The Patient Protection and Affordable Care Act, referred to as the Affordable Care Act or “ACA” for short, is the comprehensive health care reform law enacted in March 2010.
The law has 3 primary goals:
- Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
- Expand the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs.
- Support innovative medical care delivery methods designed to lower the costs of health care generally.
The health care law offers rights and protections that make coverage more fair and easy to understand. Some rights and protections apply to plans in the Health Insurance Marketplace® or other individual insurance, some apply to job-based plans, and some apply to all health coverage. The protections outlined below may not apply to grandfathered health insurance plans.
How the health care law protects you:
- Requires insurance plans to cover people with pre-existing health conditions, including pregnancy, without charging more
- Provides free preventive care
- Gives young adults more coverage options
- Ends lifetime and yearly dollar limits on coverage of essential health benefits
- Helps you understand the coverage you’re getting
- Holds insurance companies accountable for rate increases
- Makes it illegal for health insurance companies to cancel your health insurance just because you get sick
- Protects your choice of doctors
- Protects you from employer retaliation
Depending on your expected household income for the year, you may qualify for:
- Lower costs for your Marketplace plan, like the premium tax credit that lowers your monthly insurance bill, and for extra savings on out-of-pocket costs like deductibles and copayments.
- Coverage through Medicaid or the Children's Health Insurance Program (CHIP). Your children may qualify for CHIP, even if you don't qualify for Medicaid.
- 10 essential health benefits, including prescription drugs, emergency services, hospitalization, laboratory services, and mental health and substance use disorder services
- Free preventive health services at no cost to you when delivered by a doctor or provider in your plan's network
- Coverage for pre-existing conditions