The Impact of the Affordable Care Act(ACA) on Your Health Insurance Choices
With health insurance, times are turbulent and difficult to steer through. The Affordable Care Act (ACA), passed back in 2010, was a profound systematic change in American healthcare that broadly altered the way individuals and families approach health insurance. You’re shopping for the first time, looking to learn what you have or wondering whether losing your current insurance will qualify you for marketplace coverage through ObamaCare. That is where this all-encompassing guide steps in and explains the major tenets of the ACA, how it affects your health insurance world.
Table of Contents
What is the Affordable Care Act (ACA)?
Key Provisions of the ACA
Individual Mandate
Health Insurance Marketplaces
Medicaid Expansion
Essential Health Benefits
Pre-existing Conditions Protections
Young Adult Coverage
Preventive Services
Hypertension, insurance, and the ACA — Disaster or boon? (Video)
Increased Accessibility
Extended Benefits provided
Price of Health Insurance
Consumer Protections
Competition and Real Choice in the Insurance Marketplace
Finding Your Way in Health Insurance Marketplaces
How to Use the Marketplace
Health Insurance Policy Variants
Support & financial assistance
The Effects of Medicaid Expansion
Eligibility and Coverage
Medicaid Expansion in Different States
Essential Health Benefits Explained
Classification of Essential Health Benefits
Effect on Choice of Insurance Plan
Pre-existing Condition Protections
How the ACA Protects You
Why These Protections Matter
ACA Young Adult Coverage
Extended Coverage Options
Pros of Parents Keeping Adult Children on Their Plan
Preventive services and coverage
Free Preventive Services
Encouraging Preventive Care
ACA and Health Insurance Going Forward
Possible Differences & Pitfalls
Staying Informed and Prepared
Conclusion
FREQUENTLY ASKED QUESTIONS (FAQ)
Affordable Care Act (ACA) Background
Obamacare, or the Affordable Care Act (ACA), is a comprehensive reform package that was signed into law in 2010. Its main goals were extending health insurance coverage to as many Americans it could and keeping health-care costs low. The ACA fundamentally altered the U.S. healthcare system — at the individual level, for employers and insurers, and in how healthcare providers offer care and are reimbursed. The ACA has fundamentally changed how insurance is bought, regulated, and provided — meaning anyone shopping for health coverage should know more about the law.
Key Provisions of the ACA
The ACA is a massive law that includes many, well-known provisions aimed at expanding health insurance coverage and improving patient protections with the goal of encouraging preventive care. Here are a few of the biggest parts of the ACA:
Individual Mandate
The ACA was enacted with an individual mandate that most Americans must purchase health insurance or pay a penalty. The rationale of this provision was that people who did not have to use the insurance would also carry coverage, putting more money into the insurance pool and helping to keep premiums low. But then, in 2017, The Tax Cuts and Jobs Act wiped out the federal penalty for being uninsured after 2019. As a response, several states have since enacted their own mandates.
Health Insurance Marketplaces
The ACA created Health Insurance Marketplaces (also called Exchanges), which allow individuals and small businesses to compare and buy health insurance plans. They offer a place to compare a variety of plans concerning cost, coverage, and much more which take the guesswork out of finding the right plan for thousands upon thousands.
Medicaid Expansion
Among the major changes in the ACA was a broadening of Medicaid, which is state and federal medical service for impoverished patients. The ACA included a provision to expand Medicaid eligibility to adults with incomes up to 138% of the federal poverty level. But the Supreme Court then ruled that states could decide for themselves, and so Medicaid was expanded — to varying extent in different states.
Essential Health Benefits
The ACA required that all health insurance plans include a package of essential health benefits, ensuring that coverage was comprehensive and not drought-FINY. These benefits — services like emergency care, maternity and newborn care, mental health services to help with your substance use disorder, prescription drugs to manage any chronic condition you have, or preventive services like vaccines and cancer tests — save lives across our country.
Coverage For Pre-existing Conditions
Insurers are barred under the ACA from denying coverage or charging more because of pre-existing conditions. The Equitable Access to Care and Health (EACH) Act by Sen. Kamala Harris would ban healthcare discrimination against those with pre-existing health conditions, making sure that people with chronic disease and other health issues can obtain affordable health insurance.
