomplish the above goals by:

Meanwhile, key benefits, rights, and protections under the Affordable Care Act include:

OBAMACARE FACT: Roughly 1 in 2 Americans technically have a “preexisting” condition according to a a 2011 estimate done by HHS. That means half of us have a condition that we technically could have been charged more for or even denied coverage for in some states before the Affordable Care Act. The ACA chipped away at preexisting conditions until 2014 when discrimination against them by insurers was banned. Today preexisting conditions are no longer a barrier to insurance coverage for anyone, including high-risk customers. This means you can no longer be denied coverage or treatment or be charged more due to your health status. This is just one of many things the Affordable Care Act did and still doing today.

Essential ObamaCare Facts for 2019 – 2020

For 2019 – 2020 there are three main things to consider. 1. Getting covered during open enrollment (as covered above), 2. making sure you are ready to file your taxes as they relate to healthcare at tax time, and 3. keeping an eye on the latest healthcare reform news (such as repeal and replace efforts). With that in mind, here are some essential facts related to the above points for 2018 – 2019 (some of these points were already noted above, but they are reinforced here with some extra helpful links).

What Has Changed For 2019 – 2020?

A lot has changed with ObamaCare for 2019 – 2020. Changes include the mandate being repealed, short term coverage being expanded, budget cuts, and premium rate drops. Please note that most changes that impacted 2019 – 2020 also impacted 2018 – 2019. Here is that information in more detail:

  • Starting January 1st, 2019, the federal ACA tax penalty for not having health insurance coverage officially goes away. Consumer warning, some states may take measures on a state level to reverse this. Make sure to check if your state will have a mandate in 2019 or beyond.
  • Operational budget cuts, as well as funding for marketing and outreach, along with some HC.gov contractors not having their contracts renewed for call center service support, means it could be more difficult to enroll through the HC.gov over the phone.
  • There is however now going to be seamless support for WBE (web based brokers) to directly enroll consumers into Obamacare compliant on-exchange plans in a very seamless manner. This is one positive that will help ensure that an extension for open-enrollment will not be required.
  • Short-term health insurance regulations have been stripped back. Depending on where you get your news from, this could be perceived as both good and bad for consumers long term.
  • One bit of good news however, is that rates are actually expected to decline in some states for the first time in years. Below, we detail how much rates are expected to change on a state by state basis.

Everything You Need to Know about Obamacare Cost Assistance 2019 – 2020

Below is a break down of everything you need to know about cost assistance for health plans under the Affordable Care Act (ObamaCare) in 2019 and 2020. In other words, here is everything you need to know about Premium Tax Credits, Cost Sharing Reduction Subsidies, Medicaid and CHIP, HSAs, and Medical Deductions for 2019 and 2020 all in one place.

Types of Assistance

First off, the types of assistance offered under the Affordable Care Act are:

TIP: Want to find out what you can save quickly, check out our Subsidy Calculator.

Understanding Which Guidelines to Use

Below we have provided two sets of guidelines, which one you’ll use depends on specifically what you are looking for. If you are looking at Medicaid eligibility, use the 2019 guidelines. If you are looking for cost assistance for 2020, use the 2019 guidelines. If you are looking for cost assistance for 2019 (for special enrollment for example, then use the 2018 guidelines).

The 2019 Federal Poverty Guidelines (for 2020 Cost assistance and 2019 Medicaid/CHIP)

Below are the 2019 Federal Poverty Guidelines that went into effect in early 2019 (the ones you use for Medicaid/CHIP in 2019 and for 2020 marketplace cost assistance).

2018 Poverty Guidelines for the 48 contiguous states and the District of Columbia
Persons in Family/Household 100% Poverty Guideline
For families/households with more than 8 persons, add $4,420 for each additional person.
1 $12,490
2 $16,910
3 $21,330
4 $25,750
5 $30,170
6 $34,590
7 $39,010
8 $43,430

NOTE: Alaska and Hawaii use different guidelines (see this link to guidelines as published on HHS.Gov). How to calculate a percentage of the Federal Poverty Level: Medicaid uses the 138% of the Federal Poverty level to determine assistance. Until we update this, take the guideline dollar amount below, multiply by 1.38, and then round up. So $12,490 x 1.38 = $17,236.20. Thus, $17,237 is 138% of the Federal Poverty Level threshold for 2019 Medicaid and CHIP. The methodology is the same for all FPL percentages.

