The ABC's of the Affordable Care Act

In 2010 President Obama signed the Affordable Care Act (ACA), the law commonly known as health reform. Health reform is changing how people get health care, how they get health insurance, what it costs and who pays for it.

A Affordable – You or members of your family may qualify for help paying for a health insurance plan. New rules make it possible for many Americans to qualify for a tax credit (also called a subsidy) to help pay insurance premiums.These savings may come in the form of a Premium Tax Credit which can be used to reduce your monthly premium payment or a program like Medicare , Medicaid or the Children's Health Insurance Program (CHIP) .

The amount of assistance you qualify for is based on things like:

  • The number of people in your household
  • Age of household members
  • Annual household income
  • Where you live

See if you qualify for a tax credit

If you do not have health insurance through your employer, you may be eligible for help paying for a plan offered in the Health Insurance Marketplace. You may qualify for one of government subsidies which pay for a portion of the plan premiums, and can be taken as a credit against annual federal taxes, or as a credit against the monthly plan premium.

B Benefits – The health insurance plans offered on the Health Insurance Marketplace include a comprehensive set of essential health benefits defined by the government. Qualifying plans sold outside the Marketplaces also include these benefits.

No matter which plan you choose, these categories of Essential Health Benefits will be covered:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity and newborn care
  • Mental health and substance use disorder services including behavioral health treatment
  • Pediatric services, including oral and vision care
  • Prescription drugs
  • Preventive and wellness services and chronic disease management
  • Rehabilitative and habilitative services and devices

C Coverage – As part of the ACA, everyone, with a few exceptions, is required to have health insurance. People who choose not to buy health insurance may pay a penalty, or fee, each year. They also pay for the costs of all their health care.

The Affordable Care Act guarantees:

  • Coverage for pre-existing conditions
  • Coverage for essential health benefits
  • Financial assistance for those who qualify. This may include a Premium Tax Credit, Medicaid, Children's Health Insurance Program (CHIP), or Medicare.

Here's a summary of other important changes:

  • If a plan covers children, they can be added to or kept on the parent's health insurance policy until they turn 26 years old.
  • You can choose your doctor from among any primary care provider (PCP) or pediatrician who's in your plan's network and accepting new patients.
  • You don't need approval in advance for emergency care.
  • You can't be denied coverage if you have a pre-existing health condition (such as diabetes or heart disease). And you can't be charged a higher premium because of your condition.

There are no lifetime or annual limits on essential health benefits.

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