ObamaCare open enrollment dates and deadlines.

Our ObamaCare 2022 Guide: Everything You Need to Know About ObamaCare Subsidies, Rates, Dates, Enrollment, and More

We cover everything you need to know about ObamaCare in 2022 including information on enrollmentassistancebenefitsplan types, and more. In this article, we’ll cover what you need to know for 2022 coverage purchased during open enrollment 2022 (Nov 1, 2021 – Jan 15, 2021, in most states) and during the 2022 plan year. NOTE: The American Rescue Act made a few changes to the way assistance and deadlines work in 2022. Please see the aforementioned link for specific changes. In some cases, the changes can result in qualifying for more assistance options than are noted on this page. TIP: Open Enrollment will be extended from 45 days to 75 days this year. Open enrollment will run from Nov 1st, 2021 to Jan 15th, 2022 in most states.

Getting Ready for 2022

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] Also, the American Rescue Act expanded some cost assistance options. Under the act subsidies are increased, more people can get $0 coverage, and those making over 400% FPL still have plans capped at 8.5% of household income. See details below. Here are some key facts for Obamacare for 2022:

  1. To be clear, the Affordable Care Act is still in effect and there is no major court case opposing it.
  2. There is no fee for not having coverage in 2022 in most states, but some states have their own state-based mandate.
  3. Obamacare alternatives are expanded since 2019, so individuals and families who want limited benefit coverage have more options (like short-term coverage).
  4. 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.
  5. Medicaid and CHIP are still expanded in many states, and more states continue to expand.
  6. Open enrollment is still in place. If you don’t have coverage by Jan 15th 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. Check your state deadlines to see if you can enroll after Jan 15th without qualifying for special enrollment!
  7. 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.

States that have their own mandate for 2022 include: California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont (mandate, but no fee for Vermont). Please note this list is subject to change.

Open Enrollment 2022

To get covered for 2022, enroll in coverage offered on the marketplace between November 1st, 2021, and January 15th, 2022 in most states (some states have extended deadlines). 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 are 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 2022 start as early as January 1st, 2022.

Getting Cost Assistance in 2022

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: Employers 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 Does ObamaCare Do?

The ACA was signed into law to reform the healthcare industry by President Barack Obama on March 23, 2010, and upheld by the Supreme Court on June 28, 2012, and June 17, 2021. 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 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 2022

For 2022 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).

Everything You Need to Know About Obamacare Cost Assistance 2022

Below is a breakdown of everything you need to know about cost assistance for health plans under the Affordable Care Act (ObamaCare) in 2022. 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. First off, the types of assistance offered under the Affordable Care Act are:

The chart below offers a quick overview of ObamaCare’s cost assistance options by “MAGI” income for 2022.

Types of Cost Assistance For 2021 Individual Annual Income Family of Four Annual Income
     
Medicaid health coverage (if your state decides to offer it) Up to $17,775* Up to $36,570*
     
Help to pay your premium (if you buy in your state’s online marketplace) Between $12,880-$51,520 Between $26,500- $106,00
     
Subsidies for out-of-pocket costs (if you buy a Silver plan in your state’s online marketplace) Between $12,880- $32,200 Between $26,500- $66,250

NOTE: Medicaid/CHIP eligibility will be updated when the new Federal Poverty level data is published in early 2022. TIP: Want to find out what you can save quickly, check out our Subsidy Calculator.

The 2021 Federal Poverty Guidelines Used in 2022

The amount of assistance you qualify for is based on the Federal Poverty Guidelines. As such, they are an important part of the cost assistance conversation below, so let’s core them now.

Below are the 2021 Federal Poverty Guidelines that went into effect in early 2021 (the ones you use for 2021 Medicaid/CHIP and for 2022 marketplace cost assistance).[7] These guidelines are the key to all cost assistance under the Affordable Care Act. Specifically, these guidelines are used for:

  • Medicaid/CHIP between late Jan 2021 – Jan 2022 after the poverty level guidelines are published.
  • 2022 marketplace cost assistance on all marketplace health plans held in 2022 and purchased during open enrollment for 2022 (which runs from November 1, 2021, to December 15, 2021).
  • For special enrollment in 2022.
  • For ACA taxes for the 2022 calendar year filed in 2023.

NOTE: Our federal poverty guideline list has the 100% poverty level, 138% Medicaid expansion threshold, the 250% CSR subsidy threshold, and the 400% premium tax credit thresholds so you can at a glance see what assistance you qualify for. Please note that for Medicaid Expansion if you make under 138% you qualify, for CSR it is between 100% – 250%, and for tax credits, it is between 100% and 400%. See details on subsidies under the ACA. TIP: For mobile and smaller screen sizes, drag the table below to scroll and see the different poverty levels.

