“ObamaCare” is the common name for marketplace health insurance that is made more affordable by the Affordable Care Act. The average cost of an Obamacare plan ranges from $328 to $482 but varies depending on the company, type of plan, and where you live. These plans often come with substantial deductibles, copayments, and coinsurance.
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The Cost of ObamaCare
The Affordable Care Act of 2010, commonly known as ObamaCare, made health insurance plans more affordable in the public health insurance market exchange. There are, therefore, no specific ObamaCare plans, but just more affordable options through different companies. ObamaCare plans vary in price depending on the company, type of plan you choose, and where you live. The average monthly cost of a plan from the public health insurance market ranges from $328 to $482.
Average Marketplace Premiums in 2021 By Metal Tier
Average Lowest Cost Bronze Plan
Average Lowest Cost Silver Plan
Average Benchmark Plan
Average Lowest Cost Gold Plan
United States Avg.
District of Columbia
Source: Kaiser Family Foundation
Understanding Other Costs
Understanding health insurance terms and costs can be tricky. There are several different costs associated with the plan that you ultimately choose. When people refer to the “monthly cost” of an insurance plan, this is known as a premium. As the coverage level of a plan increases, the premium will increase, as seen above. Therefore, the lowest coverage plan offered is a bronze plan. This cost is paid out of pocket if you purchase the plan yourself off of the public health insurance market.
Deductibles are another health insurance-related cost. This refers to the amount of money you pay before your insurance company begins paying for a health-related service. This does not include free preventive services. Deductibles vary for each type of plan. The less you pay for a monthly premium, the more you pay for your deductible.
Average Split Costs Between You and Your Insurance Plan
You Pay (Deductible)
Two additional terms you may frequently hear when referring to health insurance are copayments and coinsurance. Although fairly similar, a copay is a fixed amount, while coinsurance is a percentage. If you have reached your annual deductible, your insurance plan may have a copay, or fixed amount of money, that you pay out of pocket for a covered health service. Similarly, your plan may have coinsurance, or a percentage, that you pay out of pocket for a covered health service.
Finally, your plan will have an out-of-pocket maximum limit, which refers to the maximum amount you will pay on deductibles, copays, and coinsurance before the remainder of your healthcare services are paid in full by your insurance company. This limit does not include the monthly premium you pay to have your insurance or anything that you pay for that your insurance doesn’t typically cover. This amount varies across all plans, but it cannot go over a set amount. For the 2021 year, this cost cannot be more than $8,550 for an individual and $17,100 for a family.
Qualifying for ObamaCare
Technically, Obamacare ‘plans’ are not run by the federal government but must comply with certain federal and state laws. To apply for an ACA health insurance market plan, you must be a legal resident of the U.S. currently living in the country. Anyone can purchase a plan, but not everyone can receive discounted monthly premiums based on annual income.
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ObamaCare Tax Subsidies
You can receive a tax credit to help lower your monthly insurance payment. This is based on the information you submit about your annual income and your household when you are applying for marketplace insurance. To qualify, your income must be between 100-400% (in California, 600%) of the federal poverty levels (FPLs). Through expanded Medicaid, the lower threshold for some states is 139%. Because of the new American Rescue Act signed into law in 2021, there is now expanded eligibility for a Premium Tax Credit. If you are above 400% of the FPLs, you may now be eligible.
Eligibility for the tax subsidy is determined by the year you are looking for health coverage, not on the previous year’s tax return. Therefore, when you apply for subsidies, you estimate what you believe your annual income will be. If you earn more than expected, you may have to pay some money back to the government, and if you earn less than expected, you may be entitled to additional assistance at the end of the year.
You can receive your subsidy in two different ways: in advance or at the end of the year. If you want to receive Advanced Premium Tax Credits (APTC), you can select this option when enrolling in public marketplace insurance. If you qualify, you will estimate an amount for the federal government to pay towards your monthly health insurance premium to reduce the cost. Or, you can receive the entire credit when you complete your tax return at the end of the year. Either way, you will receive the same amount because the amount paid in advance will be reconciled to match your actual annual income.
