The Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act is a 2010 health-reform law better known as the Affordable Care Act (ACA) or Obamacare. This was the largest comprehensive federal healthcare legislation passed since Medicare and Medicaid were established in 1965.
Creating a new way to approach health insurance and healthcare also meant meeting three main goals:
Making affordable health insurance available to more people through marketplaces, premium tax credits, and extended coverage for young adults
Expanding the Medicaid program
Supporting innovative medical-care delivery that reduces costs
The law has survived several legal challenges before the Supreme Court. The ACA reached a record enrollment of more than 24 million people for the 2025 coverage year.
The ACA gives most uninsured people in the U.S. access to health insurance. Generally, you qualify to apply for coverage if you:
Live in the U.S.
Are a U.S. citizen, a U.S. national, or lawfully present in the U.S.
Are not incarcerated
Are not covered by Medicare
You also qualify if you have preexisting conditions, which are previous medical circumstances. Examples include cancer, diabetes, and pregnancy.
Any eligible person can buy insurance on an ACA marketplace. If you have lower or moderate income, you may qualify for financial assistance. This reduces premiums and out-of-pocket costs when you or your covered family member receives care.
If your household income is 100% to 400% of the federal poverty level (FPL) — sometimes higher — you may qualify for a premium tax credit for the monthly cost of your insurance. (FPL amounts are higher in Alaska and Hawaii.) You also may be eligible for extra savings, known as cost-sharing reductions. These will lower your out-of-pocket costs when you receive care.
In the fall of 2026 for the 2027 coverage year, ACA open enrollment will become more uniform nationwide. Regardless of where you live and whether you use HealthCare.gov or a state marketplace, the open enrollment period must:
Begin no later than November 1
End by December 31
Last no longer than 9 weeks
HealthCare.gov will have open enrollment for the 2027 coverage year from November 1 to December 15, 2026. Enrollment requires you to complete an application with information about the people in your household and your income. Then you will choose a plan and pay any premium.
There are several ways to sign up for ACA insurance on your own, with a navigator, or with an agent or broker. You can:
Enroll online through HealthCare.gov.
Use the Find Local Help tool to locate in-person assistance in your area with a navigator, an agent, or a broker. All are trained to walk you through the marketplace process, and 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 1-800-318-2596. This line is available 24/7, excluding holidays. Service is available in English and other languages.
Complete an application, and mail it in.
ACA plans are presented in “metal” tiers. These are health plan categories that are based on how you and your plan will split the cost of care. The metal tiers are:
Bronze: Plans in this tier have the lowest monthly premiums but the highest costs when you need care.
Silver: Options in this tier are known as the benchmark because they have moderate monthly premiums and moderate costs when you access care. You must choose a silver plan to qualify for cost-sharing reductions, known as “extra savings.” These lower out-of-pocket expenses, such as deductibles, copays, and coinsurance. Your plan also has a lower out-of-pocket maximum.
Gold: This tier features plans with high monthly premiums but low costs when you need care.
Platinum: Plans in this tier have the highest monthly premiums and the lowest costs when you access care.
There are also catastrophic health plans for people under age 30, anyone 30 and older who doesn’t qualify for savings on an ACA plan, and anyone 30 and older with a hardship or an affordability exemption. Catastrophic plan premiums are very low, but the plans have extremely high deductibles. These plans cover preventive health services without a deductible.
Essential health benefits are medical services that must be covered under any ACA marketplace plan. There are 10 essential health benefits that all ACA plans must cover:
Emergency services
Hospitalization
Laboratory services
Mental health and substance use disorder services
Outpatient care
Pediatric services
Pregnancy, maternity, and newborn services
Prescription drugs
Preventive care, wellness services, and chronic disease management
Rehabilitative and habilitative services and devices
ACA plans must also offer dental coverage for children. They may provide other benefits.
One important category of essential health benefits that applies to almost everyone is preventive care.
Preventive health services, such as vaccinations and screenings, are provided without out-of-pocket costs when you receive routine care from a provider in your plan’s network.
There are specific preventive health benefits for children, adults, and women.
The total costs of each plan will depend on what type you choose and how much you access care. ACA health plans require you to pay a monthly premium. This may be reduced by a premium subsidy, also called a premium tax credit.
When you access care, you will often have these other out-of-pocket costs:
Deductible: The deductible is how much you will spend before the insurance begins to pay. But you can usually access preventive health services at no cost even if you haven’t met your deductible.
