What is Affordable Care Act? (Updated for 2021)

What is Affordable Care Act?What is Affordable Care Act?

What is Affordable Care Act? – Also known as Obamacare, the Affordable Care Act (ACA) is a healthcare reform that includes a list of healthcare policies that open opportunities for Americans. The overarching goals of ACA are intended to expand access to affordable health insurance, improve quality and system performance, increase consumer protections, emphasize prevention and wellness, expand the health workforce, and reducing the costs of healthcare. 

Historically, the ACA was for employers, adults, children, and uninsured individuals observed below the poverty line. 

What is Affordable Care Act? – Overview

The Obama administration successfully passed the ACA in 2010 as the comprehensive healthcare reform. Also known as the Patient Protection and Affordable Care Act(PPACA), and often called Obamacare, the law is designed to expand health insurance coverage to millions of uninsured Americans.

ACA aimed to reduce the cost of health insurance coverage for qualified and lower-income people. The law offers premium tax credits and cost-sharing reductions to lower expenses.

Premium tax credits are a federal tax credit that lowers your health insurance bill each month. Cost-sharing reductions reduce out-of-pocket costs for co-pays, deductibles, and coinsurance while lowering the out-of-pocket maximum, that is, the total amount paid for health expenses in a year. 

All ACA-compliant health insurance plans sold on the Health Insurance Marketplace must cover essential health benefits. People can buy or switch insurance plans during an open enrollment period on Health Insurance Marketplace every year. 

Key Takeaways

  • The Affordable Care Act, also known as Patient Protection and Affordable Care Act (PPACA) or Obamacare, was signed into law in March 2010.
  • It was designed to expand health coverage to uninsured Americans.
  • The Act expanded Medicaid eligibility, mandated Americans to purchase or obtain health insurance, created a Health Insurance Marketplace, prohibited insurance companies from denying coverage, and allowed children to stay on their parent’s insurance plan until the age of 26.
  • For coverage purchased through the marketplace, lower-income families qualify for subsidies.
What is Affordable Care Act? - Overview

What is Affordable Care Act? – Coverage Highlights

What is Affordable Care Act? – Coverage Highlights

The health insurance carriers, under the ACA, are required to grant the following provisions for policyholders.

  • Medicaid Expansion

The ACA expanded Medicaid and Children’s Health Insurance Program (CHIP) to provide coverage to uninsured and low-income families in America. Originally, the intention of ACA was to cover individuals under the age of 65, earning below Federal Poverty Level (FPL) through state-sponsored Medicaid programs. Now, individuals without children and with low-income qualify for Medicaid. 

Low-income men and women, like uninsured individuals, eligible for Medicaid can browse various coverage options using ACA Healthcare Exchange.

  • Young Adult Coverage

Men and women under 26 are eligible to be covered under their parent’s health insurance plan, whether it is an individual or employer-sponsored coverage plan. 

This rule is applicable in all the states of the United States, regardless of marital status and educational status.

  • Subsidized Coverage

The mandated ACA might seem like an additional expense for some individuals and households. However, to help such people whose annual income falls below 400% of FDL qualify for federal government subsidies. 

To determine the amount and calculate the subsidy, visit eHealthInsurance and get an online calculator. 

  • Consumer Protection

ACA has emphasized on prevention and wellness of consumers. Under ACA, the policyholders cannot be denied by health insurance companies due to pre-existing conditions such as a chronic illness or permanent disability. Additionally, the insurance providers cannot impose premiums for individuals or women facing chronic health issues.

Free preventative services must be included in the plan, where insurance companies cannot impose limitations on Essential Health Benefits that include screenings and preventative treatments.

As per the 80-20 rule. The insurance providers spending less than 80% of premium revenue on medical services are required to rebate the coverage to their policyholders. 

  • Essential Benefits

Under the ACA, there are certain benefits that must be included in individual and group coverage plans. These are:

  1. Ambulatory patient services
  2. Hospitalization
  3. Emergency services
  4. Mental health and substance abuse disorder services
  5. Prescription drugs
  6. Laboratory services
  7. Preventive services and chronic disease management
  8. Maternity and newborn care
  9. Rehabilitative and habitability services 
  10. Pediatric services

What is Affordable Care Act? – ACA Health Insurance Marketplace

To ease the process by which individuals and business owners can purchase health insurance and maximize enrollments, the Federal government created an online health insurance marketplace. The interested individuals can browse health insurance plans listed on the marketplace and signup for coverage within ACA Open Enrollment Period. There are four plans that match the coverage rate. To learn more, visit https://www.healthcare.gov/quick-guide/

How to Apply for ACA?