2021 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA
Persons in Family/Household 100% FPL: Minimum to Qualify for ACA Assistance 138% FPL: Medicaid Cap (in States that Expanded) 250% FPL: CSR Subsidies Cap 400% FPL: Premium Tax Credit Cap
1 $12,880 $17,775 $32,200 $51,520
2 $17,420 $24,040 $43,550 $69,680
3 $21,960 $30,305 $54,900 $87,840
4 $26,500 $36.570 $66,250 $106,000
5 $31,040 $42,836 $77,600 $124,160
6 $35,580 $49,101 $88,950 $142,320
7 $40,120 $55,366 $100,300 $160,480
8 $44,660 $61,631 $111,650 $178,640
For families/households with more than 8 persons, add $4,540 for each additional person.

NOTE: Alaska and Hawaii use different guidelines (see this link to guidelines as published in the Federal Register). FACT: The Federal Register notice for the 2021 Poverty Guidelines was published on February 1st, 2021.

Details on Each Cost Assitance Type

Below are details on each type of cost assitance.

Medicaid and CHIP

In all states that expanded Medicaid adults making below 138% of the poverty level qualify for Medicaid. Other states have unique eligibility. CHIP eligibility tends to be higher but differs by state. You can sign up for Medicaid and CHIP 365 days a year. You may qualify for free or low-cost care for Medicaid based on income and family size if you make 138% of the poverty level or, for example, $17,775 for an individual or $36,570 for a family of four for Jan 2021 – Jan 2022. Specifics may differ by state. Contact your state Medicaid office or use the marketplace for details. TIP: Starting in late Jan / early Feb each year new guidelines are published. After the new guidelines are published in 2022 you’ll use those for Medicaid and CHIP.

The Premium Tax Credit Subsidy Caps By Percentage of Household Income for SLCSP 2022

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 2021 from Rev. Proc. 2021-23: NOTE: For 2021 – 2022, Section 9661 of the American Rescue Plan caps marketplace health insurance premiums. Not only does it provide lower caps for those who get subsidies through cost assistance, but it also caps the premium that can be charged the benchmark plan at no more than 8.5% of household income. This means even without subsidies you won’t pay more than 8.5% of household income for a benchmark health plan.

Income 2021
Less Than 150% FPL 0.00% – 0.00%
At least 133% but less than 150% 0.00% – 0.00%
At least 150% but less than 200% 0.00% – 2.00%
At least 200% but less than 250% 2.00% – 4.00%
At least 250% but less than 300% 4.00% – 6.00%
At least 300% but not more than 400% 6.00% – 8.50%
At least 400% and higher 8.50% – 8.50%

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. However, please note, those who aren’t eligible for Medicaid expansion who are on unemployment can get marketplace assistance under the American Rescue Act.

Cost Sharing Reduction Subsidies 2022

Cost Sharing Reduction (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

NOTE: For more information see the 2022 Actuarial Value Calculator. NOTE: Actuarial values are subject to change each year, the % numbers above may be adjusted before open enrollment.

Out-of-Pocket Maximums and Deductible Limits For 2022

Each year the ACA sets new limits for out-of-pocket maximums and deductibles. Here are the limits for 2022 plans for individuals and families.

  • $8,700 for self-only coverage ($8,550 in 2021)
  • $17,400 for family coverage ($17,100 in 2021)

NOTE: For 2022, your maximum deductible is the same as the out-of-pocket maximum. NOTE: The individual limit applies to each individual in the plan. Thus, for 2022, even though the family limit is $17,400, no one member can occur more than $8,700 in covered expenses before the maximum is reached for that member. NOTE: See Notice of Benefit and Payment Parameters for 2022 for final levels.

Maximums and Deductibles on HSA-Eligible Plans in 2022

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 2022.

Minimum Deductible for HSA Eligibility 2022

  • $1,400 for self-only coverage (no change from 2021)
  • $2,800 for family coverage (no change from 2021)

NOTE: It is $2,800 for embedded individual deductible (no change from 2021) 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 2022

  • $7,050 for self-only coverage ($50 increase from 2021)
  • $14,100 for family coverage ($100 increase from 2021)

NOTE: The maximum out-of-pocket is the highest maximum a plan can have to qualify for an HSA. TIP: The maximums are slightly lower on HSA compatible plans than 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 2022

  • $3,650 for self-only coverage
  • $7,300 for family coverage

NOTE: 55 plus can contribute an extra $1,000. TIP: See Revenue Procedure 2021-25 for final HSA levels.

Medical Deductions 2022

For 2017 and 2018, medical expenses were deductible if they exceed 7.5 percent of your AGI (adjusted gross income). For 2019 forward, this threshold increased to 10 percent of your AGI. Thus, in 2022 the threshold is 10 percent of AGI.

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 regard 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 has been reduced to $0, 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 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.

 

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.
  7. notice 2021-01969. Federalregister.gov.