Quick Start Guides: Affordable Care Act Basics

To enlarge the video to full screen, please click on the lower right corner.

The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA) or Obamacare, is a law that puts in place comprehensive health insurance reforms that will be implemented in stages over a multi-year period.  The purpose of the law is to provide quality, affordable health care for all Americans.  It will allow individuals, families, and small businesses to choose insurance coverage in an open, competitive insurance market.  The Act also requires insurance companies to provide more coverage, reduce costs, and provide healthcare to those individuals previously disqualified.

In California, Covered California is the marketplace for health insurance as well as the primary source of information about how the ACA is implemented for California residents and businesses.  For broader information about the ACA or information for states other than California, the official websites for the Affordable Care Act and the Health Insurance Marketplace are also available now.

Coverage

• Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
• Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
• Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
• Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.
• Shared Responsibility Provision (sometimes called the Individual Mandate): Everyone, with some exceptions, will be required to have a minimum essential coverage or pay a penalty.

Costs

• Ends Lifetime Limits on Coverage: Most benefits are banned from having a lifetime limit on coverage for all new health insurance plans.
• Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
• Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.

Care

• Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services without a copayment.
• Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
• Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.

2010: A new Patient's Bill of Rights goes into effect.  Cost-free preventative services begin for many Americans.

2011: People with Medicare can get key preventive services for free and receive a 50% discount on brand name drugs that fall in the Medicare Part D coverage gap (Donut Hole).

2013: Open enrollment in the Health Insurance Marketplace begins on October 1st.

2014: Insurance plans are prohibited from discriminating due to pre-existing conditions or gender, annual limits on insurance coverage are eliminated , tax credits for middle and lower income people go into effect, Medicaid will be available to a larger population.

2015: Physicians will be paid based on quality of care rather than the number of patients that are treated.

Portions of this guide were graciously provided by Albuquerque-Bernalillo County Library.

Some insurance companies, in order to comply with the law, have cancelled policies that do not meet the requirements of the ACA.  For example, the ACA requires that policies cover pre-natal care. If your current policy does not cover pre-natal care, your insurance company may cancel the policy, even if you don't need or want coverage for pre-natal care.  To alleviate this problem, the federal government granted an extension to allow people to keep their non-compliant plans through 2016, but neither states nor insurance companies are bound go along with the extension.

Unlike the federal marketplace, Covered California will abide by the original decision to find non-compliant health insurance plans to fail to meet the standard for coverage criteria as originally decided.  In other words, California residents' health insurance plans that do not meet the requirements of the ACA may be cancelled.