The Affordable Care Act (ACA) 

Full name: The Patient Protection and Affordable Care Act

The ACA was signed into law to reform the health care industry by President Barack Obama on March 23, 2010 the and upheld by the Supreme Court on June 28, 2012.

The goal of the ACA is to give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending. It expands the affordability, quality, and availability of private and public health insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms.

The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. 

READ THE FULL LAW

Official certified full-text of the laws in PDF form:

Summary and certified full-text version in HTML (web page) format:

Here are some of the new benefits and protections included in the ACA:

PATIENT PROTECTIONS

  • Letting young adults stay on their parents’ plan until 26
  • Stopping insurance companies from denying you coverage or charging you more based on health status
  • Stopping insurance companies from dropping you when you are sick or if you make an honest mistake on your application
  • Preventing gender discrimination
  • Stopping insurance companies from imposing unjustified rate hikes
  • Doing away with life-time and annual dollar limits
  • Giving you the right to a rapid appeal of insurance company decisions
  • Expanding Medicaid to millions in states that chose to expand the program (not Kansas) 
  • Providing tax breaks to small businesses for offering health insurance to their employees
  • Requiring large businesses to insure employees
  • Requiring all insurers to cover people with pre-existing conditions
  • Making CHIP easier for kids to get
  • Improving Medicare for seniors
  • Ensuring all plans cover minimum benefits like limits on cost sharing and ten essential benefits including free preventive care, OB-GYN services with no referrals, free birth control, and coverage for emergency room visits out-of-network

AFFORDABLE COVERAGE THROUGH FINANCIAL ASSISTANCE

The ACA aims to make coverage more affordable by offering 2 forms of financial assistance - advanced premium tax credits and cost-sharing reductions.

1. Advanced Premium Tax Credits (APTC) = financial assistance to lower monthly premiums

APTC is a tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace, you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium.

  • If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return.
  • If you’ve taken less than you qualify for, you’ll get the difference back.

 

2. Cost-sharing reductions (CSR) = lower out-of-pocket costs 

CSR is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.”

  • These savings will be listed in the Silver category even though the plans may offer more coverage than a typical Silver plan. 
  • If you're a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for additional cost-sharing reductions.

You may qualify for help to pay your monthly premiums and/or out of pocket costs if you:

  • Have a household income between 100-400% FPL (see chart below) 
  • Are not offered insurance through a job (self or family member) 
    • If insurance for the employee is affordable but expensive for the family, you may fall in the "family glitch" and not be eligible for assistance. 
  • Are not offered other insurance (Medicaid, Medicare, VA, etc.)
  • Have legal immigration status

See if you qualify for help paying for coverage by clicking here.