The 2018 Federal Poverty Guidelines (For 2019 Cost Assistance and 2018 Medicaid/CHIP)

Below are the 2018 Federal Poverty Guidelines that went into effect in early 2018 (the ones you use for Medicaid/CHIP in 2018 and for 2019 marketplace cost assistance).

2018 Poverty Guidelines for the 48 contiguous states and the District of Columbia
Persons in Family/Household 100% Poverty Guideline
For families/households with more than 8 persons, add $4,320 for each additional person.
1 $12,140
2 $16,460
3 $20,780
4 $25,100
5 $29,420
6 $33,740
7 $38,060
8 $42,380

NOTE: Alaska and Hawaii use different guidelines (see this link to guidelines as published on HHS.Gov).

Details on Each Assistance Type

Below are details on each type of cost assistance for 2019 (this data is subject to change for 2020 plans bought during open enrollment 2020 in late 2019).

Medicaid and CHIP for 2019

In all states that expanded Medicaid adults making below 138% of the poverty level qualify for Medicaid ($16,754 for an individual and $34,638 for a family four). Other states have unique eligibility. CHIP eligibility tends to be higher but differs by state. Contact your state Medicaid office or use the marketplace for details.

The Premium Tax Credit Subsidy Caps By Percentage of Household Income for SLCSP 2019

Premium tax credits are tax credits that can be taken in advance as Advanced Premium Tax Credits or at tax time as Premium Tax credits (or you can do a mix). Premium tax credits cap premium spending for a family based on MAGI income compared to the federal poverty level and are based on the cost of the second lowest silver plan (SLCSP) in a state’s Marketplace. To qualify you must purchase a marketplace plan.

The chart below shows the minimum and maximum percentage of the household income that a person will pay for that plan. The amount you’ll pay is based on your household income (compared to the federal poverty level) and is adjusted based on the price of the plan chosen.

The premium tax credit caps for 2019 work this:

  • Less than 133%, then the initial percentage is 2.08% and the final percentage is 2.08%;
  • At least 133% but less than 150%, 3.11% and 4.15%;
  • At least 150% but less than 200%, 4.15% and 6.54%;
  • At least 200% but less than 250%, 6.54% and 8.36%;
  • At least 250% but less than 300%, 8.36% and 9.86%; and
  • At least 300% but not more than 400%, 9.86% and 9.86%.

NOTE: To qualify for tax credits you must make between 100% – 400% of the poverty level (FPL). If your state expanded Medicaid you will be eligible for Medicaid instead of tax credits below 133% (or 138% adjusted) FPL.

Cost Sharing Reduction Subsidies 2019

CSR subsidies reduce your out-of-pocket expenses on silver plans purchased through the health insurance marketplace for those with incomes between 100% – 250% of the poverty level. CSR subsidies lower your coinsurance, and lower copays, deductibles, and maximum out-of-pocket costs you will pay in a policy period. There are three levels of CSR subsidies: CSR 73, CSR 87, and CSR 94. The numbers refer to the actuarial value (AV). Benefits sheets will include different summaries for different CSR levels. Please note values may adjust each year. Income Level Actuarial Value (the costs a Silver plan will cover due to cost-sharing reduction subsidies for % of the Poverty Level). 100-150% FPL = 94% Actuarial Value (CSR 94) 150-200% FPL = 87% Actuarial Value (CSR 87) 200-250% FPL = 73% Actuarial Value (CSR 73) More than 250% FPL = 70% Actuarial Value

Out-of-Pocket Maximums and Deductible Limits For 2019

Each year the ACA sets new limits for out-of-pocket maximums and deductibles. Here are the limits for 2018 plans for individuals and families.[1]

  • For 2019, your out-of-pocket maximum can be no more than $7,900 for an individual plan and $15,800 for a family plan before marketplace subsidies.[2]
  • For 2019, your maximum deductible is the same as the out-of-pocket maximum.

