Affordable Care Act Explained

How the Affordable Care Act Affects Seniors and Family Caregivers

Obamacare? Affordable Care Act? What if you already have insurance? What if you can't afford insurance? Let's cut through the chaos and find out how the new law will affect you and your family.

What is it?

President Obama signed the Affordable Care Act (ACA) into law in 2010 to increase the quality of healthcare and decrease costs. The ACA aims to lower rates for the uninsured by expanding public and private health coverage, in multiple phases lasting through 2020.

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It is the biggest change in healthcare since the creation of Medicare and Medicaid. Here are some fundamental goals of the ACA:

  • Easier to get coverage
  • Financial help for those meeting income requirements
  • Improved consumers' rights
  • No coverage denial for preexisting conditions, gender, or residence
  • Essential benefits mandatory in all health insurance plans

How the ACA affects Medicaid

The most significant change will be seen with Medicaid, the federal program that pays healthcare costs for people with limited income. Historically, millions have been ineligible for Medicaid. However, the ACA has raised the income limit to 138 percent of the 2012 federal poverty level (that level is about $12,000 for a single adult, and $15,000 for a couple). Before, adults without dependent children could not qualify, and income included assets. Now eligibility is determined by Moderate Adjusted Gross Income (MAGI). This is income after deduction and other credits; it does not take into account most assets (such as vehicles, etc.). For most, it will be the same as the adjusted gross income (AGI). You can find this number on your tax return from last year.

Many of the new provisions of Medicaid are optional. States that opt in will provide additional home- and community-based long-term services and supports. Even if your state does not choose to expand its Medicaid program, it must change the enrollment process and eligibility requirements. Find out what is offered in your state at

I don't qualify for Medicaid. What are my healthcare options?

If you do not get insurance through an employer or you are self-employed, unemployed, or have been denied coverage, you can seek coverage through the Marketplace or Exchanges, a collection of participating plans in your area. There are four different levels of coverage: bronze, silver, gold, and platinum. Levels do not indicate quality of care but the amount the patient pays out of pocket and for premiums. A person with a bronze plan may have 60 percent of healthcare costs covered and pay 40 percent out of pocket. Cost information for the levels became available on October 1, 2013, the day that open enrollment began. Open enrollment ends March 31, 2014. Coverage begins January 1, 2014 (or as soon as you enroll after that date). If you qualify for Medicaid, you may enroll at any time. You can find state-by-state Marketplace information at

Can I get help to pay for insurance?

There are options outside of Medicaid for people who have to buy their own coverage. If your insurance costs more than 9.5 percent of your income or does not cover 60 percent of your medical costs, you may qualify for tax credits to help you pay for your health insurance. These tax credits are only for health coverage purchased through the Marketplace. If you are single and make less than $46,000, in a family of three making less than $78,000, or in a family of four with less than about $94,000 in income, you may get a tax credit from the government to help you pay for your premium. Then you can use the credit as a deduction when you file your taxes.

In order to pay for this additional coverage, more healthy people are needed to pay for coverage. Increasing the risk pool enables more people to get preventive care and theoretically decreases the amount spent on care in the future. The ACA includes a financial penalty to ensure that everyone chips in to keep the program viable. In 2014, almost everyone will need coverage or will pay a penalty in their 2014 taxes. The first year the penalty is $95 for each adult and $47.50 for each child (up to $285) -- or 1 percent of your household income, whichever is greater.

Penalties will go up each year and are expected be significant once the program has grown. You will not have to pay a penalty if you:

  1. Were uninsured for less than three months.
  2. Are not required to file a federal tax return.
  3. Would qualify for Medicaid, but your state did not expand the program.

There will be other ways to avoid this penalty; call your state-specific exchange or the federal exchange for additional information.

What do I need to do to get health coverage under the Affordable Care Act?

