Many Americans are confused and overwhelmed by the Affordable Care Act (ACA or “Obamacare”) and how it might affect you and your family. To help you understand key provisions of the ACA that may have an impact on your health care, start by understanding the coverage you have now or the coverage you would like to have. One of the primary goals of healthcare reform from the beginning was to make sure that all U.S. citizens have health insurance.
If you already have health insurance…
It will benefit you to understand what it covers and how much it costs. You are probably responsible for part, if not all, of your premiums as well as out-of-pocket costs, such as deductibles and copayments. Click here to learn more about how health insurance works.
If you do not have health insurance…
You have a variety of options for getting coverage. The ACA requires that everyone has at least minimum essential coverage (see “Minimum essential coverage”) in 2014. With few exceptions, such as homelessness and bankruptcy, people without health insurance are required to pay a penalty. Click here to learn more about how you can get health insurance.
In addition to requiring that everyone have health insurance, the ACA has also changed health care in other ways by -
Giving You More Rights and Protections
The ACA attempts to protect consumers by:
- requiring insurance companies to provide a summary of your benefits in plain and simple language
- allowing you to choose your doctor and use any emergency room
- eliminating pre-existing conditions as a reason to deny coverage and raise premiums
- eliminating annual and lifetime limits on your coverage
- outlawing the retroactive cancellation of insurance policies
- giving you the right to appeal coverage decisions by your insurance company
- providing a process for independent, third-party review of denied claims,
- regulating how your premium is spent
Some exceptions do apply. Click here to learn more about your rights and protections under the ACA.
The ACA made more people eligible for health insurance coverage by changing the income requirements for Medicaid, creating a marketplace for comparing and buying coverage, and raising the age limit to 26 for adult children covered by their parents’ insurance plans. Click here to learn more.
Creating a Health Insurance Marketplace
The ACA provides a venue for comparing and buying health insurance coverage from private companies. When you visit healthcare.gov to shop for a plan, you will also learn if you qualify for free or low-cost coverage through Medicaid or Children’s Health Insurance Program (CHIP). Click here to learn more about the federal and state marketplaces.
Encouraging Preventive Care
Many of us don’t get the care we need to prevent serious illnesses, such as cardiovascular disease. The ACA provides funding for prevention and public health programs and eliminates deductibles, co-pays, and co-insurance for employer-sponsored health plans or individual health insurance policies. Click here to learn more.
Improving Quality of Care
The ACA requires insurers to spend 80 to 85 percent of your health insurance premium dollars on health care and quality improvement or give you a rebate. It also lays out a plan for strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources. Click here to learn more about how the ACA may improve quality of care.
The ACA calls for extending the life of Medicare and improving coverage by attempting to eliminate waste, fraud, and inefficiency; reducing annual payment increases to insurance companies, hospitals, and nursing homes from Medicare; and eliminating the “doughnut hole” in prescription drug coverage. Click here to learn more about changes to Medicare.
Learn More About the ACA
The ACA is a complex piece of legislation that has an impact on many aspects of health care. Its implementation will span many years, it encompasses many exceptions and it is always changing. You can learn more about the law in the SecondsCount Guide to the Affordable Care Act center.
Note: This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. While every effort is made to ensure that this information is accurate and current, SCAI makes no guarantees and disclaims any expressed or implied warranty or representation about its accuracy, relevance, timeliness, completeness or appropriateness for a particular purpose.