The Affordable Care Act
Congress passed and the President signed the Affordable Care Act in March 2010. This allows most young adults who can’t get coverage through their jobs to stay on their parents’ plans until age 26.
Through this act, individuals with private insurance can get recommended preventive care without paying any copay or deductible. The law eliminated lifetime limits from health insurance, discrimination due to pre-existing conditions or gender, and annual limits on insurance coverage.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is designed to help you find health insurance that fits your budget. No matter where you live, you may buy insurance from private health plans that cover a comprehensive set of benefits, including doctor visits, hospital stays, preventive care, and prescriptions. With a single application, you also will find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
What does this mean for me?
If you need coverage, you can use the Marketplace. If you have coverage, you gain additional rights and protections. If you don’t have coverage, you may have to pay a fee.
The Marketplace will operate in all states, so no matter where you live you’ll have access to coverage.
In the Marketplace, you can compare coverage options based on price, benefits, quality, and other features important to you. You can choose the combination of price and benefits that fits your budget and meets your needs.
•You may get lower costs on coverage: The Marketplace application will tell you if you’re eligible for a new way to get lower costs on your monthly premiums or out-of-pocket costs for private insurance. You’ll also learn if you can get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
•Essential health benefits are covered in the Marketplace: All plans must offer a comprehensive set of essential health benefits including:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
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)
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)
Preventive and wellness services and chronic disease management
•Pre-existing conditions will be covered: Including a pregnancy or disability.
•Preventive care: Many insurance companies are now required to cover preventive care for free. This includes 15 covered benefits for all adults, 22 for women (including pregnant women), and 26 for children
• Fees apply: Most people are required to have health coverage. If they don’t, they may have to pay a fee.
The first Marketplace open enrollment period ends March 31, 2014. Starting in 2014, open enrollment is from October 15 – December 7. HealthCare.gov is your best source of information about the Marketplace. You can read information that pertains to you, print checklists, and watch videos to help you apply and enroll.
Want help or need more information?
If you need help finding a plan, several kinds of help will be available to give you personalized assistance with the process. If you have questions about what the Health Insurance Marketplace offers or how to apply, help is available. You can visit HealthCare.gov and click on the Help link in the upper right of the screen or use the online web chat on the website; or call the Marketplace Call Center toll-free at 1-800-318-2596 , to speak with a trained customer service representative. TTY users should call 1-855-889-4325 . Tell the customer service representative if you need help in a language other than English.
Submitted by Christiana Mpaka, MA, Public Affairs Specialist, Centers for Medicare & Medicaid Services (CMS)