Who Is Eligible for Obamacare (Affordable Care Act) Coverage?

Health insurance can be costly — especially if you don't have a job that offers healthcare coverage as a benefit.

The Patient Protection and Affordable Care Act is a 2010 health-reform law better known as the Affordable Care Act, or ACA, and, often, Obamacare. 

The comprehensive ACA law has three main goals:

1. Make affordable health insurance available to more people.

2. Expand the Medicaid program.

3. Support medical care delivery that reduces costs.

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Obamacare offers many consumer protections. The law protects you by offering coverage for people who have preexisting conditions. The law also requires health plans to offer preventive care without out-of-pocket costs, and it allows adults under the age of 26 to stay on a parent’s health insurance plan. 

Who is eligible for Obamacare?

Obamacare is designed to make healthcare affordable for people regardless of their income. Individuals at all income levels can sign up for health insurance under Obamacare. 

If you have a household income between 100% and 400% of the federal poverty level (FPL), you may qualify for a premium tax credit, which is a subsidy based on income limits that will reduce the monthly cost of health insurance for you and your family on any plan. And households above 400% of FPL also may be eligible for premium tax credits. The FPL for 2024 will be used to calculate subsidies for the 2025 coverage year.

The FPL, which is updated every year, is the same for the contiguous 48 states and Washington, D.C., but higher in Alaska and Hawaii.

2024 Federal Poverty Level (FPL) Snapshot

Who is not eligible for Obamacare?

Most people who live in the U.S. are eligible for healthcare insurance coverage under Obamacare. However, there are exceptions. You are not eligible for Obamacare if:

• You do not live in the U.S.

• You are incarcerated.

• You are not a U.S. citizen, U.S. national, or lawfully present noncitizen in the U.S.

• You are covered by Medicare.

EXPERT PICKS: WHAT TO READ NEXT

• What to know before leaving a job: It’s a good idea to explore your health insurance options before you quit your job. Here’s how to keep you and your family covered.

• Shopping for other low-cost insurance? Consider other government health insurance programs like Medicaid or Medicare with Extra Help. Read more about what other options are available here.

• What’s the right ACA plan for you? Placement in the Affordable Care Act’s “metal tiers” is based on your income and determines how much you’ll pay. Learn about each of the tiers before picking a plan.

If you are not a U.S. citizen or national but are lawfully present in the U.S., you also may qualify for Obamacare if your immigration status is one of the following:

• Lawful permanent resident or green-card holder

• Refugee

• Asylum-seeker 

• Cuban or Haitian entrant

• Immigrant paroled into the U.S.

• Immigrant granted conditional entrance before 1980

• Battered spouse, child, or parent

• Victim of trafficking and that person is a spouse, child, sibling, or parent

• Those granted withholding of deportation or withholding of removal under the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment, or Punishment (CAT), or immigration laws

• Nonimmigrant status, including those with worker visas and student visas

• Temporary protected status (TPS)

• Deferred enforced departure (DED)

• Deferred action status, excluding Deferred Action for Childhood Arrivals (DACA)

• Lawful temporary resident

• Those with an administrative order issued by the U.S. Department of Homeland Security that stays their removal 

• Member of a federally recognized Indian tribe, or an American Indian born in Canada

What is the income level to qualify for Obamacare?

While anyone who is eligible can buy health insurance under Obamacare, those with household incomes between 100% and 400% of the federal poverty level (FPL) and above may qualify for financial assistance that reduces their premiums and out-of-pocket costs.

Using 2024 federal poverty levels, a family of four would qualify for subsidies with a household income of $31,200 to $124,800 or more. A single person would qualify for subsidies if they made $15,060 to $60,240 or more. (Federal poverty level amounts are higher in Alaska and Hawaii.)

What are the requirements to qualify for Obamacare?

You qualify for Obamacare if you:

• Live in the U.S.

• Are a U.S. citizen, U.S. national, or a lawfully present noncitizen in the U.S.

• Are not incarcerated

• Are not covered by Medicare

How do I apply for Obamacare?

There are a number of ways to sign up for Obamacare. First, determine whether you need to use the national marketplace or if your state has its own marketplace. You can sign up on your own, with an ACA navigator, or with an agent or broker. After you determine whether you need help, you can:

• Enroll online at HealthCare.gov.

• Use the “find local help” tool to locate in-person assistance in your area with a navigator, agent, or broker — and let them help you enroll. All are trained to walk you through the marketplace process, and their services are free.

