Changes in the way Americans purchase healthcare insurance and in health insurance practices are essential elements of the Affordable Care Act.
Planning for healthcare costs isn’t easy. Fortunately, depending on your income and circumstances, the benefits of the Affordable Care Act (ACA) that were implemented in 2014 could help you reduce and manage your expenses.
More Consumer Protection
The ACA mandates these protections as of January 1, 2014:
- Discrimination due to pre-existing condition or gender is prohibited.
Up to this point, health insurance companies could refuse to offer new or renewed policies to people with a pre-existing condition. They could also charge individuals higher rates based on their gender or health status.
- Annual dollar limits for health insurance coverage are eliminated.
Health insurance companies are not allowed to set an annual dollar cap on the amount of benefits coverage you can receive.
Previously, your health insurance company could refuse to pay claims that exceeded an amount set as your annual and lifetime limit. Be aware that some exceptions exist. For example, a company could impose a limit if not doing so would greatly increase your premiums.
- Coverage for individuals who participate in clinical trials cannot be dropped.
Previously, health insurers could drop or limit benefits for anyone who chose to enroll in a clinical trial that treated cancer or other life-threatening conditions.
The following cost-saving measures went into effect for consumers in 2014:
An online competitive health insurance marketplace.
The marketplace offers a choice of policies that meet benefit and consumer costs set by the government. Certain life events, like changing jobs, getting married, or having a baby, may qualify you for a special temporary enrollment period. Visit healthcare.gov for more information.
The marketplace (or health insurance exchange) is open to people who don’t have health insurance and to those who have insurance but want to make a change in their coverage. The policies are offered by private companies and include a set of benefits known as “essential health benefits.” These benefits include many preventive care services, hospital visits, maternity and newborn care, prescription drugs, mental health, and recovery from substance abuse.
Most Americans can make one application to the marketplace that allows them to compare the health insurance policies they are eligible for in their state side by side. For more information and to enroll, visit healthcare.gov or call toll-free 800.318.2596.
- Tax credits making health insurance more affordable.
Middle-income individuals and families who are between 100 and 400 percent of the poverty line and unable to obtain affordable health insurance from another source will be eligible for tax credits, as well as affordable copayments, coinsurance, and deductibles.
These changes also debuted in 2014:
- Increased access to Medicaid.
In many states, people who earn up to 133 percent of the federal poverty level can now get health coverage through an expanded Medicaid program. Visit healthcare.gov to see if you live in one of these states.
- Required health insurance coverage.
Most people who can afford insurance will be required to purchase coverage.