Copays and coinsurance: These are payments you make each time you get care, excluding preventive health services. A copay is a fixed amount that you contribute for a health service after meeting your deductible. Coinsurance is a percentage of the cost of a covered health service that you pay after you have met your deductible.
Out-of-pocket maximum: This is the most you would have to pay for covered services in a plan year. After your deductible, copays, and coinsurance reach this amount, all covered services in a plan year are paid 100% by the insurance company. For 2026 marketplace plans, the out-of-pocket maximum is $10,600 for an individual and $21,200 for a family.
HealthCare.gov is the national platform for ACA health insurance. The website is the enrollment portal for people in 30 states in the 2026 coverage year. Washington, D.C., and 20 states have their own marketplaces and deadlines for ACA enrollment.
If you live in one of these 20 states or D.C., you will enroll through a state marketplace:
California
Colorado
Connecticut
Georgia
Idaho
Illinois
Kentucky
Maine
Maryland
Massachusetts
Minnesota
Nevada
New Jersey
New Mexico
New York
Pennsylvania
Rhode Island
Vermont
Virginia
Washington state
Washington, D.C.
If you live in any other state, you will enroll through the national marketplace.
Under the ACA, you may qualify for premium subsidies. These are discounts that reduce the monthly costs of your health insurance plan. Subsidies are premium tax credits based on ACA income limits or your estimated income in a coverage year.
Most often, ACA subsidies are provided in the form of an advance premium tax credit. This amount is paid to your insurer throughout the year and reduces your monthly bill. Because this credit is based on estimated income, your final income will determine whether you have to pay the government at tax time. If you were eligible for more than you received, the difference will be refunded to you.
To avoid surprises, make sure you report income changes throughout the year. You also have the option to pay the premium in full each month and receive a credit on your taxes for the coverage year.
The 2026 coverage year is the first time since 2021 that ACA enrollees do not have access to enhanced premium tax credits that made plans affordable for millions of individuals and families. Enhanced premium tax credits significantly lowered premiums and expanded the population eligible for savings. These subsidies were eliminated for the 2026 coverage year. As a result, many people have higher premiums.
It depends. The ACA originally had a nationwide individual mandate that required people to have insurance or claim a health coverage exemption. Otherwise, they faced a financial penalty at tax time. The federal requirement for health insurance coverage, known as the individual shared responsibility provision, ended in 2018.
As of the 2026 coverage year, only four states and the nation’s capital still have an insurance mandate with financial penalties for being uninsured:
Vermont residents must report whether they have insurance when they file their state taxes, but there is no penalty for being uninsured. Maryland asks residents about health insurance on their state tax filings as an avenue to enrollment.
It depends. The ACA originally had a nationwide individual mandate that required people to have insurance or claim a health coverage exemption. Otherwise, they faced a financial penalty at tax time. The federal requirement for health insurance coverage, known as the individual shared responsibility provision, ended in 2018.
As of the 2026 coverage year, only four states and the nation’s capital still have an insurance mandate with financial penalties for being uninsured:
Vermont residents must report whether they have insurance when they file their state taxes, but there is no penalty for being uninsured. Maryland asks residents about health insurance on their state tax filings as an avenue to enrollment.
If you cannot afford Obamacare, you may qualify for state-based Medicaid insurance. Your ACA application can help you determine if you qualify for Medicaid.
Every state, Washington, D.C., 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 the ACA, some states have expanded Medicaid to include people with slightly higher incomes. If you don’t qualify for Medicaid and can’t afford any ACA health plan, you have other free and low-cost options to access healthcare, including safety-net clinics and community health centers.
If you miss the open enrollment deadline in your state, you may qualify for a special enrollment period if you have a qualifying life event. Qualifying events include:
Losing health coverage
Moving to a new state
Getting married
Having a baby
Adopting a child
Yes, you do. You can usually remain on your parent’s health insurance plan until the end of the year you turn 26 — even if you’re married, you’re a parent, you’re not your parent’s dependent for tax purposes, or you don’t live at home. This applies if your parent has job-based insurance or an insurance plan through the ACA marketplace. This may work best if you go to school or live in the same state as your parent. If not, you should check the provider network in the plan to see if you can access care where you live or go to school.
The cost to add someone under age 26 to a parent’s plan is usually less than what you’d pay for separate health insurance coverage. People under 30 also have access to catastrophic health plans.
Armour, S. (2021). The Affordable Care Act: A brief history. The Wall Street Journal.
DC Health Link. (n.d.). Get covered. Stay covered.
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