WASHINGTON (CBSMiami) – As of Wednesday, the much maligned Affordable Care Act went into full effect across the country. The law fundamentally shifts parts of the health care industry and open the door for millions of uninsured Americans to finally afford health care.

According to government numbers, roughly two million have enrolled in health insurance plans by using the federally run healthcare.gov website and state healthcare exchange websites. The government said another 3.9 million Americans benefited from the expansion of Medicaid and CHIP and an additional 3 million stayed on their parents’ health insurance.

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If the numbers are accurate, it would mean roughly nine million Americans who didn’t have health insurance this time last year now have coverage. Original forecasts from the government aimed for 3.3 million enrollees through the federal and state exchanges.

However, when the federal website was rolled out in early October it was a disaster and few if any signed up for the new coverage. The White House began working on the site and said it was up and running properly on November 30.

But, not every American will receive benefits from the Affordable Care Act. States, most of them controlled by Republican legislatures or governors, that refused to expand Medicaid will leave millions without access to affordable health care and don’t qualify for federal subsidies because they should have been under Medicaid.

In Florida the number is over 500,000 who will fall into the state-imposed doughnut hole.

For most Americans, they will not notice any difference in their health care from last year to this year. Eighty percent of Americans get their insurance through their employers and those programs will not be impacted much by the ACA’s provisions.

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That said, millions of Americans may have to find new insurance if their old plans don’t meet minimum requirements. Those “essential” requirements, according to the Washington Post, include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehab and habilitative services and devices; lab services, preventive and wellness services along with chronic disease management; and pediatric services.

The exact cost of the insurance will vary by state, region, number of plans available, and Medicaid coverage. But, preexisting conditions will no longer matters as the ACA makes it illegal to deny coverage based on preexisting conditions.

Citizens looking to buy health insurance must do it by the 15th of each month through March 31. After that, no policies can be purchased until next October when enrollment opens up again. If a person signs up before the 15th of a month, the coverage will begin on the first day of the next month.

While the ACA does mandate everyone buy health insurance, citizens can still choose not to purchase any insurance. If they don’t, a $95 tax will be levied, but no liens can be placed on homes or have IRS agents come to your home. The worst that can happen is the IRS takes it out of your tax refund or adds it to your tax bill.

In addition, if you can’t find a plan that costs less than 8 percent of your income, you are exempted from the requirement to purchase health insurance.

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For more information on the ACA, click here for information form the Kaiser Family Foundation. Click here to visit healthcare.gov.