Affordable Care Act

On March 23, 2010, President Obama signed into law The Affordable Care Act, also referred to as ACA. This comprehensive health care reform program aims to improve access to affordable healthcare coverage and protect against unfair insurance rules.  

The effect of the Affordable Care Act on families will differ depending on current health coverage and health status. The Affordable Care Act will have little effect on healthy families with existing health insurance plans. Families with existing coverage are allowed to keep their current coverage. In 2017, all existing health insurance plans will be required to comply with the ACA regulations.

Families that do not have coverage are required to purchase a health insurance plan, or face a fee . This is called “the individual mandate”.

 Penalties for Not Having Insurance:

Depending on income,a family may be eligible for Medicaid or another public insurance option, therefore they would not face a penalty.

The Affordable Care Act is a complex law with many regulations for insurance companies, state governments and individuals.  Below are some key provisions of the ACA, that will help individuals become informed consumers.

Key Parts of the Law:

-Creation of the Health Insurance Marketplace:

The Health Insurance Marketplace is also known as the Health Insurance Exchange (or HIE). The Marketplace was created by the Affordable Care Act as a way for people and small businesses to compare and buy health insurance plans. A person is not required to buy health insurance from the marketplace, it was created as a way to easily buy health insurance.

The marketplace is located at https://www.healthcare.gov/get-coverage/

-Prohibits Health Insurance Plans from Setting Lifetime Limits on Certain Benefits:

Before the ACA, many healthcare plans set a lifetime limit (a dollar limit on what they would spend for your covered benefits during the entire time you were part of the plan). The ACA does not allow healthcare plans to have lifetime dollar limits on certain health benefits.

-Health Plans are required to cover dependent children until age 26:

The ACA allows children to stay on their parent’s plan until age 26. However, until 2014, grandfathered group plans can take young adults off of their parent’s plan if the young adult qualifies for his/her own group coverage.

-Health plans are not allowed to deny or limit coverage to children under 19 because of a pre-existing condition:

Beginning in 2014 insurance companies will not be able to deny coverage to anyone (including adults) with a pre-existing condition. In addition health insurance companies are no longer allowed to charge more based on health status, gender or salary.

-Expansion of Medicaid eligibility:

Beginning in 2014, it will be easier to qualify for Medicaid in some states. Nearly all U.S. citizens under 65 with family incomes up to 133 percent of the federal poverty level ($30,675 for a family of four in 2012) will qualify for Medicaid under the ACA

-Establishment of Essential Health Benefits:

The Affordable Care Act established ten healthcare categories that must be covered by small group plans and non-grandfathered plans. The plans available in the Health Insurance Marketplace will cover these health care categories. This includes services such as Maternity and Newborn Care, Pediatric Services, Preventative Services and Rehabilitative Services.

For more information, visit:

www.healthcare.gov

http://healthreform.kaiserpermanente.org/en/your-guide-to-reform.html