What is ACA Health Insurance?

Health insurance is a vital aspect of maintaining good health, and in the United States, the Affordable Care Act (ACA) has made health care more accessible and affordable for millions of people. ACA health insurance, also known as Obamacare, is a federal law that was signed in 2010. The law aimed to expand access to health insurance, improve the quality of care, and reduce the cost of health care for individuals and families.

The Basics of ACA Health Insurance

ACA health insurance is a type of health insurance that is available to individuals and families who do not have health coverage through their employer or through a government program like Medicare or Medicaid. ACA health insurance plans are sold through state-based marketplaces or exchanges, and they offer comprehensive coverage that includes essential health benefits such as preventative care, hospitalization, prescription drugs, and mental health services.

Unlike traditional health insurance plans, ACA health insurance plans cannot deny coverage to individuals with pre-existing conditions, and they cannot charge higher premiums based on a person’s health status or gender. ACA health insurance plans also provide financial assistance to individuals and families who meet certain income requirements.

Who is Eligible for ACA Health Insurance?

All U.S. citizens and legal residents are eligible to purchase ACA health insurance, regardless of their health status or income level. The law also requires most Americans to have health insurance or pay a penalty, unless they qualify for an exemption.

Individuals and families with incomes up to 400 percent of the federal poverty level may qualify for financial assistance to help them pay for their insurance premiums and out-of-pocket costs. The federal poverty level changes each year, but in 2021, it is $12,880 for an individual and $26,500 for a family of four.

Benefits of ACA Health Insurance

ACA health insurance has several benefits for individuals and families, including:

Essential Health Benefits

Essential health benefits are a core set of benefits that all ACA health insurance plans must cover. These benefits include:

• Ambulatory patient services (outpatient care that you get without being admitted to a hospital)
• Emergency services
• Hospitalization (including surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services (including counseling and psychotherapy)
• Prescription drugs
• 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)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including oral and vision care)

Consumer Protections

ACA health insurance plans are required to meet certain standards for quality and consumer protections. These protections include:

• Guaranteed issue: ACA health insurance plans cannot deny coverage to individuals with pre-existing conditions.
• Community rating: ACA health insurance plans cannot charge higher premiums based on a person’s health status or gender.
• No annual or lifetime limits on essential health benefits.
• Maximum out-of-pocket limits: ACA health insurance plans must have annual out-of-pocket maximums that limit the amount of money that individuals and families pay for covered health care services each year.

FAQ About ACA Health Insurance

What is the deadline for enrolling in ACA health insurance?

The open enrollment period for ACA health insurance runs from November 1 to December 15 each year. However, individuals who experience certain life events, such as getting married, having a baby, or losing their health coverage, may qualify for a special enrollment period.

How much does ACA health insurance cost?

The cost of ACA health insurance depends on several factors, including a person’s age, income, family size, and location. However, individuals and families with low and moderate incomes may qualify for financial assistance to help them pay for their insurance premiums and out-of-pocket costs.

Can I keep my doctor if I enroll in an ACA health insurance plan?

Most ACA health insurance plans have provider networks, which means that individuals may need to choose a doctor or hospital that is in their plan’s network in order to receive the highest level of coverage. However, some plans may allow individuals to see providers outside of their network, although they may pay more for those services.

What happens if I don’t have health insurance?

Under ACA, most Americans are required to have health insurance or pay a penalty. The penalty for not having health coverage varies depending on a person’s income and family size. However, the penalty was eliminated starting in 2019.

Is ACA health insurance the same as Medicare?

No, ACA health insurance is not the same as Medicare. Medicare is a federal health insurance program for individuals who are 65 and older or who have certain disabilities. ACA health insurance is available to individuals and families who do not have health insurance through their employer or through a government program like Medicare or Medicaid.