Young Adult Coverage
Under the ACA, you can remain on your parents’ health insurance plan until age 26. It provides coverage for longer periods of time than these folks may have ever been insured before early adulthood.
Preventive Services
The ACA mandates that some preventive services (e.g., vaccinations, screenings and an annual exam) to be covered without any out-of-pocket cost-sharing (e.g., copayments or deductibles). This focus on early prevention is designed to catch problems before they have a significant impact on personal health – and well as collective public health.
How the ACA Affected Health Insurance Options
The ACA has dramatically reshaped the landscape of health insurance throughout the United States and with it, many ways individuals and families obtain and provider their healthcare coverage.
Increased Accessibility
The ACA has provided millions of Americans with subsidies to help them buy coverage on the marketplaces and expanded access to Medicaid in participating states. This has decreased the uninsured population and allowed people to gain coverage regardless of income or health status.
Improved Coverage and Benefits
By mandating that health plans cover essential benefits and not deny coverage because of pre-existing conditions, the ACA has made insurance overall more comprehensive. This improvement ensures that patients won’t be held responsible for unanticipated expenses and opens the door to a wider array of medical services.
Health Insurance is Affordable
The ACA created income-based subsidies to assist individuals [and families] in paying premium costs for insurance plans purchased through the Health Insurance Marketplaces. These small benefits have helped to make getting health insurance easier for everyone in Philippines who would otherwise not be able to afford any coverage.
Consumer Protections
Protections for the Consumer-–The ACA prohibited lifetime and annual coverage limits, co-payments for essential preventive services, as well as providing consumers with the ability to appeal decisions of insurance companies. Those protections, which are life-saving for some consumers and will continue, give consumers drastically more security than they had in the old days when insurance companies could discriminate based on age.
Market competition and choice in insurance
The ACA has expanded competition among health insurers by establishing Health Insurance Marketplaces and requiring essential health benefits. This competition can produce more, and better options for plans as insurers push hard to create appealing packages so they can more effectively compete within the marketplaces.
How To Navigate Health Insurance Marketplaces
These dedicated Health Insurance Marketplaces are crucial to the ACA’s purpose to increase access to affordable health insurance. You need to know how to shop around in these markets if you are going to choose a plan.
How to Use the Marketplace
The Health Insurance Marketplaces are open to the public through the federal site, HealthCare Producers will have access to the exchanges either through HealthCare. gov, or through the state-run exchanges in states that have decided to set up their own. Coverage is often purchased during the Annual Enrollment period, however, qualifying life events can trigger Special Election Periods.
Different Health Insurance Plan Types
Marktetplaces have three tiers of health insurance plans organized according to the benefits and cost-sharing they provide:
Bronze Plans: These have the lowest premiums per month but come with more out-of-pocket costs. They pay for about 60% of the United States health care costs.
Silver Plans—The middle of the road, Silver plans pick up about 70% of costs with higher premiums and lower out-of-pocket limits
Gold Plans: Gold plans, which also include high premiums and low costs for medical treatment, cover about 80% of your health care expenses.
Platinum Plans offer the highest premiums and smallest out-of-pocket costs but pay out 90% of healthcare expenses
Rebates and Grants
The ACA gives this aid to assist lower income folks afford health insurance. These subsidies can take two shapes:
Premium Tax Credits: For qualifying individuals and families, reducing the amount of premiums to be paid each month.
The Senate Health Care Bill Would Result In $321 Billion Less For Health Care Assistance Funded By The ACA, 94% Reduction Federal Funding For Cost-Sharing Reductions (CSRs) Lower out-of-pocket costs like deductibles, copayments, and coinsurance for those with incomes between 100%-250% of the federal poverty level.
Income, family size and other considerations determine eligibility for these subsidies, so a careful evaluation of your finances is required when applying.
The Impact of Medicaid Expansion
Medicaid expansion due to the ACA has been a very effective way of insuring low income people.
Eligibility and Coverage
Prior to the ACA, Medicaid was available only to select low-income populations, such as pregnant women, children, elderly people or those with disabilities. The ACA has greatly increased the number of people enrolled in Medicaid by allowing all residents with incomes up to 138% of the federal poverty level to be covered under certain guidelines.
