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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

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.

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What You Should Know About The Affordable Care Act

  • ACA was enacted in 2010 and offers several consumer protections.
  • Under ACA, you may qualify for premium tax credits that make health insurance premiums more affordable.
  • The ACA also expanded Medicaid and enacted cost-saving provisions.

What Is the Affordable Care Act?

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.

Premium tax credits

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 qualify 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:

  • You can get advance payments of the premium tax credit (APTC) paid to the insurance company to lower monthly health insurance premiums.
  • Or, you can take the entire credit when you file your federal income tax return.

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.

Expanded Medicaid program

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.

Cost-saving innovations

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:

  • How care is introduced and managed
  • Shifting care from costly settings like emergency departments to outpatient and other less-expensive venues in the community or home
  • Examining payment methods
  • Narrowing provider networks
  • Expanding electronic medical records
  • Focusing on how chronic diseases are managed to reduce healthcare spend

How Does the Affordable Care Act Impact Your Health Insurance?

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:

  • Reducing the number of uninsured Americans
  • Protecting people with pre-existing conditions from denial of coverage
  • A Medicaid expansion that gives more low-income Americans access to affordable health insurance
  • Providing financial help for people who enroll in marketplace plans
  • No more gender rating that used to prevent women from accessing affordable coverage
  • More coverage for young adults and children, including allowing them to stay on a parent’s insurance until age 26
  • Better access to and coverage of brand-name and generic prescription drugs
  • Medicaid expansion delivering affordable care to more people in rural communities with extended FPL requirements
  • Lower Medicare costs for older adults
  • More protections for disabled individuals through Medicare

As for coverage, the ACA impacts your health insurance because all marketplace plans must cover 10 essential health benefits that are minimum requirements:

  • Ambulatory patient services (outpatient)
  • Emergency services
  • Hospitalization
  • Pregnancy
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services including oral and vision care

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.

What Is Open Enrollment for Coverage Under the ACA?

Open Enrollment is the period when you can enroll in a health insurance plan. Generally, open enrollment on Healthcare.gov is from November 1 to December 15, but due to the coronavirus, the federal government extended open enrollment in 2021 through August 15. 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.

Essential Affordable Care Act Resources

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:

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