Affordable Care Act

The Patient Protection and Affordable Care Act, often referred to as ACA or Obamacare, is a 2010 federal law establishing protections for individuals with their health insurance coverage, standards for care by doctors and hospitals and an expansion of health coverage.  

Most job-based private insurance, individual private insurance, public insurance such as Medicaid, military coverage, and veterans’ coverage common health insurance coverage fulfills the requirement.

It is important to note that individuals who use Medicare are not affected by the ACA and DO NOT HAVE TO CHANGE  their coverage.

The Open Enrollment Period for ACA is November 1st through January 31st annually. You may qualify to enroll outside of this time period if you:

  • Lost Employer Coverage
  • Moved to a New State
  • Had Significant Changes in Income
  • Changes in Family Size (if you marry, divorce, or have a baby)
  • Gain Membership in a Federally Recognized Tribe
  • Gain Status as an Alaska Native
  • Lose Medicaid (MaineCare)

Tax Credits or Subsidy

Tax credits will be offered to people (based on income) who purchase health coverage through the State Exchanges as a monthly premium discount.  Individuals making between $11,700 and $47,080 annually, or a family of four making between $24,250 and $97,000 per year, are eligible for credits when filing their federal income taxes.  Individuals or families at the lower amounts will pay 2 percent of their income for a State Exchange plan, and those at the upper amounts will pay 9.5 percent of their income.

There are exemptions to the ACA’s health insurance coverage requirement for individuals:

  • Individuals who are not required to file federal income taxes are exempt.  Generally, this applies to individuals earning less than $11,500 per year ($23,550 for a family of four).
  • Individuals with a legitimate religious reason for not believing in health insurance are exempt.
  • Members of Indian Tribes are exempt.
  • People who cannot find health coverage that costs them less than 8% of their (or their family’s) income – including an employer contribution and/or available tax credits – are exempt.
  • Individuals experiencing a general hardship or unusual circumstances – for example, a natural disaster – are exempt.
  • Individuals can be without health coverage less than 3 months in a calendar year without triggering the fine.


The fines are as follows: $695 per adult and $347.50 per child up to $2,085 for a family (or 2.5% of income, whichever is greater) in 2016.

After 2016, the amounts are increased by the Federal Cost of Living Adjustment.

Why an Agent?

Having an agent will NOT cost you anything – we don’t charge you for our services. We will shop around for the best plan to fit your described needs, and complete the application for you. We will also help you when you have billing, payment, and coverage issues. Having an agent on your side that understands your coverage makes the process much less stressful.