ObamaCare 2020 – 2021

Our ObamaCare 2020 – 2021 Guide: Everything You Need to Know About ObamaCare Subsidies, Rates, Dates, Enrollment, and More

We cover everything you need to know about ObamaCare in 2020 including information on enrollment, assistance, benefits, plan types, and more. Below we’ll cover what you need to know for 2020, and for 2021 coverage purchased in 2020.

TIP: Make sure to check out the 2021 information below if you are buying a plan for 2021 in 2020.

ObamaCare in 2020 (and Getting Ready for 2021)

For the most part, ObamaCare still offers the same benefits, rights, and protections it always has. For example, it offers protections for pre-existing conditions and benefits like cost assistance. However, there have been some changes in recent years. For example, for 2019 forward the fee for not having health coverage was reduced to $0 in most states.^[1][2]

Here are some key facts for Obamacare in 2020:

1. There is no fee for not having coverage in 2020 in most states, but some states have their own state-based mandate (this is true for 2021 open enrollment at the ned of 2020 as well). See a list of states with their own mandate for 2020. See a list of states with their own mandate for 2021 (use this one for 2021 health insurance). 
2. Obamacare alternatives are expanded, 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 had to enroll in a plan from Nov 1 2019 – Dec 15 2019 for 2020 coverage (and for 2021 coverage you have to enroll from Nov 1 2020 – Dec 15 2o2o). If you don’t have coverage by Dec 15 each year, in most states you’ll be left with limited options including special enrollment unless you qualify for another insurance type like employer coverage, Medicare, or Medicaid/CHIP. Coverage purchased during open enrollment starts as early as Jan 1st.
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 if you got tax credits.
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 2020: States that have their own mandate for 2020 include: the District of Columbia, Massachusetts, New Jersey, and Vermont. States considering a mandate for the future: California, Connecticut, Hawaii, Maryland, Minnesota Rhode Island, and Washington. Please note this list is not official and is subject to change.

STATE BASED MANDATES FOR 2021: States that have their own mandate for 2021 include: California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont (mandate, but no fee for 2021 for Vermont). States considering a mandate for the future: Connecticut, Hawaii, Maryland, Minnesota, and Washington.

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 2021

To get covered for 2021, enroll in coverage offered on the marketplace between November 1st and December 15th 2020.

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.

TIP: Short term plans sold year-round, but they don’t have to offer the same benefits, rights, and protections as major medical plans sold during open enrollment.

TIP: Go 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.

FACT: Plans sold during open enrollment 2021 start as early as January 1st, 2021.

Getting Cost Assistance in 2020 – 2021

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.

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:

• The Affordable Care Act’s goal is to give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending.
• The Affordable Care Act aims to accomplish its goal of expanding the affordability, quality, and availability of private and public health insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms.

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

• Offering Americans some new benefits, rights, and protections in regards to their healthcare.
• Setting up a Health Insurance Marketplace (HealthCare.Gov) where Americans can purchase federally regulated and subsidized health insurance during open enrollment.
• Expanding Medicaid to all adults in states that embraced the program.
• Improving Medicare for seniors and those with long-term disabilities.
• Expanding employer coverage to millions of employees.
• Requiring most people to have coverage, get an exemption, or pay a fee for each month (the fee has been reduced to zero in most states since 2019).
• Introducing new taxes and tax breaks.

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

• Letting young adults stay on their parents’ plan until 26.
• Stopping insurance companies from denying you coverage or charging you more based on health status.
• Stopping insurance companies from dropping you when you are sick or if you make an honest mistake on your application.
• Preventing gender discrimination.
• Stopping insurance companies from imposing unjustified rate hikes.
• Doing away with lifetime and annual dollar limits.
• Giving you the right to a rapid appeal of insurance company decisions.
• Expanding coverage to tens of millions by subsidizing health insurance costs through the Health Insurance Marketplaces (HealthCare.Gov and the state-run Marketplaces).
• Providing tax breaks to small businesses for offering health insurance to their employees.
• Requiring large businesses to insure employees.
• Requiring all insurers to cover people with pre-existing conditions.
• Making CHIP easier for kids to get.
• Improving Medicare for seniors.
• Ensuring all plans cover minimum benefits like limits on cost sharing and ten essential benefits including free preventive care, OB-GYN services with no referrals, free birth control, and coverage for emergency room visits out-of-network.

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 2020 – 2021

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 (some of these points were already noted above, but they are reinforced here with some extra helpful links).

• As noted above, ObamaCare’s 2021 Open Enrollment period for 2021 health plans starts November 1, 2020, and ends December 15, 2020.
• HealthCare.Gov is the official website to use if you want to lower costs on private health insurance and qualify for Medicaid under the Affordable Care Act!  Make sure to shop during open enrollment for coverage inside or Outside the marketplace.
• Those who use the marketplace may qualify for one or more of three different types of assistance based on family size and income. First, premium tax credits lower premiums. Second, out-of-pocket cost assistance lowers out-of-pocket costs on Silver plans. Third, Medicaid and CHIP are free or low-cost health insurance for low-income individuals and families.
• Options outside of open enrollment are limited to Short-Term Health Insurance, Medicaid, and CHIP. Keep in mind employer coverage and Medicare have unique enrollment periods. Learn more about enrollment periods.
• If you are getting cost assistance and your income changes throughout the year, make sure to update the Marketplace if your income or family size changes. If you take too many or too few of Advanced Premium Tax Credits, you’ll have to adjust them at tax time using form 8962.
• Despite rate increases, many families will be able to get a plan for less than $100! This is true each year, primarily because the ACA’s Advanced Premium Tax Credits cap premiums based on “household income and family size.” Learn more about how cost assistance works with the Affordable Care Act.

