Affordable Care Act (ACA)
About Affordable Care Act
The Affordable Care Act (ACA), also known as Obamacare, was signed into law on March 23, 2010, with the goal of increasing access to different types of healthcare, improving affordability and improving quality.
What is the Affordable Care Act?
The ACA, or Obamacare, created Health Marketplaces, also known as Exchanges, to help people find affordable health coverage. Federal subsidies in the form of premium tax credits are available to consumers meeting income requirements to make the coverage more affordable. However, you can only get financial help from the government if you buy coverage through a Marketplace.
At Freeway, our caring and bilingual healthcare agents are ready to help you find your way through the complicated maze of health insurance.
Open Enrollment
Open enrollment is a period during which people who want to can apply for insurance through the federal marketplace or their state’s health exchange. It typically lasts around 3 months, although the time period differs from state to state.
Special Enrollment
Special enrollment is a period after open enrollment where people who missed open enrollment can apply for healthcare if they have a qualifying life event. For example, most people can enroll during special enrollment if they lose their employer-sponsored health plan through a job change.
What Does the Health Plan Cover?
Health plans must offer essential health benefit standards, including at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Who Pays for Services Provided by the Act?
Typically, both the policyholder and the federal government. You pay a monthly premium, based on the coverage you choose. That monthly premium may be lowered by a federal subsidy to help you pay for your plan. Middle and low-income families will get tax credits (stipend) that cover a significant portion of the cost of coverage. All new plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance.
Who’s Eligible?
Most people are eligible for health coverage through the Health Marketplace. To be eligible for health coverage through the Marketplace, you:
- Must live in the United States
- Must be a U.S. citizen or national (or be lawfully present)
- Are not currently incarcerated
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.
What Are the Benefits of the Program?
- New Health Marketplaces (AKA Exchanges) allow shoppers to compare health plans that include all new benefits, rights and protections.
- Cost assistance to individuals, families and small businesses through the marketplace.
- Medicaid eligibility is expanded in some states to 138% of the federal poverty level, giving millions of Americans access to healthcare.
- No annual or lifetime limits on healthcare.
- All major medical insurance is guaranteed, meaning you can’t be denied coverage for any reason.
- Insurance companies can’t drop you when you are sick or for making a mistake on your application.
Facts about ACA for Immigrants, Veterans, Children and Students
In making healthcare easier and better for most Americans, the ACA recognizes there are several groups within the population who are particularly vulnerable due to age and/or status. Fortunately, the act addresses the wellbeing of these groups who may have previously found it hard to access healthcare.
Immigrants
Immigrants who are in the U.S. legally are most likely eligible for care under the ACA. Some undocumented immigrants, such as a pregnant woman and children, may qualify for some health coverage through Medicaid. Immigrants will need to prove they are in the country legally to access healthcare through the marketplace.
Immigration Status and the Health Marketplace
Following is a list of immigration statuses that qualify for Marketplace coverage.
- Lawful Permanent Resident (LPR/Green Card holder)
- Asylee
- Refugee
- Cuban/Haitian Entrant
- Paroled into the U.S.
- Conditional Entrant Granted before 1980
- Battered Spouse, Child and Parent
- Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
- Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
- Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
- Temporary Protected Status (TPS)
- Deferred Enforced Departure (DED)
- Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health coverage)
- Lawful Temporary Resident
- Administrative order staying removal issued by the Department of Homeland Security
- Member of a federally-recognized Indian tribe or American Indian Born in Canada
- Resident of American Samoa
Applicant for any of these statuses:
- Temporary Protected Status with Employment Authorization
- Special Immigrant Juvenile Status
- Victim of Trafficking Visa
- Adjustment to LPR Status
- Asylum
- Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention Against Torture (CAT)
Only those who have been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days are eligible.
Children
Most children are covered under their parents’ health plan and coverage can now extend until the child is 26 years old. This benefit covers children whether they live at home or not, whether they are still dependents or not – even if they get married.
Some states still impose a penalty for people who do not sign up for a health plan, Medicare or Medicaid, if eligible. If you live in one of these states and your children are not receiving healthcare, you may receive a penalty. If parents cannot afford healthcare for their children, a federal program known as Children’s Health Insurance Program (CHIP) is available.
Veterans
Most veterans will receive their care through the nation’s Veterans Administration (VA) program. VA plans meet the health mandate so veterans who receive their care through the VA will not be penalized. Veterans are free to cancel their VA coverage and apply for a plan through the marketplace. Just be aware that it may increase some costs and it could affect one’s ability to enroll in VA plans later.
Veterans who are not eligible for VA benefits must apply for and receive a health policy through the marketplace and/or Medicaid/Medicare in states that penalize for not carrying coverage.
Students
Fortunately, if your parent’s plan covers you, you can stay on their plan until you are 26, regardless of whether you are a student or not. If you are not on that plan, you can apply for your own marketplace coverage.
Students who do not file taxes do not have to carry any health plan. Likewise, students who make less than $10,000 annually would not face fines for no health coverage. Students in these situations should try to find affordable healthcare through their school or through Medicaid.
Students who are not on their parent’s plan and who make more than $10,000 yearly will be penalized in states that mandate health coverage.
Why People Choose ACA
- You can’t be denied coverage for pre-existing conditions.
- You have the right to quickly appeal any insurance company decision.
- You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage.
- Young adults can stay on their parents’ plan until 26.
- The plan contains a large improvement to women’s health services.
- Better care and protections for seniors.
- New preventative services at no-out-of-pocket costs.
Find out if you are eligible for subsidized health plans and get a free quote today.
The ACA does not replace private insurance, Medicare or Medicaid.
Get Affordable Health Insurance through the ACA Today
You have choices when you shop for health insurance. At Freeway Insurance, our bilingual, experienced healthcare agents can help you work your way through finding affordable or no-cost healthcare for you and your family.
Give us a call today at 800-777-5620 to find out how we can help you and your family get insurance for all your needs.