The Affordable Care Act (ACA) has endured since 2010, and it's important for all Americans to understand how it might affect them and their family. To help you understand key provisions of the ACA that may have an impact on your healthcare, start by understanding the coverage you have now or the coverage you would like to have. One of the primary goals of healthcare reform from the beginning was to make sure that all U.S. citizens have health insurance.
If you already have health insurance, it will benefit you to understand what it covers and how much it costs. You’re probably responsible for part, if not all, of your premiums and out-of-pocket costs such as deductibles and copayments. If you don’t have health insurance, you have various options for getting coverage.
Providing more rights and protections
The ACA attempts to protect consumers by the following:
- Requiring insurance companies to provide a summary of your benefits in plain and simple language
- Allowing you to choose your doctor and use any emergency room
- Eliminating preexisting conditions as a reason to deny coverage and raise premiums
- Eliminating annual and lifetime limits on your coverage
- Outlawing the retroactive cancellation of insurance policies
- Giving you the right to appeal coverage decisions by your insurance company
- Providing a process for independent, third-party reviews of denied claims
- Regulating how your premium is spent
Some exceptions do apply.
The ACA made more people eligible for health insurance coverage by changing the income requirements for Medicaid, creating a marketplace for comparing and buying coverage, and raising the age limit to 26 for adult children covered by their parent’s insurance plans.
Creating a health insurance marketplace
The ACA provides a venue for comparing and buying health insurance coverage from private companies. When you visit HealthCare.gov to shop for a plan, you’ll also learn if you qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
Encouraging preventive care
Many don’t get the necessary care to prevent serious illnesses like cardiovascular disease (CVD). The ACA provides funding for prevention and public health programs and eliminates deductibles, copays, and coinsurance for employer-sponsored health plans or individual health insurance policies for preventive services.
Improving the quality of care
The ACA requires insurers to spend 80% to 85% of their health insurance premium dollars on healthcare and quality improvement or give you a rebate. It also lays out a plan for strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources.
The ACA calls for extending the life of Medicare and improving coverage by attempting to eliminate waste, fraud, and inefficiency; reducing annual payment increases to insurance companies, hospitals, and nursing homes from Medicare; and eliminating the “doughnut hole” in prescription drug coverage.