This is an exciting time for people who have been responsible for paying for their own or their loved ones' healthcare. The best action you can take is to be prepared; get started by taking these three steps:

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1. Organize your documents and be sure to include:

  • Social security numbers (or document numbers for legal immigrants in your household)
  • Employer and income information for every member of your household who needs coverage (pay stubs, W-2s, wage or tax statements)
  • Policy numbers for any health insurance plans covering members of your household

2. Complete the employer coverage tool for every job-based health insurance plan you or someone in your household is eligible for. This form is required even if you are not enrolled; it is available at

3. Sign up in person, online, or by phone. Some states operate their own Marketplaces. There is a menu on that will direct you to your state's site. If the federal government operates your state's Exchange, you will still need to go to to create an account, compare plans, and purchase insurance.

Anyone, regardless of where they live, can call (800) 318-2596 to get started and ask questions.

There have been significant wait times to enroll, and some state websites have crashed or had other technical problems. However, the bugs are being worked out and wait times are decreasing. Don't give up, and find the plan that works best for you and your loved ones.

Hear additional answers to key questions about the ACA from this segment on National Public Radio.

Stephanie Peterson

Stephanie Peterson is a public health professional and contract specialist in the San Francisco area. See full bio

almost 4 years ago, said...

Young, low income applicants will receive coverage at rates unheard of in the industry. Elderly, fixed income applicants will pay thousands more under ACA for the coverage they enjoyed at much lower premiums before ACA. Please tell the whole story.

almost 4 years ago, said...

Hello, Thank you for reaching out in search of resources. has a resource page regarding Medicaid here: For the state of Illinois you may also click here: Please let me know if I can direct you to additional resources. I am happy to help.

about 4 years ago, said...

Hello, I want to apply for medicaid. I am 36 live with my parents and have no income or job at the moment. I have not had health insur. in many years. My parents will NOt pay for my medical at all. Problem is, they are both on SSI and my dad has a small prt. time job. I think they make too much (just barely) to receive medicaid. Since I am in their "household" when I go to apply, will I be denied due to their income level Thanks. What am I going to do? I'm in Illinois.

about 4 years ago, said...

Helpful - somewhat. However,the author did not mention the downside and there are plenty of downsides to the ACA. Not suprised - since Ms. Peterson is a public health professional and contract specialist at the San Francisco Health Plan.

about 4 years ago, said...

My sister is in the process of signing up through the California website for the ACA. It looks like she may save about $1500/month. She is not through the process yet, so I'll see what her experience is before I complain about the ACA. Since I am still employed by a large (non-exempted) employer, it does not appear to be affecting me.

about 4 years ago, said...

The tax credit comes to late to assist in making payments earlier. If you are stuck making large monthly payments you cannot afford will they wait for the tax credit to pay for it. I DON"T THINK SO. So much for assistance. It is another phony way of getting people to sign up. I think you had better mention all the people who had affordable insurance before and now do not thanks to this act. Also, you do not mention all the additional insurance you have to pay for such as maternity and pediatric medical and pediatric dental when you have no children and will not be having any. Also, when I lived in NYC all the Chinese, Russian and Muslim immigrants were already on Medicaid and getting enormous benefits for seniors when our own longstanding American seniors are being denied the same or equal benefits, I have witnessed this firsthand and wrote to all political leaders who are just as horrified at the benefits these people reap while never having put a cent into our SS or Medicare. This affordable care act really isn't helping because assistance was already available. I think it will help illegals more than citizens. And what about the millions losing good coverage because the Gov't thinks we have to share the wealth while Obama and most political figures would never sign up. Think about it.

about 4 years ago, said...

So, this article lists benefits of the ACA, but doesn't have a list of negatives. Does this mean that the author believes that there are no negatives? That would be hard to believe. I think it would be best to show both sides of the discussion and not just one.

about 4 years ago, said...

I find it extremely sad that you are drinking the obama koolaid. I am blocking you from my email about a non partisan view???

about 4 years ago, said...