What is The Affordable Care Act?

The Affordable Care Act, also commonly referred to as “Obamacare,” is healthcare reform legislation that was signed into law by President Barak Obama in 2010. The law has many provisions that have been and continue to roll out in phases, some of which will not go into effect until 2022.

With the passing of Obamacare, nearly all Americans are now required to carry health insurance, and large employers must also offer their employees access to group health insurance plans. Failing to do so on either account results in a tax penalty, payable when filing income taxes. In addition to these mandates, states have been encouraged to expand Medicaid, and every individual who purchases their own health insurance has access to a state exchange or the federal marketplace to shop for insurance and receive a cost subsidy to lower the monthly premium amount on their healthcare plan.

What are the benefits of the Affordable Care Act? There are many. Individuals with a pre-existing condition can no longer be denied health insurance, and are eligible for health insurance at the same rate as a healthy individual. Gender discrimination was also struck down with the mandate, allowing men and woman to pay the same rate each month. One of the biggest victories for Obamacare advocates was gaining essential health benefits. Every health insurance company selling healthcare plans on a state exchange or the federal marketplace must include 10 essential health benefits in every plan for it to be considered a qualified Obamacare healthcare policy. The benefits include (although some specific services do vary by state):

  1. Outpatient care
  2. Trips to the emergency room
  3. Treatment in the hospital for inpatient care (an overnight stay)
  4. Pregnancy care before and after the baby is born
  5. Mental health and substance abuse services
  6. Prescription drug coverage
  7. Services and devices that help you recover from a debilitating injury or disability
  8. Lab tests
  9. Preventive services
  10. Pediatric services, which includes dental and vision care for children.

One of the essential health benefits, preventive services, are free of charge, upholding President Obama’s campaign promise of “healthcare for all.” Today preventive services include:

  • One-time screening for abdominal aortic aneurysm in men of specified ages who have ever smoked
  • Alcohol abuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster (Shingles)
    • Human Papillomavirus
    • Influenza (Flu Shot)
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
  • Obesity screening and counseling for all adults
  • Sexually transmitted infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco use screening for all adults and cessation interventions for tobacco users

There are many rules and regulations when it comes to the Affordable Care Act, but here are some of the most important things to know about the law:

  1. Obamacare is not a government program. Health insurance is sold by private insurance companies to Americans through a state exchange, the federal marketplace or through website entities like HealthCare.org. The Affordable Care Act is the regulation that health insurance companies must abide by.
  1. Young adults can stay on their parent’s health insurance plan until they are 26 years old, whether they are single or married.
  1. The time to purchase health insurance or change plans is during the open enrollment period. This typically runs for several months at the end of each year. If enrollment is missed, certain life situations such as moving to a new ZIP code, getting married or divorced, having a baby or losing employer coverage allow individuals to enroll outside of the open enrollment period.

4. Tax credits in the form of a cost subsidy help Americans lower the cost of their health insurance if their household income falls beneath 400% of the Federal Poverty Level. A family of four that makes between $23,550 and $94,200 is usually eligible for a tax credit to reduce the cost of their health insurance.

  1. Individuals can only go up to a maximum of three months without health insurance to skip paying a penalty for not having coverage. Other exemptions do allow individuals to avoid paying the penalty at all. In 2016, those who do not carry health insurance and are not exempt from pay a penalty will owe $695 per adult person or 2.5% of their income, whichever is greater.