What is The Affordable Care Act (Obamacare)?
The Affordable Care Act (ACA) is designed to make guaranteed issued health insurance plans available to everyone. These plans cover preexisting conditions along with a list of essential health benefits that don’t change from plan to plan.
Getting ACA Coverage
The ACA has established a yearly Open Enrollment Period for individual health insurance. In most cases, if you want ACA coverage, you must enroll in an ACA-compliant medical plan within that period. However, if you experience a qualifying event outside of that Open Enrollment window, you may be able to enroll during a Special Enrollment Period.
Open Enrollment Period for 2024 ACA plans
Open Enrollment Period for 2024 ACA Medical Insurance plans begins November 1, 2023No qualifying event needed to enroll.
Qualifying for a medical insurance premium tax credit
Many who apply for health insurance coverage on the marketplace qualify for premium tax credits that can help lower the costs of getting coverage. The amount you may receive is based on the size of your family and your annual income. You can learn more about tax credits and other ways you might save at Healthcare.gov.
Health Insurance Coverage and Exemptions
When the ACA was first implemented, you could be subject to a federal tax penalty if you weren’t covered by a health plan that met or exceeded the ACA’s minimum essential coverage requirements. The federal tax penalty no longer applies. However, state penalties may still apply in some states. Check with a tax advisor in your state for more information.
If you are subject to a state penalty, different kinds of exemptions may apply to your situation: income-related, health coverage-related, group-related, hardship-related, and more. If you believe you may be eligible for an exemption, you can learn more at Healthcare.gov about fees and exemptions
ACA Medical Insurance Plans and Preexisting Conditions
Preexisting condition limitations have been eliminated from ACA health plans. You can’t be denied ACA health insurance coverage based on a health condition, and you can’t be charged a higher premium because of your condition.
The Essential Health Benefits
Federal guidelines have been established to expand coverage and to ensure important health areas like maternity care, newborn care and mental health care are a part of all ACA coverage. To be minimum essential coverage all ACA medical insurance plans must cover what are known as “essential health benefits,” including:
- Outpatient services
- Emergency services
- Hospitalization
- Laboratory services
- Maternity and newborn care
- Mental health and substance use disorder services including behavioral health treatment
- Pediatric services, including dental and vision care
- Prescription drugs
- Preventive and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices
Coverage for Older Children
If a health insurance plan covers children, they can be added to or kept on the parent’s policy until they turn 26 years old.
Health Care Reform & Existing Coverage
Over time, we anticipate further regulations to guide in implementing the health care reform law, and there may be new requirements in individual states as well. We can assure you that our health plans comply with applicable state and federal laws today and will continue to do so as changes take effect.
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