If you do not have health insurance or your health insurance does not cover the care you need, you may have options under the Affordable Care Act, the federal health reform law.


What is the Affordable Care Act?

The Affordable Care Act (ACA) is sometimes called “Obamacare” or the “health reform law.” It is a federal law that:

- Reforms how health insurance companies operate.

- Expands the ways that people can get and afford health insurance.

- Takes initial steps towards lowering costs in the health care system.

The law was passed in 2010 but many of the most important parts of the law started in 2014. The law affects different groups of people differently. For many people who already have insurance (such as job-based insurance or Medicare), you may not notice many changes. For others who do not have insurance, the ACA may help you get health coverage.

What Does the Affordable Care Act Do?

The ACA stops health insurance companies from:

- Refusing to offer health insurance to people with health problems (called “pre-existing conditions”).

- Charging people with health problems higher premiums than others. 

- Only covering medical expenses up to a certain dollar amount each year or a person’s lifetime.

- Making unlimited profits.

Among many other changes, the ACA also:

- Introduces new ways to get and afford health coverage (See Coverage Options in Washington).

- Requires most people to have health insurance (See Health Care Reform: Requirement to Get Health Coverage).

- Allows young adults to stay on their parents’ insurance to age 26.

- Closes the Medicare Part D “donut hole” by 2020, making prescription drugs more affordable for seniors and people with disabilities.

How Can I Get Coverage under the Affordable Care Act?

Washington residents can apply for new health coverage programs through Washington Healthplanfinder, www.wahealthplanfinder.org.

- Medicaid (called “Washington Apple Health”) is now available for adults age 19-64 with lower incomes. If you qualify, this coverage is free.

- State-approved “Qualified Health Plans” for adults and children. If you qualify, there are subsidies to make these plans more affordable.

- Small business plans are also now available through Washington Healthplanfinder.

The ACA requires health coverage to:

- Include a core set of benefits, including doctor visits, hospital stays, maternity care, emergency room visits, prescription drugs, and preventive care with no co-pays.

- Be available even if you have a pre-existing condition.

You can apply for the new coverage programs through Washington Healthplanfinder, a state-approved website and toll-free hotline (1-855-WAFINDER, or 1-855-923-4633) that will help you understand and compare your new options. You can apply for Qualified Health Plans (QHPs) during the third open enrollment period, which starts November 1, 2015 and ends January 31, 2016. If you miss this window you may need to wait until next year. However, you may apply for QHPs before or after open enrollment under certain conditions.

You may apply for QHPs before or after open enrollment under certain conditions. Washington Apple Health is available through Healthplanfinder year-round.

For information about coverage options in Washington State visit Coverage Options in Washington State.

For more information about the Affordable Care Act, visit Resources.