What Has Changed?

A lot has changed with ObamaCare for 2019 – 2021. 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 2020 – 2021

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.

Notes on the numbers: Each year you may need multiple sets of figures depending on exactly what cost assistance information you are looking for. For example, for 2020 coverage and 2019 Medicaid/CHIP you’ll reference the 2019 Federal poverty Levels, and for 2021 cost assistance and 2020 Medicaid/CHIP you’ll reference the 2020 federal poverty levels. Further, you may need to reference older poverty level guidelines if you are doing taxes. Please keep in mind the years we say the numbers are for below. We don’t have all the 2021 information you’ll need for open enrollment 2021 yet. None of this matters much for getting a general idea about assistance, but make sure to use the correct set of figures when doing exact calculations.

Types of Assistance

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

• Premium Tax Credits
• Cost Sharing Reduction Subsidies (Silver Plans only)
• Medicaid Expansion and CHIP
• HSAs (Health Savings Accounts) and Medical Deductions

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).

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 2020 Federal Poverty Guidelines (for 2021 Cost assistance and 2020 Medicaid/CHIP)

Below are the 2020 Federal Poverty Guidelines that went into effect in early 2020 (the ones you use for Medicaid/CHIP in 2020 and for 2021 marketplace cost assistance).

TIP: For mobile and smaller screen sizes, drag the table below to scroll and see the different poverty levels.

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 for example $12,760 x 1.38 = $17608.80. We round up, and thus $17,609 is 138% of the Federal Poverty Level threshold for 2020 Medicaid and CHIP. The methodology is the same for all FPL percentages. We have made the calculations for you above, but it still helps to know the methodology.

Details on Each Assistance Type

Below are details on each type of cost assistance for 2020 and 2021.

Assistance Overview 2021

Here is an overview of eligibility for assistance in 2021 based on income:

NOTE: The Medicaid/CHIP amounts above apply in 2020 and early 2021. Medicaid and CHIP eligibility will be based on the 2021 guidelines as soon as they are published in the federal register in early 2021.

Medicaid and CHIP for 2020 – 2021

In all states that expanded Medicaid adults making below 138% of the poverty level qualify for Medicaid ($17,609 for an individual and $36,156 for a family four in 2019). 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.

NOTE: Medicaid and CHIP levels will change in early 2021 and will adjust upward at that time. See the federal poverty level.

The Premium Tax Credit Subsidy Caps By Percentage of Household Income for SLCSP 2020

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.

Here are the Premium Tax Credit Subsidy Caps for 2020 from Rev. Proc. 2019-29:

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.

The Premium Tax Credit Subsidy Caps By Percentage of Household Income for SLCSP 2021

Here are the Premium Tax Credit Subsidy Caps for 2020 from Rev. Proc. 2020-36:

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 2020 – 2021

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 2020

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 2020, your out-of-pocket maximum can be no more than $8,150 for an individual plan and $16,300 for a family plan before marketplace subsidies.
• For 2020, your maximum deductible is the same as the out-of-pocket maximum.

TIP: See Notice of Benefit and Payment Parameters for 2020 for final levels (they were slightly higher, $8,200 and $16,400 respectively, but then revised down in the final rule).

Minimum Deductible for HSA Eligibility

• Self-only: $1,400
• Family: $2,800

Maximum Out-of-Pocket Limit for HSA Eligibility

• Self-only: $6,900
• Family: $13,800

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.”

HSA Contribution Limit for 2020

• Self-only: $3,550
• Family: $7,100

NOTE: 55 plus can contribute an extra $1,000. TIP: See Revenue Procedure 2019-25 for final HSA levels.

Out-of-Pocket Maximums and Deductible Limits For 2021

• For 2021, your out-of-pocket maximum can be no more than $8,550 for an individual plan and $17,100 for a family plan before marketplace subsidies. These numbers have been revised up for 2021, they were slightly lower, $8,150 and $16,300 respectively in 2020.
• For 2021, your maximum deductible is the same as the out-of-pocket maximum.

TIP: See Notice of Benefit and Payment Parameters for 2021 for final levels.

Maximums and Deductibles on HSA-Eligible Plans in 2021

The maximum and deductible requirements for HSA qualifying plans are not the same as maximums and deductibles on health plans in general. Below are the HSA limits for 2021.

Minimum Deductible for HSA Eligibility

• Self-only: $1,400
• Family: $2,800

NOTE: The minimum deductible, which is the minimum deductible your High Deductible Health Plan must have after cost assistance.

Maximum Out-of-Pocket Limit for HSA Eligibility

• Self-only: $7,000
• Family: $14,000

NOTE: The maximum out-of-pocket is the highest maximum a plan can have to qualify for an HSA.

Medical Deductions

For 2017 and 2018, medical expenses were deductible if they exceed 7.5 percent of your AGI (adjusted gross income). For 2019 and 2020, this threshold is 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:

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.