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Having some form of health insurance has always been a wise decision, given the rising cost of health care. Now, under provisions of the Affordable Care Act (also known as ObamaCare or ACA), it is a legal requirement. With few exceptions, all U.S. citizens including children must have a qualifying health care plan that covers a minimum of 10 essential standardized benefits or pay a tax penalty. You cannot be denied coverage or charged a significantly higher premium because of a pre-existing condition or your gender. All coverage is renewable, if you choose to renew it. Your health insurance can only be canceled for non-payment of premiums or fraud.

Many Americans are covered by policies provided by their employer or union (see Group Health Insurance). Many more, including the self-employed and unemployed, purchase their own health insurance coverage. The Affordable Care Act allows individuals to buy qualifying plans through government-operated exchanges (marketplaces) or in the private market place. Wherever you purchase your plan, your coverage will be provided by a private insurance company and will comply with the provisions of the Affordable Care Act. However, you can only apply for available tax credits and subsidies through the federal exchange (HealthCare.gov) or your state exchange; and you can only purchase personal coverage on the government exchanges during open enrollment periods or when you have a qualifying life event.

Your Personal Health Care Options

To help you more easily compare costs and benefits, the Affordable Care Act designates that all qualifying plans be one of four metals:

Metal Plan Insurer Pays You Pay
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

Each is based on the average amount of healthcare costs the plan will cover, shown as a percentage of what is covered by your insurance company and what is paid for by you. All metal plans have a shared maximum out-of-pocket amount that you can be charged in any calendar year. In addition, if you are under 30 or meet the criteria for a hardship exemption, you can purchase a catastrophic plan.

Depending on which plan and which insurance provider you choose, you may also have your choice of additional coverage options, deductibles and copays.

Premiums may vary depending on the provider and plan you choose. Each state can set the criteria for what insurers can base premiums on. For example, depending on the state you live in, you may be charged a higher premium based on your age, tobacco use, rating area or some other factor.

To learn more about personal health insurance in your state, see our State Health Care Guides. To learn more about the provisions of the Affordable Care Act, visit obamacarefacts.com

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