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Affordable Care Act: Information about the ACA

Information about the Affordable Care Act

Affordable Care Act

Features of the Affordable Care Act & what it means for Americans
 

Key Features of the Affordable Care Act

There are many features to the Patient Protection and Affordable Care Act. Below is a short list of those features frequently asked about. Many of these provisions do not take effect until January 1, 2014. Please note: eligibility for benefits under the Affordable Care Act is limited to U.S. Citizens and legal resident immigrants.

  • The Individual Mandate requires most U.S. citizens and legal residents to have health insurance. (effective Jan 1, 2014) Those that do not have insurance and who do not meet exemption requirements will be fined. The fine, unless you qualify for an exemption, is 1% of family income or $95 per adult ($47.50 for a child), whichever is greater.

    Who's exempt?
    - Individuals that qualify for Medicare, Medicaid or the Children's Health Insurance Program (CHIPS).
    - Active or retired service members and their families that qualify for Tricare.
    - Those covered by Veteran's health services
    - Anyone covered by an employer sponsored insurance program
    - Individual purchased insurance at least at the Bronze level.
    - Covered by a grandfathered insurance plan that was in existence prior to the enactment of the Affordable Care Act
     
  • Health Insurance Exchanges. (effective Jan 1, 2014) The law allows for the creation of state-based health insurance exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009). There is also a separate set of exchanges through which small businesses can purchase health insurance.
     
  • Requirement for Employers to Provide Coverage. (effective Jan 1, 2014) Employers with 50 or more full-time employees that do not offer coverage will be assessed a penalty.
    The law also requires any employer with over 200 employees to automatically enroll employees into health insurance plans offered by the employer.
     
  • Expansion of Medicaid. (effective Jan 1, 2014) The law allows for the expansion of Medicaid to individuals under 65 (children, pregnant women, parents, and adults without dependent children) whose gross income is 133% of the federal poverty level. States will receive federal funding to implement and oversee this expansion.
     
  • High Risk Pool. (effective March 23, 2010-January 1, 2014) The law establishes a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions.Individuals who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums.
     
  • Expanded Dependent Coverage. (effective March 23, 2010) Dependents under the age of 26 can be covered by a parent's individual or group policy.
     
  • Preventive Care. (effective September 23, 2010) You and your family may be eligible for some important preventive services at no additional cost to you.  If your plan is subject to the new requirements, you may not have to pay a copayment, co-insurance, or deductible to receive recommended preventive health services, such as screenings, vaccinations, and counseling.  For more information, visit: About the ACA: Preventive Care.
     
  • Closing the Medicare "Donut." In 2011, seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.
     
  • Limits on the Insurance Market. (effective January 1, 2014)
    - Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prohibit insurers from rescinding coverage except in cases of fraud.
    - Prohibit pre-existing condition exclusions for children.
    - Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits.
    - Limit any waiting periods for coverage to 90 days.

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