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What Is The Affordable Care Act (ACA)?

The Affordable Care Act (ACA) was designed to give people and their families better access to affordable health insurance options. These options include coverage for medical, vision, dental, and other types of health insurance that may not be obtainable on their own or through an employer.

If you have coverage under the ACA:

  • You may be able to purchase health care through your state or federal marketplace. These offer a choice of healthcare plans and coverages.
  • Insurance companies cannot refuse to cover you based on pre-existing conditions or gender.
  • The annual and lifetime limits on coverage are eliminated.
  • Young adults can stay on their family’s private healthcare insurance plans until they reach the age of 26.
  • Seniors who may fall under the Medicare Prescription Drug Plan coverage gap can receive discounts on medications.

Part of the ACA was a tax penalty for those citizens who did not have insurance coverage. The flat fee for individuals without insurance was $695 per adult and $347.50 per child under 18 years of age. The maximum amount for the penalty was $2,085 per family.

In one of his first acts of office, President Donald Trump spoke of his intention to defund the Affordable Care Act. The repeal of the entire law was not successful. However, Congress did sign for the penalties to be removed. The change took effect with the 2019 tax year.

Despite the repeal of the penalties, there is no good reason for families not to have health insurance. State and other programs are available through the ACA to help with the affordability of health insurance coverage.

When To Enroll For Coverage Through ACA Marketplace

Each year, an open enrollment period is available for citizens to signup or make changes to their existing healthcare coverages. This open enrollment period is for those plans that have been purchased through the ACA Health Insurance Marketplace. As a general rule, these enrollment periods often open within the last two to three months of the year (October, November, December).

What Happens During Open Enrollment?

Open enrollment only happens one time during the year. Once it is closed, you can only make coverage changes or start new coverage if you meet qualifications for specific life changes. Keep in mind that all changes made during open enrollment will not take effect until January 1 of the next calendar year.

During open enrollment, you can:

  • Re-enroll in your current plan for the next year
  • Choose a coverage plan for the first time
  • Replace your existing plan with a new one
  • Make changes to the existing plan

You can also enroll or change your plan year-round if you have specific life changes, including:

  • Getting married or divorced
  • Having a baby, adopting a child, or adding a dependent to your family
  • Losing coverage you previously had
  • Moving to a new state
  • Qualifying for a Medicaid or CHIP healthcare plan

How To Enroll and Get Your Questions Answered

If you are interested in going through the ACA Health Insurance Marketplace for coverage, you can go online to HealthCare.gov. When enrolling, the site may redirect you to your state’s health insurance marketplace. Marketplaces, subsidies, prices, programs, and plans vary by state, which can change the plans available.

You can also contact the Marketplace Call Center by phone at 1-800-318-2596 or TTY at 1-855-889-4325.

If you need a more personalized approach for assistance, you can also find a local agent, broker, or assister near you. These local resources are available to help you with your application. They should be able to answer generalized questions for you about the ACA and your coverage options as well. Some states even certify their assisters, which will be available through your state’s marketplace site for assistance.

If you prefer, you can download the application and print it out. The address to return the form will be listed on the form. If you must submit documents, those can be sent as well, or you can upload all documents online.

Individual Coverage Questions

Any questions you might have about your purchased policy will have to be discussed with the insurance company. The insurance company can provide you with detailed information about doctors, treatments, medications, medical equipment, and what is or is not covered under your health insurance policy.

The contact information for the insurance company should be listed on the back of your insurance card. You should receive this card in the mail (or online) prior to the effective date of the policy. You may be able to use the bill for the premium to find contact information for the insurance company as well.

All payments for premiums are made to the insurance company, not through the ACA Health Insurance Marketplace. If you cannot find your insurance company’s contact information, you can call the Marketplace Call Center to obtain the correct information.

If you have filed a claim with the insurance company and they are disputing it, you can reach out to the Marketplace Call Center for additional help with the appeal process.

Essential Health Benefits Covered

All health insurance plans that are ACA-compliant, including those sold through the ACA Health Insurance Marketplace, must cover specific essential health benefits. These required covered services include:

  • Breastfeeding
  • Family planning
  • Laboratory services
  • Pregnancy, maternity, and newborn care
  • Preventative and wellness services
  • Chronic disease management
  • Rehabilitative and habilitative services
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Mental health and substance abuse disorder services
  • Prescription medicines
  • Pediatric services

In addition to these required services, a list of preventative services must also be provided at no cost to the insurance policyholder. Most preventive services are to help with disease screening, immunizations, identify the risk factors for disease, discuss tips for a healthy lifestyle, and maintain a good relationship with a healthcare provider. Preventive services are available for adults, women, and children. These services are covered at no cost to help policyholders stay healthy.

The ACA Makes Health Insurance Coverage Possible

One of the central goals of the ACA was to expand Medicaid coverage, allowing low-income adults to be included in the eligibility criteria. The expansion brought the income level to 138% of the federal poverty level. The expansion made it possible for many low-income adults to receive medical treatment that was unable to get it before.

Even with all the different options for enrollment and premium requirements, the Affordable Care Act made a lot more possible for the country when looking to receive healthcare. Many private health insurance companies are a part of the network that provides ACA-compliant health insurance coverage to individuals and families across the country.