Health Coverage for Immigrants
Unfortunately, undocumented immigrants aren’t able to purchase marketplace insurance themselves, but there are many healthcare alternatives. One option is Mira, which offers low-cost urgent care visits, same-day lab testing, and discounted prescriptions for only $45/month. When signing up for Mira, you are only asked to enter your name, birth date, and gender. You will never be asked for documentation papers or your resident status. Another option is to apply for coverage on behalf of another documented individual.
It can often take a while for legal immigrants to receive health coverage through the government, especially if the immigration status is recent. There is a five-year waiting period to receive Medicaid for any recent immigrants. Even if they fall below the poverty level of 138%, they cannot receive this healthcare assistance. Luckily, the ACA allows this group of people to receive premium tax credits to help reduce their monthly premium costs.
Open Enrollment Period
The Open Enrollment Period (OEP) is the period each year when people can enroll in a health insurance plan. In most states, this is typically from November 1 to December 15, and the plan doesn’t take effect until January 1 of that following year. Therefore, you will not always receive health coverage right away, depending on when you apply. If you miss the OEP, you can apply for a short-term health insurance plan until the period opens back up the following year. This can be purchased for up to 364 days. This is a temporary fix for healthy people, as it doesn’t cover many pre-existing conditions.
Special Enrollment Period
Another option when you miss the OEP is to see if you qualify for a Special Enrollment Period (SEP). You may meet the requirements for a SEP if you have experienced a qualifying life event, including things like the loss of health insurance through your job, a change in your address, or a significant life change like a divorce. To be eligible, this event had to have happened within 60 days of you enrolling in a plan. Because of the COVID-19 pandemic, the OEP has been extended until August 15th. Your plan will start on the first day of the following month after you sign up.
ObamaCare Frequently Asked Questions (FAQs)
Having a better understanding of Obamacare, in general, can help you make more informed decisions when it comes to healthcare. Here are answers to some common questions asked about the ACA.
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Can I get Obamacare if I lose my job?
Yes. If you lose your job, you may be eligible to apply for insurance in the Special Enrollment Period. However, if your annual income decreases dramatically, you may eventually qualify to receive Medicaid through your state government.
How do Medicaid and Obamacare differ?
Obamacare refers to the law passed to expand health coverage across the United States, and Medicaid expansion was a big part of that law. Medicaid, in general, is an assistance program, while Obamacare is an actual insurance plan purchased from a company. Medicaid also covers people with a much lower income than those who receive tax subsidies through Obamacare. In addition, you can enroll in Medicaid throughout the entire year, while there is only a certain time frame for marketplace insurance.
How do I sign up for Obamacare?
You can begin signing up for Obamacare by visiting healthcare.gov. Here you can apply for benefits through your state’s marketplace website. You can also fill out a paper application and send it in by mail. When you are applying, there will be an option to ask for Premium Tax Credits to help reduce your monthly health insurance cost. Your estimated annual income will be used to determine if you are eligible or not.
What is the difference between Obamacare and Trumpcare?
Trumpcare refers to the American Health Care Act (AHCA) passed in 2017 by President Trump. Overall, there are not that many differences between the two bills. With Trumpcare, there is no tax penalty for not having a health insurance plan, and states are not required to offer preventative care in their marketplace plans. Trumpcare also ensured that state authority was responsible for managing Medicaid and implemented the Federal Invisible Risk Sharing Program.
The cost of Obamacare can vary greatly depending on the type of plan you are looking for and what state you currently live in. On average, an Obamacare marketplace insurance plan will have a monthly premium of $328 to $482. This cost is before Premium Tax Credits have been applied, which people can receive if they are between 139-400% of the Federal Poverty Levels. Learn all the basics of health insurance plans before selecting the one that is right for you.
Health insurance plans can be costly, especially if you pay completely out of pocket and receive no tax subsidies. Saving money on healthcare is simple with Mira. Get affordable urgent and virtual care, low-cost lab testing, and discounted prescriptions for as low as $25 per month. Avoid the wait; receive care as soon as today through Mira.
Talor graduated from Penn State University with a B.S. in Biobehavioral Health, and minors in Spanish and Diversity & Inclusion in May of 2022. She has a passion for health equity and diversity in health. In the future, Talor hopes to work in public health policy reform to help eliminate health disparities. She enjoys reading, cooking, and listening to podcasts in her free time.