The Affordable Care Act (ACA), also known as “Obamacare,” has fundamentally changed the health insurance landscape in the United States. Whether you’re buying individual insurance, choosing a plan through your employer, or navigating public programs, the ACA impacts your options. In this blog, we’ll break down the key features of the ACA and how they affect your health insurance choices.

1. Creation of the Health Insurance Marketplace

The ACA established an online Health Insurance Marketplace (or Exchange), making it easier to compare and purchase health insurance plans. Individuals, families, and small businesses can compare coverage options based on price, benefits, quality, and other features. The Marketplace is also where you can apply for Premium Tax Credits and other savings based on your income.

2. Expansion of Medicaid

The ACA provided states with the option to expand Medicaid eligibility to cover more low-income adults. This means that in many states, you may be eligible for Medicaid if your income is up to 138% of the federal poverty level. Check with your state’s Medicaid program to see if you qualify.

3. Coverage for Pre-existing Conditions

Before the ACA, insurance companies could deny coverage, charge higher premiums, or exclude certain benefits based on pre-existing conditions. The ACA banned these practices, meaning you can’t be denied coverage or charged more because of your health history.

4. Essential Health Benefits

Under the ACA, all health insurance plans sold on the Marketplace, as well as most other private insurance plans, must cover a set of essential health benefits. These include preventive services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, and pediatric services.

5. Preventive Care at No Cost

The ACA requires health insurance plans to cover certain preventive services at no cost to you, even if you haven’t met your yearly deductible. These services include vaccinations, screenings for various conditions, and certain types of counseling.

6. Adult Children Can Stay on Parents’ Plan

Under the ACA, you can add or keep your children on your health insurance policy until they turn 26 years old, even if they are married, not living with you, or eligible to enroll in their employer’s plan.

7. Individual Mandate (Now Effectively Repealed)

Originally, the ACA required nearly all Americans to have health insurance or pay a penalty. However, the federal penalty was effectively reduced to $0 as of 2019. Some states, however, have implemented their own individual mandates.

8. Changes to Medicare

The ACA made several changes to Medicare, including shrinking the prescription drug “donut hole”, offering more preventive services, and expanding coverage for hospital readmissions.

Conclusion

The Affordable Care Act has greatly expanded health insurance options and protections for consumers. Understanding these provisions can help you make the most of your health insurance choices and ensure you’re getting the coverage you need. Keep following our blog for more information and resources about health insurance.