• Apply through the website of a certified enrollment partner, such as a private health insurance company.

• Enroll by phone by contacting the marketplace call center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays.

• Complete and mail in an application.  

How much does Obamacare cost monthly?

Affordability provisions in the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022 extend financial assistance for ACA plans through the 2025 coverage year. That means that 4 out of 5 people will be able to find a plan for $10 or less per month.

Your premium, or the amount you might pay monthly for Obamacare, will vary depending upon where you live, your income, your household size, what plan you choose, and the amount of your premium tax credit.

Generally, ACA plans are organized into “metal tiers,” which determine how you and your plan split the cost of care. The tiers and their characteristics are listed in the chart below.

* This is the estimated average cost-sharing for a typical population. Your costs will vary.

Some states require health plans to be even more uniform, to help customers make comparisons. These are called standardized individual health plans. Each will have an identical deductible, copayment, and coinsurance for specific services.

According to a KFF analysis of marketplace plans nationwide for a 40-year-old person, the average premium (without subsidies) for a silver plan in 2025 is $497. The price ranges from a low of $325 in New Hampshire to a high of $1,277 in Vermont.

What if I cannot afford Obamacare?

If you cannot afford Obamacare, see if you qualify for the state-based insurance program called Medicaid. Your Obamacare application can help you determine if you qualify for Medicaid.

Every state, the District of Columbia, and all five U.S. territories with permanent populations (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands) have Medicaid programs. You may qualify for Medicaid depending on your household income, family size, and other factors.

Under Obamacare, some states have expanded Medicaid to include a group of people with slightly higher incomes. If you do not qualify for Medicaid and cannot afford any ACA health plan, you have other free and low-cost health insurance options, as well as potential access to free and low-cost healthcare via community health centers.

Can you be denied Obamacare?

As long as you are eligible for Obamacare, you can’t be denied. That means that as long as you are living in the U.S. lawfully and are not incarcerated or covered by Medicare, you can enroll in an ACA insurance plan. Depending on your income and other factors, your plan may not qualify for a premium tax credit or extra savings.

Your application can be denied if you try to sign up outside of the annual open enrollment period. For 2025 coverage, the open enrollment deadline is January 15, 2025, for most people. If you want your coverage to begin on January 1, 2025, the deadline to enroll is December 15, 2024, in most states.

If you miss open enrollment, you may qualify for a special enrollment period if you have a qualifying life event, such as:

• Losing health coverage

• Moving to a new state

• Getting married

• Having a baby

• Adopting a child

What happens if my job circumstance changes while I’m on Obamacare?

If you have an Obamacare plan and you get a new job that offers health insurance, you will no longer be eligible for ACA subsidies. In that case, you may want to cancel your Obamacare plan and switch to your employer’s plan.

If you have a new job that does not offer health insurance and your earnings exceed the income estimate on your Obamacare application, you may no longer qualify for the same amount in subsidies. In that circumstance, you should update your application by reporting all income and household changes to HealthCare.gov to determine whether your subsidies or other savings will change. If you end up making less than your income estimate, you should also update your application, because you may qualify for more savings under Obamacare.

If you have an employer-based health plan and lose your job, you qualify for a special enrollment period. That means you can apply for Obamacare health insurance outside of open enrollment. You also can sign up to keep your job-based insurance through the Consolidated Omnibus Budget Reconciliation Act, known as COBRA insurance, but you may have to pay the entire premium — including the portion that was previously being paid by your employer.

Does Obamacare differ from Medicaid?

Obamacare is the 2010 health-reform law that makes affordable insurance more widely available to everyone, including those who do not qualify for Medicaid. Medicaid is a federal program administered by states that provides health insurance to persons with low incomes.

The Obamacare law also allows states to expand their Medicaid programs to cover people with slightly higher incomes. However, states have the right to refuse the Medicaid expansion. As of November 2024, the 10 states that have not expanded Medicaid are:

• Alabama

• Florida

• Georgia

• Kansas

• Mississippi

• South Carolina

• Tennessee

• Texas

• Wisconsin

• Wyoming

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Written by:

Tamara E. Holmes

Tamara E. Holmes is a Washington, DC-based freelance journalist and content strategist who has been writing about personal finance, health, and health insurance for more than a decade. Her work has appeared in various print and online publications, such as USA Today, AARP, Working Mother, and Diversity Woman.

Edited by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

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