Whether you get health insurance through an employer or have explored the Health Insurance Marketplace to buy your plan, you’ve heard about the Affordable Care Act (ACA) and healthcare reform. But what does the ACA entail, and how does it impact your coverage, enrollment period, and overall access to health insurance?
The ACA, also known as Obamacare or the Patient Protection and Affordable Care Act (PPACA), is a law enacted in March 2010 to make affordable insurance available to more people. It expanded Medicaid and supports medical care that lowers the cost of healthcare.
This ACA Resource Center helps you navigate what the law means for you.
The ACA healthcare reform law has two components: The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act. You can read a compilation of the ACA, but here’s what you need to know.
Providing affordable healthcare to more individuals and families is possible through the ACA because of subsidies called premium tax credits. The subsidies lower the cost of health insurance for households with incomes between 100% and 400% of the federal poverty level (FPL). In 2021, households with an income of greater than 400% still qualified for the premium tax credit.
Premium tax credits are refundable, and they help low- or moderate-income individuals and families buy coverage through the Health Insurance Marketplace. As the IRS explains, your premium tax credit amount depends on household income. The marketplace computes your premium tax credit when you enroll.
There are two ways to use a premium tax credit:
The ACA Health Insurance Marketplace, also called the exchange, is where you can find health insurance plans, purchase coverage, and determine whether you qualify for premium and out-of-pocket cost assistance or Medicaid.
Another aspect of the ACA is an expanded Medicaid program to cover all adults with income below 138% of the FPL. Because states administer Medicaid, not all states adopted the expanded Medicaid program, but most have.
The expanded Medicaid program is in 39 states and the District of Columbia (D.C.), according to Kaiser Family Foundation, which provides a map so you can identify whether your state offers the benefit.
More Americans than ever are enrolled in health insurance plans from the ACA, according to a U.S. Department of Health and Human Services (HHS) report, which showed 31 million Americans with coverage. As of February 2021, 14.8 million newly eligible people enrolled in Medicaid because of the expansion act that went into place in December 2020.
Finally, the ACA supports innovative medical care delivery methods that lower the cost of healthcare. As the National Center for Biotechnology Information reports, those efforts include:
The ACA impacts how you can purchase health insurance, along with the cost of coverage and premiums. Because the ultimate goal of the ACA is to make health insurance more accessible to more people, the real benefit individuals and families gain is the ability to find, compare, purchase and utilize healthcare coverage that fits into their household budget.
The Center for American Progress identifies 10 ways the ACA has improved healthcare. Those include:
As for coverage, the ACA impacts your health insurance because all marketplace plans must cover 10 essential health benefits that are minimum requirements:
Plans purchased through the marketplace must also include coverage for birth control and breastfeeding.
Benefits can vary based on state requirements and may include dental coverage, vision coverage, and a benefit for medical management programs like weight loss, back pain, and diabetes.
Open Enrollment is the period when you can enroll in a health insurance plan. Generally, open enrollment for 2022 on Healthcare.gov ended January 15. Open enrollment for 2023 will reopen on November 1, 2022. Anyone who wants a marketplace plan has had an opportunity to enroll at any time during 2021 so far.
Employer-based plans might have different open enrollment periods. It’s a good idea to mark these on your calendar so you can select a new plan or make plan changes before the deadline. The marketplace offers a helpful tool outlining enrollment dates and deadlines.
You can qualify for a Special Enrollment Period if you experience a life event like marriage, having a baby or adopting a child, moving, or losing other health insurance coverage. Also, young adults who turn 26 are automatically granted special enrollment.
There are no enrollment dates or deadlines for Medicaid or the Children’s Health Insurance Program (CHIP). If you qualify for either program, you can enroll at any time during the year.
The go-to resource for information about the Affordable Care Act is Healthcare.gov, the Health Insurance Marketplace. This is also your resource for finding, comparing, and purchasing health insurance plans, along with applying for a premium tax credit, Medicaid, or CHIP. Following are other helpful resources housed on Healthcare.gov and others:
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.