Minimum Deductible for HSA Eligibility

  • Self-only: $1,350
  • Family: $2,700

Maximum Out-of-Pocket Limit for HSA Eligibility

  • Self-only: $6,750
  • Family: $13,500

TIP: The maximums are slightly lower on HSA compatible plans then they are in general on health plans. This has to do with the fact that the rates are raised by different mechanisms. The difference allows for non-HSA compatible high deductible plans. Thus, if you want an HSA, make sure your plan is “HSA Eligible.” Learn more about pairing HSAs with High Deductible Health Plans in 2018.

HSA Contribution Limit for 2019

  • Self-only: $3,500
  • Family: $7,000

NOTE: 55 plus can contribute an extra $1,000.

Medical Deductions

For 2017 and 2018, medical expenses were deductible if they exceed 7.5 percent of your AGI (adjusted gross income). In 2019, this threshold will increase to 10 percent of your AGI. TIP: Remember to start your journey at HealthCare.Gov.

ObamaCare Pros and Cons List

The ACA, ObamaCare, doesn’t create insurance; it regulates private insurance to ensure you get more rights and protections. In doing this, it helps tens of millions get access to high-quality affordable health insurance. Of course, health care reform has both financial and private costs. Below are just a few of ObamaCare’s pros and cons: Pros: ObamaCare (the Affordable Care Act or ACA) contains many benefits, especially for low and middle-income families and small businesses. This includes tax credits for health insurance premiums and out-of-pocket cost assistance based on income, the expansion of Medicaid to low-income adults, letting children stay on their parents plan until 26, the mandate for large employers to cover employees, the expansion of consumer protections like guaranteed coverage for pre-existing conditions and the elimination of gender discrimination, and more. Cons: ObamaCare contains some obstacles for high earners, those who had been healthy and paid low rates in the past, larger firms that didn’t insure their employees before the law, and certain sectors of the healthcare industry. After-all, ObamaCare contains some new taxes and regulations, and this means more costs for some demographics (especially for those who don’t directly benefit from assistance). Here is a more complete list of ObamaCare pros and cons:

