Affordable Care Act (ACA)
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About Affordable Care Act
The Affordable Care Act (ACA), also known as Obamacare, was signed into law on March 23, 2010, with the goal of increasing access to different types of healthcare, improving affordability and improving quality.
What is the Affordable Care Act?
The ACA, or Obamacare, created Health Marketplaces, also known as Exchanges, to help people find affordable health coverage. Federal subsidies in the form of premium tax credits are available to consumers meeting income requirements to make the coverage more affordable. However, you can only get financial help from the government if you buy coverage through a Marketplace. In California, the state marketplace is Covered California, which is the only official place to enroll in ACA plans and receive financial help if eligible.
At Freeway, our caring and bilingual healthcare agents are ready to help you find your way through the complicated maze of health insurance. If you live in California, our licensed agents can help you compare plans and enroll through Covered California at no cost.
Open Enrollment
Open enrollment is a period during which people who want to can apply for insurance through the federal marketplace or their state’s health exchange. It typically lasts around 3 months, although the time period differs from state to state. In California, Open Enrollment for the 2025–2026 coverage year runs from November 1, 2025 through January 31, 2026 via Covered California.
Special Enrollment
Special enrollment is a period after open enrollment where people who missed open enrollment can apply for healthcare if they have a qualifying life event. For example, most people can enroll during special enrollment if they lose their employer-sponsored health plan through a job change. In California, most Special Enrollment windows last 60 days from the qualifying life event and applications are submitted through Covered California.
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What Does the Health Plan Cover?
Health plans must offer essential health benefit standards, including at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Who Pays for Services Provided by the Act?
Typically, both the policyholder and the federal government. You pay a monthly premium, based on the coverage you choose. That monthly premium may be lowered by a federal subsidy to help you pay for your plan. In California, most Special Enrollment windows last 60 days from the qualifying life event and applications are submitted through Covered California.
Middle and low-income families will get tax credits (stipend) that cover a significant portion of the cost of coverage. All new plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance.
Who’s Eligible?
Most people are eligible for health coverage through the Health Marketplace. To be eligible for health coverage through the Marketplace, you:
- Must live in the United States
- Must be a U.S. citizen or national (or be lawfully present)
- Are not currently incarcerated
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.
Note for California residents: Marketplace eligibility still requires lawful presence; however, Medi-Cal eligibility rules are separate and may differ. Apply through Covered California to be screened for both programs.
What Are the Benefits of the Program?
Facts about ACA for Immigrants, Veterans, Children and Students
In creating more equitable healthcare, the ACA recognizes that certain groups — because of age, income, or status — may face extra barriers to coverage.
Through the ACA and programs like Covered California and Medi-Cal, many of these groups now have clear paths to affordable care.
Immigrants
Immigrants who are legally present in the U.S. are generally eligible for coverage through the ACA. Those living in California can apply directly through Covered California, which determines if they qualify for premium assistance or for Medi-Cal.
Some undocumented residents, such as pregnant women and children, may be eligible for limited-scope Medi-Cal that covers prenatal, emergency, or preventive services. Proof of lawful presence is required to enroll in ACA marketplace coverage.
Immigration Status and the Health Marketplace
The following immigration statuses qualify for ACA marketplace coverage:
- Lawful Permanent Resident (LPR/Green Card holder)
- Asylee
- Refugee
- Cuban/Haitian Entrant
- Paroled into the U.S.
- Conditional Entrant Granted before 1980
- Battered Spouse, Child and Parent
- Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
- Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
- Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
- Temporary Protected Status (TPS)
- Deferred Enforced Departure (DED)
- Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health coverage)
- Lawful Temporary Resident
- Administrative order staying removal issued by the Department of Homeland Security
- Member of a federally-recognized Indian tribe or American Indian Born in Canada
- Resident of American Samoa
Applicant for any of these statuses:
- Temporary Protected Status with Employment Authorization
- Special Immigrant Juvenile Status
- Victim of Trafficking Visa
- Adjustment to LPR Status
- Asylum
- Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention Against Torture (CAT)
Only those who have been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days are eligible.
Children
Under the ACA, most children can stay on their parents’ plan until age 26 — whether they live at home, attend school, or are married. Families in the state can also find affordable child coverage through Medi-Cal or the Children’s Health Insurance Program (CHIP).
In California, CHIP is part of Medi-Cal and provides no-cost or low-cost coverage for kids and teens in families that earn too much to qualify for regular Medi-Cal but still need help paying for care. These programs include essential health benefits like checkups, dental and vision care, immunizations, and emergency services.
Because the state has its own individual mandate, households without qualifying coverage may face a state tax penalty. Families who cannot afford private insurance should explore Medi-Cal or Covered California subsidies to stay protected and avoid penalties.
Veterans
Most veterans will receive their care through the nation’s Veterans Affairs (VA) program. VA plans meet the health mandate so veterans who receive their care through the VA will not be penalized. Veterans are free to cancel their VA coverage and apply for a plan through the marketplace. Just be aware that it may increase some costs and it could affect one’s ability to enroll in VA plans later.
Veterans who are not eligible for VA benefits must apply for and receive a health policy through the marketplace and/or Medicaid/Medicare in states that penalize for not carrying coverage.
Students
Fortunately, if your parent’s plan covers you, you can stay on their plan until you are 26, regardless of whether you are a student or not. If you are not on that plan, you can apply for your own marketplace coverage.
Students who do not file taxes do not have to carry any health plan. Likewise, students who make less than $10,000 annually would not face fines for no health coverage. Students in these situations should try to find affordable healthcare through their school or through Medicaid.
Students who are not on their parent’s plan and who make more than $10,000 yearly will be penalized in states that mandate health coverage.
Why People Choose ACA
- You can’t be denied coverage for pre-existing conditions.
- You have the right to quickly appeal any insurance company decision.
- You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage.
- Young adults can stay on their parents’ plan until 26.
- The plan contains a large improvement to women’s health services.
- Better care and protections for seniors.
- New preventative services at no-out-of-pocket costs.
The ACA works hand in hand with programs like Covered California and Medi-Cal to make healthcare more accessible, transparent, and affordable — helping residents find protection that fits both their needs and their budget.
Get Affordable Health Insurance through the ACA Today
You have choices when you shop for health insurance. At Freeway Insurance, our bilingual, experienced healthcare agents can help you work your way through finding affordable or no-cost healthcare for you and your family.
Give us a call today at 800-777-5620 to find out how we can help you and your family get insurance for all your needs.