ACA or "Obamacare"
The following are some of the major changes under the Patient Protection and Affordable Care Act.
Health Insurance Marketplaces
Starting this fall, there will be a new way for individuals,
families, and small businesses to buy health insurance: the Health
Insurance Marketplace (also called an Exchange). The Marketplace is
designed to help people find health insurance that fits their
budget, with less hassle. Every health insurance plan in the new
Marketplace will offer comprehensive coverage, and consumers can
compare all their insurance options based on price, benefits,
quality, and other features.
In addition, individuals with incomes between 100 and 400 percent of
the federal poverty level (FPL) may be eligible for federal premium
tax credits to help pay for private health insurance through the
Marketplace. Individuals with incomes between 100 and 250 percent
of the federal poverty level may also be eligible for additional
cost-sharing reductions to help lower their out-of-pocket expenses
(e.g., co-pays and deductibles).
Medicaid Coverage
The Affordable Care Act allows states to establish Medicaid
eligibility for low-income adults between 19-64 years of age with
income at or below 133 percent of the Federal Poverty Level (FPL).
Essential Health Benefits
People who obtain insurance through non-grandfathered plans inside
or outside Health Insurance Marketplaces or through a Medicaid
Alternative Benefit Plan will be ensured coverage of essential
health benefits, including items and services within at least the
following ten categories: ambulatory patient services, emergency
services, hospitalization, maternity and newborn care, mental health
and substance use disorder services, including behavioral health
treatment, prescription drugs, rehabilitative services and devices,
laboratory services, preventive and wellness services and chronic
disease management, and pediatric services (including oral and
vision care). Within these ten categories, the specific benefits to
be covered will vary by state.
Private Insurance Market Reforms
The Affordable Care Act includes a number of private health
insurance market reforms:
-
Guaranteed availability of coverage, which, prevents insurers
from denying coverage to individuals based on pre-existing
conditions
-
Fair health insurance premiums, which prohibits discriminatory
premium rates by preventing insurers from charging more for
individuals based on pre-existing conditions
-
Prohibition of pre-existing condition exclusions or other
discrimination based on health status
-
Prohibitions against imposing annual dollar limits on essential
health benefits
-
Dependent coverage extension (up to age 26)
-
Coverage of specified preventive health services without
cost-sharing
Most reforms will be effective on January 1, 2014, although some
provisions have been effective since 2010. Learn more about status
of ACA implementation at the
HealthCare.gov timeline.