ObamaCare Pros

ObamaCare Cons

   
Tens of millions of uninsured people have access to affordable, high-quality health insurance through Medicaid expansion, their employers, and the Health Insurance Marketplace. To get the money to help insure all these people, there are new taxes (mostly on high-earners and the healthcare industry). The taxes that may affect you directly are the individual mandate and the employer mandate.
Over half of uninsured Americans can get free or low-cost health insurance, and some can get help on out-of-pocket costs using their state’s Health Insurance Marketplace. The individual mandate says all Americans who can afford health insurance have to obtain health coverage, get an exemption, or pay a fee. That creates an extra complication with regards to filing taxes. Some folks who just barely miss the Federal Poverty Level limit of 400% are hit the hardest as they don’t qualify for assistance. Those who do get cost assistance will need to adjust tax credits on the 8962 – Premium Tax Credit form. NOTE: The fee for not having coverage is reduced to $0 2019 forward, although some states have their own mandate/fee.
Over 20 million people were exempt from the fee in 2016. Those with exemptions may still get cost assistance. Exemptions also qualify you for special enrollment. To get many of the exemptions, you’ll need to submit a form to HealthCare.Gov or file the 8965 – Exemptions form.
There are now more private coverage options, and all major medical coverage options must provide minimum essential coverage. More options mean more complicated shopping for coverage. Keeping a private health insurance system means that shopping for health insurance can be confusing, and consumers risk over-buying or under-buying. Coverage options also, by nature, create a tiered healthcare system where more money equates to a better quality of care. However, in that respect, nothing has changed.
ObamaCare’s many protections ensure that you can’t be dropped from coverage when you get sick or make an honest mistake on your application. You also can’t be denied coverage or treatment for being sick or get charged more for being sick. Additionally, you can’t be charged more for being a woman. Other protections ensure that you have the right to a rapid appeal, that health insurance companies can’t make unjustified rate hikes, and that these companies must spend the majority of premium dollars on care, not paying executives. Insurance companies must cover sick people, and this increases the cost of everyone’s insurance. To ensure people don’t just buy coverage when they need it, most people must obtain coverage or pay a per-month fee. Also, you can only get coverage during annual open enrollment periods. You can owe the fee due to forgetting to pay a premium, and then not be able to get coverage until next open enrollment. Some people benefited from being in a low-risk group. Men in good health with no pre-existing conditions, who were not responsible for anyone but themselves, and who remained healthy had low insurance costs. They may have had cheap limited coverage before the premium hikes took place in 2014.
All major medical coverage must count as minimum essential coverage. This means that coverage must offer the ACA/ObamaCare’s protections, cover essential health benefits such as free preventative services, limit deductibles and out-of-pocket maximums, provide minimum actuarial value, and not have annual or lifetime dollar limits. Minimum essential coverage can only be obtained during open enrollment unless you qualify for a special enrollment period. Those who don’t understand how to compare plans or didn’t have coverage before the ACA may be shocked by how cost sharing works on higher deductible plans. Also many may get non-minimum essential coverage like short term insurance because of their confusion.
ObamaCare, the ACA, includes some cost-curbing measures, which led to health care spending growing at the slowest rate on record (since 1960) in 2014. Meanwhile, health care price inflation is at its lowest rate in 50 years. Unfortunately, even though the costs are increasing more slowly than they might have, health care costs are steadily increasing. The law also includes spending. Upfront spending and more regulation are required to realize long-term cost-curbing measures.
Medicaid has expanded to cover up to 15.9 million men, women, and children who fall below 138% of the poverty level. Medicaid expanded using Federal and State funding. Not all States had to expand Medicaid. The states that have chosen not to expand Medicaid leave 5.7 million of our nations’ poorest people without coverage options.
CHIP has expanded to cover up to 9 million children. CHIP also uses Federal and State funding.
The employer mandate says that starting 2015/2016, businesses with the equivalent of more than 50 full-time employees must provide health coverage. In anticipation of the employer mandate, some businesses cut employee hours. This added extra operation costs to businesses that did not provide health insurance. Many lower wage employees find health insurance unaffordable and end up with no affordable options due to having been offered coverage through work (see below).
Small businesses with less than 25 full-time equivalent employees can get tax credits for up to 50% of their employees’ health insurance premium costs. Employee health benefits can be expensive. Lower wage workers may end up getting better value through the marketplace, but having employer-sponsored coverage means that they can’t get cost assistance. Also, dependents of employees with coverage are unable to use the marketplace.
Young Adults can stay on their parents’ plan until 26 and 82% of uninsured adults will qualify for free or low-cost insurance. Insurance helps everyone get healthcare and protects them in an emergency. Young adult’s uninsured rates have dropped 46% (HHS). Young people tend to be healthy and not to need coverage as often as older Americans. However, due to low premiums and the benefits of having a plan, young people have some of the best deals of anyone under the ACA when purchasing care.
Medicare has improved for Seniors by measures that eliminate the donut hole, keep rates down, cut wasteful spending and fraud, and expand free preventive services. Some Medicare payments to doctors and hospitals have been limited. Medicare pays doctors according to a fee schedule. Its rates have led to very complex problems that are driving the costs of health care up for everyone. Also, retaining supplemental Medicare options involves confusing options for seniors. The unfounded death panel rumor led to cutting out an important provision in the law that would have provided end-of-life counseling.
The ACA, ObamaCare, retrains a free market semi-private healthcare system and thus still allows our $3 trillion dollar healthcare industry to thrive. Retaining a for-profit healthcare system has economic benefits, but it also means that every aspect of the system requires making a profit. Americans have higher health care costs than other countries, which have more “universal” healthcare systems.

NOTE: The same head author runs ObamaCareFacts.com and FactMyth.com. Some content is common between those sites when offering up informational fact pages on the ACA. The intention is to share the same useful information with two audiences. So for example this page has some common content with Everything You Need to Know About ObamaCare For 2018 – 2019… but that is because it is the same author and same team running both sites.

Citations

  1. The Official Health Insurance Marketplace Website – HealthCare.Gov“. HealthCare.Gov.
  2. Read the Affordable Care Act“. HealthCare.Gov.
  3. Slower Premium Growth Under Obama“. FactCheck.Org.
  4. The Rising Cost of Health Care by Year and Its Causes“. TheBalance.Com.
  5. The HealthCare Crisis“. PBS.Org.
  6. EFFECTS OF HEALTH CARE SPENDING ON THE U.S. ECONOMY“. HHS.Gov.