It’s A Brave New World of Obamacare, Here’s How To Live In It

by Cara and Rachel

There’s been so much discussion about the battle to get the Affordable Care Act passed you may have let your focus slip from what the ACA is actually for — trying to make it easier for people (like you!) to access healthcare. The ACA, aka “Obamacare,” isn’t a health care plan in itself — it’s a set of laws that requires almost every citizen to have a health plan (or pay a penalty), and standardizes the process for getting one. It also sets minimum standards for those health plans, offers subsidies that will help a lot of people better afford insurance, and changes some eligibility requirements for federally funded programs like Medicaid. As the deadline for January coverage approaches (it’s December 23rd!), here’s a guide to what the ACA actually means for you, and what you have to do to get in on it. First, let’s quickly run through some of the questions you might have.


I don’t have health insurance. Can I just keep not having  health insurance?

Probably not. There are a few situations in which you aren’t required to have insurance, but part of the ACA is that everyone is supposed to have to have insurance for real now. Or, more accurately, you don’t have to have it, but you’ll have to pay a penalty if you don’t, so.

I do have health insurance. Do I have to change anything about it or switch to Obamacare?

If you already have insurance, you’re probably good to go! It’s worth checking out whether anything about your situation has changed — if the plan you already have has been updated, whether Obamacare might be cheaper for you, whether you might be newly eligible for Medicaid — but there’s no requirement to have Obamacare specifically, just health insurance, any health insurance.

I’m still on my parent’s insurance because I’m young enough to qualify. Can I stay on it?

Sure! You’re golden.

I’m turning 26 and won’t be able to stay on my parents’ plan soon. Should I opt for workplace/school insurance or Obamacare? Which will be cheaper/provide better coverage?

Good question! The answer is gonna vary. You’ll need to go to the Health Insurance Marketplace to figure out what options are available to you through the ACA and how those stack up against your other choices. The good news is that the ACA has set new standards for what ALL health plans are required to provide, so it’s possible that if your options for coverage were underwhelming before, they may now be beefed up a little in terms of what they’ll cover. Obamacare does have built into its infrastructure that it tries to provide subsidized plans for people, whereas your employer probably doesn’t, so there’s that.

How much does Obamacare cost?

This is complicated because “Obamacare” isn’t one singular plan; it’s more of a way to encourage and assist people in accessing a variety of different insurance plans.  So there’s not one simple answer to this. For many people, Obamacare will be cheaper than other options; for some people, that won’t be the case.

I live in one of the states that opted out of the exchange. Does that mean I can’t get Obamacare?

Nope! You can still sign up for it! Things in your state are gonna be different, though, especially as relates to Medicaid. We’re gonna talk about this more later on, so keep reading.

I keep hearing about Obamacare and abortions and birth control. I don’t really know why. Does Obamacare cover abortions?

Again, this is gonna vary, because Obamacare isn’t one thing but a gateway to many things. You could say it’s one ring to rule them all.  (One NuvaRing? I’m sorry.) Obamacare does require all plans to cover preventative care, so birth control, implantable birth control devices, Plan B and more are definitely covered. But Obamacare doesn’t require plans to cover abortion.

I’m trans*. Does Obamacare change anything about healthcare for me?

Possibly! One thing the ACA has done is codify Title VII federal nondiscrimination protections into healthcare, which should ban discrimination based on gender identity and require that your physician treat you with the same respect, dignity and quality of care as a cis patient. (This should also apply to places like rape crisis centers, drug rehab programs, and veterans health centers!) The ACA has also secured funding for cultural competency trainings for healthcare professionals, which means there’s a greater chance your doctor will have a clue about your specific health concerns and experiences.  However, the ACA doesn’t require that plans meet any level of coverage for transition-related healthcare, and so it’s still possible for insurance plans to refuse to cover transition-related expenses. For more information, check this out.

Does the Obamacare website even work? Can I use it now?

Yeah, more or less. I mean, it’s not like we have the option to sign up for Obamacare via carrier pigeon or trained capuchin monkey, so you might as well try it. Good luck.

