Affordable Care Act – What you should know!

Affordable Care Act – What you should know!

Introduction
The Affordable Care Act (ACA) is the most comprehensive federal healthcare reform law enacted since the introduction of Medicaid and Medicare in 1965. According to the official legislation, the purpose of the law is to ensure that all U.S. citizens have access to affordable healthcare coverage. Lawmakers sought to achieve this goal by increasing the likelihood of health insurance among traditionally uninsured individuals near the federal poverty level (FPL), implementing changes within the medical insurance market, and improving the delivery of medical care. President Barack Obama signed the statute into law on March 23, 2010, and provisions went into effect on January 1, 2014. A look at the key features of ACA can provide insight on how this law affects you and help you make an informed decision about healthcare coverage.

What Are the Highlights of the ACA?
As an overhaul of healthcare policy, the Affordable Care Act brought significant changes to medical insurance in the United States. These changes included expansion of healthcare coverage, creation of the enrollment marketplace, new consumer protection laws, and regulation of quality of care.

Expansion of Healthcare Coverage
Under the rules of the Affordable Care Act, people who would have been conventionally uninsured due to preexisting conditions or low income may obtain affordable or budget-friendly insurance. One of the foremost ways is that the law expanded Medicaid coverage to individuals and families as long as they fall within the federal threshold. For example, adults without dependent children who previously did not qualify for Medicaid can now sign up for coverage. The expansion raised the threshold so that households with dependent children could qualify for either Medicaid or separate Children’s Health Insurance Programs (CHIP). The law also allows young adults to remain on their parents’ insurance plans until age 26. Finally, the law offers premium subsidies for eligible individuals who buy their own insurance and tax credits to certain small businesses that cover insurance for their employees. All large businesses of 50 employees or more must provide minimum-value health insurance to anyone who works full-time.

Establishment of the Healthcare Marketplace
The ACA created the Health Insurance Marketplaces for families and small businesses. Also known as the Exchanges, the marketplaces offer a limited open enrollment period in the fall during which families or businesses can shop for coverage. Eligible individuals or families can also find subsidized plans to make premiums more affordable.

Protection of Consumers
The ACA includes several protections for consumers. One of the most significant changes is the “guaranteed issue” insurance provision. This means that the law prohibits insurers from denying coverage due to pre-existing conditions. Insurers cannot charge higher premiums solely due to health status, and they cannot charge older enrollees more than three times the rate of younger policy holders. Consumers also have the right to appeal or request external review of denied insurance claims.

In addition to the guaranteed-issue clause, all insurance plans sold on the individual and small group markets must offer “essential health benefits.” These benefits include emergency services, hospitalization, laboratory services, and some prescription drug coverage. Even further, the ACA requires policies to offer preventive care with no cost sharing. This means that individuals may receive general screenings, immunizations, and tests without incurring out-of-pocket costs. Similarly, the preventive care mandate means that Medicare plans may now include annual wellness visits.

Quality of Care and Cost Control
Several facets of the ACA address quality of care and cost control. Following the passage of ACA, an increased number of insurance plans now cover mental health services, family planning, and maternity care. The Prevention and Public Health Fund under the ACA ensures that many plans now include screenings for high blood pressure, diabetes, or cancer. In addition, the ACA also introduced value-based payment models that reimburse healthcare facilities that can demonstrate improved patient outcomes.

What Are Controversies and Reforms Associated With the ACA?
The ACA has been controversial from the start, and reception and implementation of the provisions have varied. For example, a 2012 Supreme Court ruling determined that states could choose not to participate in the ACA’s Medicaid expansion. As a result, some states have opted out of expanding the eligibility of Medicaid.

Finally, the Trump administration expanded the availability of short-term limited duration insurance (STLDI) in 2018. This allowed Americans to receive shorter and low-cost coverage without complying with the rules of ACA. While these short-term plans increased flexibility and consumer options, some healthcare experts raised concerns about gaps in medical coverage and reduction in consumer protections. The Trump administration also allowed state exemptions from some ACA requirements using Section 1332 Waivers. These waivers allowed states to create their own eligibility requirements while still meeting general federal standards.

Conclusion
The ACA has altered many components of the U.S. healthcare system. It expanded Medicaid eligibility in many parts of the country, overhauled the self-purchased insurance market, and changed employer-sponsored health insurance for large businesses. If you find the ACA overwhelming, you are not alone. Fortunately, the experts are here to help. K&B Financial is a licensed health insurance agency that provides expert guidance and enrollment assistance. Based in Darien, we offer free consultations for all Illinois residents. We can help you pick the right family insurance or sort through group plans. Whether you have questions about Medicaid, Medicare, or private plans, we are here for you. Contact K&B Financial today for all your insurance needs.