Since its signing in March 2010, the Patient Protection And Affordable Care Act, better known as Obamacare, has continued to create a stir in the American political sphere. Entering into force on January 1, 2014, this American health reform obliges all people paying taxes in the United States to obtain health insurance that meets certain criteria, under penalty of financial penalties. Penalties reduced to zero by the Trump administration ‘s Tax Cuts and Jobs Act since January 1 , 2019.

What is the Obamacare law?

The Patient Protection And Affordable Care Act , dubbed Obamacare, is a law that was passed by the United States Congress. It aims to reduce inequalities by making access to healthcare universal, in particular for nearly 50 million Americans who until now had no social security coverage. From January 1, 2014, all Americans had to have health insurance ( Individual Mandate ) offering minimum essential guarantees ( Minimum Essential Health Coverage ). Failing this, any resident or citizen was then exposed to financial penalties. 

But this reform was substantially modified by the Tax Cuts and Jobs Act passed in the fall of 2017. 

What are the changes in health insurance since January 1, 2019?

The repeal of the Obamacare pillar was an election promise by Donald Trump, which he repeatedly tried to keep. Failing that, it only managed to remove the associated financial penalties through the Tax Cuts and Jobs Act. 


Since January 1, 2019, US residents no longer incur penalties if they are not covered by health insurance or if they choose insurance that no longer meets the Minimum Essential Health Coverage criteria.  


At the federal level, only employers with more than 50 employees remain subject to the obligation to insure their employees working more than 30 hours per week. Otherwise, they can be subject to heavy penalties. 

Who is still affected by the Individual Mandate and the Individual Shared Responsibility Payment?

In theory , all American citizens and foreign nationals residing in the United States are still affected by the Individual Mandate obligation, since the latter is still in force. Just recently, in June 2021, the Supreme Court again refused to invalidate this law. 


In practice , the lack of insurance can no longer be sanctioned by a financial penalty.


Only certain States have decided to counter the provision of the Tax Cuts and Jobs Act , by maintaining in their territory the obligation of health insurance for individuals ( Individual Mandate ) and the concept of ” individual shared responsibility payment “: in particular the Massachusetts , Washington DC , or New Jersey . Their uninsured residents therefore continue to be penalized, unless they fall under Medicaid or Medicare. Citizens or taxable residents who have not taken out health insurance that meets the Minimum Essential Health Coverage criteria are exposed to a tax charge, for example from USD 695 to USD 3,012 per adult depending on their level of income.

What are the other cases of exemption?

Prisoners, Native Americans, illegal immigrants, members of a recognized religious sect, rejecting any form of insurance, or members of a health care sharing ministry are not affected by the Obamacare law. For example, a member of Medi-Share, Samaritan Ministries or the Amish community will have no penalty to pay if they are uninsured.

  1. What are the specificities of local health insurance for expatriates in the United States?

Expats can choose to take out local health insurance. A Marketplace managed by the government, , centralizes for this purpose various insurance offers respecting the Minimum Essential Health Coverage .

Each insurance solution has 4 different levels of coverage : Bronze, Silver, Gold and Platinum . These levels correspond to the average percentage of health costs that will be covered by the insurer. Thus, with Bronze coverage , 60% of the insured's health expenses are covered, compared to 90% with Platinum coverage .


The amount of the premiums varies according to the level of cover chosen . Bronze insurance is logically less expensive than a Platinum solution. While the levels of coverage offered are the same throughout the country, the amount of premiums may differ from one state or even from one city to another. Other factors, such as age or smoker/non-smoker status can also influence the cost of health insurance.

  1. What are the advantages of subscribing to a health solution in the event of expatriation to the United States?

Expatriates can also choose to take out international health insurance , especially since most offer levels of guarantee at least equivalent to or often superior to the Minimum Essential Health Coverage criteria.


By choosing APRIL International health insurance , you are opting for comprehensive coverage adapted to your expatriate profile. On the one hand, you choose the cover you need from health cover, repatriation assistance, civil liability, death benefit and daily allowances . On the other hand, you are covered both in the United States and in the rest of the world for the duration of your choice. 


You can alsofreely choose your healthcare professionals and healthcare establishments . With our direct payment of hospital expenses service, you do not advance any money if you are admitted to hospital. Similarly, by using our partner networks in the United States , you can benefit from third-party payment with 490,000 doctors and 57,000 pharmacies. 


Finally, our solutions allow you, if you wish, to benefit from coverage of your optical and dental care . As for the amount of your contributions, it does not change according to your personal expenses.

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