Let us learn about the five ways to apply for ACA coverage. 

  • Online Assistance

If you are looking for online assistance, visit https://www.healthcare.gov/ and create an account. If you already have an account, you are enrolled in a plan log-in.

  • Personal Assistance

If you want to determine the best plan for you under ACA, you can take personal assistance. There are several assisters in the community who are specially trained, helping you complete the application and enrollment process with a suitable plan.

To find community assisters, visit HealthCare.gov and enter your zip code, where you will find someone to assist you locally for your ACA coverage.

  • Telephone

Customer service representatives are always available to assist you in completing the ACA application process, helping with enrollments, and reviewing coverage options. Contact 1-800-318-2596

  • Agents and Brokers

Agents and brokers might only work with certain plans; however, they can be good options for making the best decisions. To search for brokers available in your community, visit https://localhelp.healthcare.gov/

The hard copy of the application is also available on the website. The normal processing usually takes two weeks for eligibility. Regardless of the option, you select, ACA is an option that works for the uninsured and for those who need coverage. 

There are time frames to apply, and there is a special enrollment period in case you are unable to meet the guidelines. Make sure to consider all the options carefully. 

What is Affordable Care Act? - Consider the Options Carefully

What is Affordable Care Act? – Pros & Cons

What is Affordable Care Act? – Pros

There are various benefits of implementing the ACA. 

  • Health Insurance Coverage

The ACA has given access to millions of Americans to receive health insurance coverage. 

  • Cheaper Health Insurance

Though insurance coverage under the ACA isn’t free, however, it made health insurance more affordable to lower-income families. Insurance companies are required to contribute at least 80% of insurance premiums on medical care and health improvements, thereby making it accessible for most American families.

  • Cheaper Prescription Drugs

Historically, due to the higher prices of medications, most of the seniors and low-income families were unable to meet the costs. Under ACA, prescription drugs became more affordable, allowing Medicare beneficiaries to save a huge amount. 

  • Extended Coverage for Various Health Conditions

Individuals used to experience difficulties while receiving health insurance under certain pre-existing health conditions such as cancer. Many health insurance companies denied covering the treatment for specific conditions incurred before registering for Medicare. 

With the introduction of ACA, Americans could not be denied coverage due to such circumstances. 

What is Affordable Care Act? – Cons

Besides several benefits, there are also some cons of implementing the ACA. Let us learn about them.

  • Higher Premiums

Though insurance companies offer wider options of benefits and cover Americans with pre-existing conditions, the cost of upholding such conditions charged them with higher premiums.

  • High Tax Rates

To compensate for ACA, individuals with high income were taxed at higher rates, with the rise in taxes on pharmaceutical sales and medical devices.

  • Affecting Employment Hours

The ACA enforced the rule in which businesses with 50 or more full-time workers were required to offer insurance or cover healthcare services for their employees. As a result, many businesses reduced their full-time employees to part-time, avoiding paying for additional expenses. 

What is Affordable Care Act? - Affordable Health Insurance

What is Affordable Care Act? – Ensuring that Most Americans are Insured

Conclusion

What is Affordable Care Act? Is it working? Well, to answer these questions, it is vital to understand the impact on the American healthcare system. 

The ACA ensures that more Americans are insured regardless of income and the state of their health. The main goal of ACA was to make health insurance affordable to millions of Americans. The implementation of ACA has also been beneficial to the Health insurance industry. 

Go through the available coverage options and choose the suitable one to get the maximum benefits. Keep in my that some treatments are not considered as essential hence not covered by Affordable Care Act. For instance if you are missing a tooth and cannot afford a dental implant you should try other options such as dental grants provided by the government. 

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About the Author

Abigail Friedland
I am a medical student who dedicated herself helping individuals and non profit organizations for finding medical grants for medical bills, medical treatment, medical education, research and medical equipment.

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