Affordable Care Act
The Patient Protection and Affordable Care Act, commonly called The Affordable Care Act or “Obamacare,” is the most significant overhaul of the United States Healthcare System since the passage of Medicare and Medicaid in 1965.
From its introduction into the House 2009, The Affordable Care Act (ACA) timeline is as follows:
*Introduced into the House as on September 17, 2009, followed by Ways and Means committee consideration
*Passed the House on October 8, 2009
*Passed the Senate as “Patient Protection and Affordable Care Act” on December 24, 2009
*House agreed to Senate amendment on March 21, 2010
*Signed into law by President Barack Obama on March 23, 2013
HealthCare.gov outlines The Affordable Care Act, explaining how it may affect and protect you as a United States citizen:
- Enrollment online, by mail, by phone or in person allows you to shop in The Health Insurance Marketplace. You’ll be able to compare your options based on price, benefits, quality and other important features. More people than ever will be able to save money on private insurance coverage.
- Pre-existing conditions cannot cause you to be turned down for health insurance, nor can you be charged more for plans beginning in 2014. Women cannot be charged more than men either. The exceptions to this are for grandfathered plans.
- Insurance companies and group health plans must provide you with a Summary of Benefits and Coverage (SBC) written in a plain-language and succinct form. They must also provide a Uniform Glossary of terms used in health coverage and medical care. These features are designed to allow you to make an “apples-to-apples” comparison when shopping for insurance plans.
- The new law prevents insurance companies from cancelling your coverage if a mistake was made on your application. Previously, your insurance could be cancelled due to such a mistake, your policy could be declared invalid from the first day it took effect, or you could be asked to pay back any benefits you had already received.
- You have the right to choose your doctor in your insurance plan’s network, and no referrals are necessary for OB-GYN services. Out-of-network emergency room services cannot require higher co-payments, nor is prior approval necessary for out-of-network emergency room services.
- If you are under 26 years of age, you may qualify for coverage under a parent’s plan, even if you are married, not living with parents, attending school, financially independent or ineligible to enroll in your employer’s plan. (One exception is explained on healthcare.gov.)
- Many plans are required to cover certain preventive care services at no cost to you, including blood pressure and cholesterol tests, mammograms, colonoscopies and more. These rights do not apply to grandfathered plans created or bought before March 23rd, 2010.
- Insurance companies can no longer limit lifetime coverage for essential health benefits. Beginning in 2014, this applies to yearly limits as well. Limits can be imposed on services that are not considered essential.
- Rate Review is another essential feature, protecting you from unreasonable rate increases. Any rate increase of 10% or more must be publicly justified. This does not apply to grandfathered plans. Another key component is the 80/20 rule, which requires insurance companies to spend at least 80% of the money they take in on your health care premiums and quality improvement activities instead of administrative, overhead or marketing costs. This percentage is increased to 85% for companies selling to large groups—usually more than 50 employees. If these requirements are not met, you’ll get a rebate from your premiums.
- You have the right to appeal private health plan decisions. You must also be informed of the reason why your claim has been denied, and how you can dispute their decision. An internal appeal between you and your insurance company is the first course of action. If the appeal is not resolved, an external appeal is done by an independent organization.
The Affordable Care Act (ACA) is designed to increase the quality and affordability of health insurance, lower the uninsured rate and reduce the cost of healthcare for individuals and the government. The ACA also expands Medicaid eligibility and restructures Medicare reimbursement from fee-for-service to bundled payments.
The employer mandate states that a business who employees 50 or more people must either offer insurance to their full-time employees, or face a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means.
HealthCare.gov offers more information regarding The Affordable Care Act.