Affordable Care Act

About Affordable Care Act

The Affordable Care Act (ACA) also known as Obamacare, was signed into law on March 23, 2010, with the goals of increasing access to healthcare, improving affordability and improving quality.

What is the Affordable Care Act?

The ACA created Health Insurance Marketplaces, also known as Exchanges, to help uninsured people find health coverage, starting on January 1, 2014. Federal subsidies in the form of premium tax credits are available to consumers meeting income requirements to make the coverage more affordable. However, under the ACA, you can only get financial help from the government if you buy coverage through a Marketplace.

What Does the Affordable Care Act 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 Affordable Care Act?

You pay a monthly premium, based on the coverage you choose. However, middle and low-income families will get tax credits 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 for the Affordable Care Act?

Most people are eligible for health coverage through the Health Insurance Marketplace. To be eligible for health coverage through the Marketplace, you:

1

Must live in the United States
2

Must be a U.S. citizen or national (or be lawfully present)
3

Can’t be currently incarcerated

If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.

Immigration status and the 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 insurance)
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.

What Are the Benefits of the Affordable Care Act?

New Health Insurance 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 26 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 issue, 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.

Why Do People Choose

You can’t be denied coverage for pre-existing conditions.
You have the right to quickly appeal any health 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.
A large improvement to women’s health services.
Better care and protections for seniors.
New preventative services at no-out-of-pocket costs.

The ACA does not replace private insurance, Medicare or Medicaid. Did you know you don’t have to be retired to apply for Medicaid?

You have choices when you shop for health insurance. Familiarize yourself with the available types of health insurance plans. There are many available programs that meet the new government health insurance requirements that can ensure you obtain the health coverage you need.