Medicaid Expansion — the Current State of Affairs
For starters, the ACA goal was for all states to expand Medicaid but as a result of a Supreme Court ruling it became optional. Because of this, some states have accepted the expansion while others have not, creating a patchwork quilt of coverage around the country. If a state where you reside has not expanded Medicaid, there may be fewer available plans with low costs.
Breaking down essential health benefits
An ACA cornerstone is its prohibition on health insurance plans that do not meet the requirements of a set of essential health benefits to provide comprehensive coverage benefits for members.
Essential Health Benefits Categories
The ACA designs ten categories of essential health benefits that will be included in all plans available through the marketplaces:
Ambulatory Patient Services: Care received on an outpatient basis without being admitted to a hospital.
Emergency Services — Treatment for Conditions such as broken bones or seizures.
Hospital Care: Inpatient treatment at a hospital
Maternity and Newborn Care: Care you receive before, during and after your pregnancy that may include:
Mental health and substance use disorder services: Behavioral health treatment, includes inpatient and outpatient care for mental health assessments (MHAs), diagnosing and treating various conditions.
Many prescription drugs: Drugs given by a doctor
Rehabilitative and Habilitative Services: This includes support that helps a person keep, learn or improve skills to function in daily living.
Lab services: Tests to help diagnose medical conditions
Preventive and Wellness Services: For example, weight management counseling.
Pediatric Services: Care for Children that may include dental and vision care.
Impact on Plan Selection
In making those comparisons, consumers are fairly secure in knowing that essential health benefits will make it into any plan. This guarantees that literally every type of plan has the ability to give access to a wide array of health care service, which ensures better coverage no matter what plan you go with.
Pre-Existing Conditions Protections
Health insurance companies regularly denied coverage to individuals with pre-existing conditions before the ACA. This is an issue that the ACA implemented strong protections to guard against.
How the ACA Protects You
There are several MORE requirements under the ACA, but health insurance companies cannot:
Refuse to cover you for pre-existing conditions.
Increase the cost of premiums because of pre-existing conditions
Enact caps on life time or annual coverage.
Drop coverage because of your health
They stop insurers from pricing individuals with chronic conditions or a history of health problems out of the market, ensuring those people can buy and hold on to coverage that’s also affordable in price.
The Significance Of These Safeguards
These protections are important to ensure that of all Americans have the right to access health care and to prevent people from facing financial hardship due to their health status or because they need medical treatment.
ACA Young Adult Coverage
One of the most important features protecting young adults from being uninsured up to age 4Q — failure that we have described before in this blog — is found in very specific provisions included within the ACA.
Extended Coverage Options
People up to age 26 can stay on their parents’ health insurance plans. Such provision shall not apply:
Marital status.
Residency.
Financial independence.
Enrollment in school.
Pros of keeping young adults on parents’ plans
The extension ensures less coverage disruption for young adults during a stage of life considered transitional, with career changes, education and financial independence being high on the agenda. It can avoid insurance coverage gaps which can result in Medical bills that are costly or non existent care.
ServicesNeed to Know: Preventive Services and their Coverage.
The ACA promotes preventive care through enforcing a defined list of covered services (at no cost sharing), which in turn encourages patients to seek out preventative measures.
Zero Costs for Preventive Services
Under the ACA, health insurance plans are required to cover certain preventive services at no cost to you, meaning that you should not have a copayment, coinsurance, or deductible at all_HCFA_DOT_gov_virtual_posterangent protect access LC Interactionentence 83 period. These services include:
Routine physical exams.
Vaccinations.
Diabetes & hypertension screenings
MammogramsColonoscopies—randosimon/lstock123/GettyImages
Mental health screenings.
Encouraging Preventive Care
The ACA expands access to preventive services by lifting financial barriers that discourage early detection and treatment of health problems, in turn preventing more costly, severe forms of the same conditions from emerging later on.
We look to the ACA and Beyond with Health Insurance
The ACA has altered the health insurance landscape substantially, but its future is still subject to much debate in Congress and the judiciary. Consumers will need to understand potential changes and be engaged in their options for health insurance.
