The Most Important Aspects of the Affordable Care Act
What You Should Know About the Affordable Care Act
For the average American consumer, the Affordable Care Act means one thing: an opportunity to buy much-needed health insurance. For millions of Americans, health insurance coverage is just too expensive. Even worse, millions of Americans are denied health insurance each year for a pre-existing condition. Still others are kicked off their insurance plan when they require too much care.
Click through this slideshow to learn about the seven most important aspects of the Affordable Care Act, how they affect you, and how you can prepare for the new changes.
The Key Dates
Mark these three dates on your calendar.
October 1, 2013
The Health Insurance Marketplace opens. Individuals who need to buy health insurance can apply for and see their health insurance options. Your health insurance coverage could begin as soon as January 2014 if you buy insurance early in the open enrollment period.
January 1, 2014
Insurance plans purchased through the Marketplace can start today. If you purchase your insurance later in the open enrollment, your coverage may begin later.
March 31, 2014
The Marketplace open enrollment period closes. You cannot apply for or purchase health insurance through the Marketplace until the next open enrollment period begins.
What You Need to Apply
Be prepared when you are ready to apply for health insurance. Before you begin the application process, gather a few important documents. This information will help determine the type of offers you receive. You will also find out if you are eligible for a tax credit, lower-cost premiums, or Medicaid.
When you are ready to apply for insurance, be sure to have:
- Your most recent W-2, a current pay stub, or your tax return
- Social Security Numbers of each person for whom you’re purchasing insurance
- Policy numbers for any existing health insurance plans
Essential Health Benefits
Health insurance companies are required to provide specific core health insurance benefits. These core benefits are called essential health benefits.
The essential health benefits include:
- Outpatient services (when you receive care at a hospital without being admitted)
- Inpatient services (care received while admitted to a hospital)
- Emergency services
- Prenatal, maternity, and newborn care
- Pediatric care
- Preventive and wellness services
- Chronic disease management
- Mental health disorder counseling and care
- Substance use and abuse counseling and treatment
- Prescription drug coverage
- Laboratory tests and services
Some insurance plans may offer additional benefits. However, you are only required to have insurance that meets the essential health benefits coverage.
You cannot be denied coverage.
Soon, you can buy health insurance even if you are sick. If you applied for health insurance previously and were denied coverage, you cannot be denied starting in 2014. Also, health insurance companies cannot charge you more if you have a pre-existing condition. Women cannot be charged more just because they are female.
However, there is one exception. People who have individual health insurance plans before 2014 can keep those plans. A plan that excludes a pre-existing condition will continue to not cover expenses related to that condition. These plans are grandfathered in and do not have to comply with the new law. If you would like insurance that covers a pre-existing condition, you can apply for insurance in the Marketplace.
Your insurance company cannot put a cap on your benefits.
In 2014, you will be protected against annual limits on essential health benefits. Health insurance companies cannot limit these core benefits or deny coverage for them. If you become ill or are diagnosed with a chronic condition, you will not run out of your benefits.
Again, there is one exception. Individual health insurance plans purchased before 2014 can still cap your benefits. These individual health insurance plans are grandfathered in by the new law. If you would like insurance that cannot be limited, you can apply for insurance in the Marketplace.
Also, health insurance benefits that are not part of the essential health benefits may still have a cap.
What to do if your state doesn’t have the expanded Medicaid
The Act gives money to states so that they will expand their Medicaid program and cover more people. Medicaid is a health insurance plan that covers millions of low-income families and individuals. However, 23 states have chosen not to expand their Medicaid programs.
If your state is not expanding its Medicaid program, you should still apply for health insurance. You may qualify for tax credits that can help you pay for coverage. Plus, if you qualify for the expanded Medicaid but live in a state that is not expanding the program, you will be given an exemption and will not have to pay the penalty. The only way to get the exemption is to apply for insurance.
Where to Shop
If you live in a state with a state-based health insurance exchange, you will begin your search at Healthcare.gov. If you live in a state that does not have its own state-based health insurance exchange, you will use a federally operated exchange. You will also apply at Healthcare.gov. You can apply for insurance starting October 1, 2014.
Once you apply, the site will show you all the plan options you have. Private insurance companies offer the health insurance plans. Once you decide which plan you would like to purchase, you will complete the purchase through the insurance’s website.
Where to Get Help
The Affordable Care Act may seem complicated and confusing. However, it can help you if you do not have health insurance. Focus on the seven more important pieces of the law, and you will be able to get the most benefits from it.
If at any time you need help, you can reach out to customer representatives through Healthcare.gov. You may call 1-800-318-2596 or chat with a representative through the website. You can also find organizations in your area that can help you at LocalHelp.Healthcare.gov.
- What key dates do I need to know? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/what-key-dates-do-i-need-to-know/.
- How can I get ready to enroll in the Marketplace? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/how-can-i-get-ready-to-enroll-in-the-marketplace/.
- What if I have a pre-existing health condition? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/.
- What does Marketplace health insurance cover? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/.
- How does the health care law protect me – Part 9: Ending Lifetime & Yearly Limits. (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part=9.
- What if my state is not expanding Medicaid? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
- How do I apply for Marketplace coverage? (n.d.) The U.S. Centers for Medicare & Medicaid Services. Retrieved September 9, 2013, from https://www.healthcare.gov/how-do-i-apply-for-marketplace-coverage/.