Ok, but how do I actually do all of this stuff? How do I find out if I’m one of the people exempt from the insurance requirement? Do I qualify for Medicaid now? I’m confused. Hold my hand.

YOU ARE IN LUCK. We will now explain all of these things in even greater detail. Check out the next page!

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Cara is a former contributing editor for Autostraddle and a current staff writer at Atlas Obscura. She lives in Somerville with her girlfriend, their roommate, and a cat who can flush the toilet, and is generally thinking about gender, sustainable biodiversity, and/or rock & roll music. You can follow her on twitter @cjgiaimo if you want.

Cara has written 113 articles for us.


  1. All of these changes are boggling my brain. I currently have insurance through my employer, but they dropped my current HMO plan, and the only plan that’s semi close to it is a POS and is super expensive. I had to make my decision in like 10 minutes, so I ended up going with their HRA plan. But I still don’t even really understand it. Apparently my out of pocket costs will be cut down a lot, but I’m really hoping that this plan wont end up messing me over. You know, if something “bad” happens. Sigh… Stupid question. Do you know if we can claim our healthcare costs on our taxes?

    • Working with social workers ive always been told to never get an HMO. Just stick with the one your employer gives you.

    • I believe there are some healthcare costs that you can claim on taxes. It has to hit a certain threshold, unless things have changed. Might be good to ask an accountant.

      I do know that some of my expenses related to being gluten-free and having celiac are deductible, but I never actually hit the threshold to make it worth it, so I don’t know the details.

  2. Thanks for the amazing article!! I know y’all wrote about it a few weeks ago but is a fantastic resource – it has tons of LGBTQ-specific information (like how to navigate this as a trans* person) and also the basics.

  3. Awesome breakdown of the ACA. And the cat pictures make it even more awesome. I wish I felt the same way about the new law…I have such mixed feelings about what we ended up with in terms of healthcare reform. I’m glad we finally got SOMETHING, but I’m also really disappointed in how little is actually changing in terms of providing affordable and accessible healthcare to folks.

  4. This is great!! For anyone based in NYC, I put together a free seminar on Dec. 16th with Actors Fund called Every Artist Insured: Navigating Health Care Reform. It’s specifically tailored to freelancers and those working in the visual/performing/creative arts. Here’s a link to the RSVP and details:

  5. oh my. thanks for this. I know I could have figured it all out. But I have been avoiding it because I know it will be anxiety inducing. This should help bunches!

    • Torre! I know a lot of the people helping folks enroll through the CO exchange (you don’t have to deal with the federal website because our state got their shit together on their own); let me know if you need any help navigating your way through the process!

  6. For those of you who are still extremely confused, might I make a suggestion. Find a company/agent in your area that will search among the various health insurance providers and find you the best bang for your buck. I did this with my auto-insurance and will be doing it again with my health insurance. Right now, it’s cheaper for me not to purchase my own insurance and just pay the fine. But like Cara said, the penalty will continue to rise and eventually I’ll have to suck it up.

  7. This is the clearest explanation that I’ve read so far — and I learned a few very useful things! Thank you!!

  8. This article is really super helpful. I’m under 26 and still on my dad’s insurance, so I have been trying to figure out whether I actually need to do anything and what exactly to do when the time comes.

  9. So I just found out about “health care sharing ministries” while visiting my super conservative Christian uncle over Thanksgiving, and when he was describing how everyone pays for each other’s healthcare I just wanted to shout “THIS IS COMMUNISM!!! WHY DO YOU HATE OBAMA THE ‘SOCIALIST’ WHEN YOU ARE BASICALLY PARTICIPATING IN MANY COMMUNISM?!?!” Maybe I was over-reacting…I had a lot of mulled wine that day…but still…it puzzled me…

  10. Cara thank you for this. While as a filthy dirty liberal whatever, I would prefer a single payer system, I think this will be a big improvement for most people. I’m thankful to have insurance through school that is pretty good (and my department pays 75% of the cost) so that’s awesome.

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