Possible Changes and Challenges
Finally, other potential developments that could affect the future of the ACA include:
Legislative Reforms: The original provisions of the ACA could also be changed, either by reintroducing things like the individual mandate or tweaking subsidies.
State-level Adjustments: Eligibility for the program was traditionally left to states, meaning that following expansion or restrictions of Medicaid within a given state could affect who can receive benefits.
Court Rulings: The enforcement and interpretation of ACA provisions could be affected by judicial decisions.
Public Opinion and Political Will: Public support for elements of the ACA may wane, leading to changes or revisions of certain parts of the law.
Staying Informed and Prepared
To better stay on top of the changing world of health insurance:
Monitor Legislative Changes — Pay attention to proposed bills and reform affecting the ACA Understand State-Specific Policies — This depends on the decision of your state on Medicaid expansion and marketplace regulations Consult with Experts — talk to health insurance experts or navigators on changes and how they will impact your plan Review Coverage Annually — Evaluate your health insurance plan yearly during open enrolment to ensure it still fits your needs and budget Conclusion The ACA has profoundly reshaped the American health insurance industry, and change access, expanding coverage, and including necessary consumer safeguards. Learning about the ACA’s most substantial reforms and how they affect health insurance alternatives would allow families and persons to manage their healthcare coverage with confidence. The ACA offers a guide to more reasonable and widespread health care, whether you’re evaluating Health Insurance Marketplaces or considering Medicaid extension and necessary health advantages. Local state eligibility rules may shift, and out-of-pocket policy benefits may shift as the healthcare environment persists to evolve. It is essential to be well-aware and proactive about your health insurance. This guarantees that you and your loved ones receive health insurance and professional attention. Frequently Asked Questions What is the Affordable Care Act? The Affordable Care Act is a comprehensive 2010 regulation aimed at increasing Americans’ access to health insurance, improving care, and cutting costs. How can I get health insurance? The ACA prohibits insurance providers from disallowing policies due to pre-existing circumstances, expands Medicaid eligibility, and establishes Health Insurance Marketplaces where you and your families can choose policies.
3. What is an Health Insurance Marketplace?
Health Insurance Marketplaces (The Exchanges): Platforms created by the ACA where individuals and small businesses can compare, and purchase health insurance plans. These sites have a range of different plans available, and notes on how much subsidy you could be eligible to receive depending on your household income.
4. Do I need health insurance to cover the ACA?
The federal government in 2019 all but did away with the individual mandate, which compelled most Americans to have health insurance or pay a fine. But some states have their own rules mandating that residents have health insurance.
5. What Are “Essential Health Benefits”?
Guaranteed or essential health benefits refer to a group of ten services that all ACA plans are required to cover. This means that they have to cover essential health benefits such as ambulance services — but that also includes emergency care, maternity care, mental health services, prescription drugs, and preventive services.
6. What Does The ACA Do to Protect People with Pre-Existing Conditions?
Insurers cannot deny coverage or charge higher premiums for people with pre-existing conditions, as they could under the Affordable Care Act. This allows those with pre-existing conditions or chronic disease to purchase and keep affordable health insurance.
7. Lucky for young adults, their parents can keep them on their health insurance plans.
The ACA does allow young adults to stay on their parents health insurance plan until age 26, giving them coverage during a key portion of their lives.
8. Medicaid Expansion: What Is It & What Does It Mean For Me?
Under the ACA, Medicaid expansion increased eligibility for Medicaid to individuals with an income of up to 138% of federal poverty level. Whether or not this expansion is available in your state, based on optional decisions states can make that impact opportunities to access low-income health coverage.
9. Do they cover preventive services with no cost-sharing?
Indeed it is, and in particular, the ACA mandates that a wide range of preventive services (from vaccinations to screenings to annual check-ups) must be covered by health insurance plans without any out of pocket costs such as copayments or deductibles.
10. How do I handle open enrollment?
You will evaluate health insurance options, consider your healthcare needs, and insure there are no subsidies or Medicaid for which you qualify – then purchase a plan that works best for covering what you need covered while not breaking the bank.