The Affordable Health Care Act and You

The Affordable Health Care Act and You

While it is not possible to summarize the 2000-plus page document here, there are some highlights of the affordable health care act that you should know that are currently in effect and those that will go into effect in the next few years.

According to the Affordable Care Act,* the face of health care coverage is changing. By law, insurance plans that went into effect after March 23, 2012 have to meet certain requirements. If you have had health insurance for the past year, you may want to check with your insurance company to see what these changes mean to you.

If you purchased a new plan after March 23, you may see some changes. You may now have:

Access to free preventive services such as certain screenings, counseling, routine vaccinations, flu and pneumonia shots and regular well-baby check-ups.

The right to keep your young adult child on your plan until he or she is 26 years of age, even if your child does not live with you, is married, does not depend on you for financial support and is no longer in school. (There are a few exceptions; if you had group health or employer health insurance before March 23, 2010, check with your employer to see if your child qualifies.)

The Affordable Care Act also:

Provides access to health insurance care plans without limit or denial of benefits for your child or young adult (up to age 19) if he or she has a pre-existing disease or disability. (If your health plan was in place before March 23, 2010, it may be exempt. Call your health care provider to verify coverage.)

May allow many adults who have been uninsured for at least 6 months and have been denied coverage because of pre-existing condition to enroll in the Pre-Existing Condition Insurance Plan (PCIP).Adults may enroll in the Standard Plan, the Extended Plan and the Health Savings Account eligible plan. Children may be enrolled at child-only rates. These plans may vary by state. Visit for more information.

Employer health and individual insurance plans purchased after March 23, 2010 can no longer specify lifetime dollar limits on care, although health insurance plans can limit the annual dollar amount of non-essential health services.

The Affordable Care Act also helps close the coverage gap for people in the Medicare Part D “doughnut hole.” These are the people who pay the full amount for their drugs after they reached the drug spending limits of their health plans. Under the Affordable Care Act, they will get a 50 percent discount on name-brand prescription drugs and a 7 percent discount on generic prescription drugs. Over the next 10 years there will be even more savings on prescription drugs. People enrolled in “Extra Help,” a program that helps people pay for their drugs are not eligible for the automatic discount.

People currently receiving Medicare Part-B can now receive yearly wellness exam, as well as preventive screenings for cholesterol, diabetes, certain types of cancer and other diseases at no cost to them. Visit for a complete list of services.

People who will be enrolling in Medicare Part B, will be welcomed to the program with a “Welcome to Medicare” physical at no cost during the first 12 months of coverage. Twelve months after the initial exam, patients can get a yearly wellness exam to update or develop a care plan with their health provider.

Small businesses with 25 employees or less may qualify for tax credits if they meet certain eligibility requirements. This tax credit will increase in 2014.

2014 will bring even more changes

As of January 1, 2014, insurance companies will cover everyone, even those people with pre-existing conditions or disabilities. In addition, premiums will no longer be based on gender and health status.

The health insurance shopping process will be more streamlined. Health insurance plans will have to offer a list of key health benefits and coverage, which will make it easier to make a decision when purchasing insurance. Some of these benefits include:

  • Emergency room visits
  • Hospitalizations
  • Maternity and newborn care
  • Mental health
  • Prescriptions
  • Lab services
  • Preventive care
  • Chronic disease management (such as asthma or diabetes)

Most people will be to buy health insurance that covers essential health benefits. There may be financial assistance to those who cannot afford the cost. People who do not purchase insurance will pay a fee ranging from $695 to $2,085 depending on their income. People who would have to pay more than eight percent of their monthly income to by insurance may be exempt.

Annual dollar limits on how much care a health insurance plans will cover will not be allowed in most instances. Though some health plans may be eligible to opt out.

Individuals and small companies will be able to purchase health insurance through state-based exchanges. All health insurance plans in the exchange must offer the essential health benefits. Tax credits may be offered to people who can’t afford to purchase the insurance.

People earning less than 133 percent of the federal poverty level, will be eligible to enroll in Medicaid no matter which state they live in.


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