Key Facts About the ACA
One of our roles as a healthcare provider is to help make our community healthier by providing relevant information and education. Here are the key facts you need to know about the Affordable Care Act:
- The Affordable Care Act requires everyone to have health insurance, as of January 1, 2014. The goal is to make coverage more accessible and affordable for people who don’t have health insurance or who have limited coverage.
- There are new, affordable insurance options available for people without insurance.
- All insurance plans have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.
- Financial help is available so it’s easier for people to find plans that fit their budgets.
- All insurance plans have to show the costs and what is covered in simple language with no fine print.
- Insurance plans can’t deny people for pre-existing conditions.
- Help is available online, by phone, and in person to help people find the plan that works best for them. Plus there’s support for every language that’s spoken in the United States.
- You can apply starting November 1 and coverage can start January 1 of the following year.
- After January 31, you can’t buy a health insurance plan for the rest of that year, unless you have a life change — like having a baby, getting married, or losing other health coverage — that qualifies you for a Special Enrollment Period.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is for people who don’t have health coverage. If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help you get covered.
- If you have job-based insurance: You can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards. Most job-based plans do.
- If you have Medicare: You can’t switch to Marketplace insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan.
A Health Insurance Plan with Savings
Most people who apply qualify for a premium tax credit that lowers their monthly insurance bill. Some also save on out-of-pocket costs like deductibles and co-payments. The plans are offered by private insurance companies with a range of prices and features. All plans cover:
You can add dental to a health plan, but you don’t have to. You can’t buy a dental plan unless you enroll in a health plan.
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and CHIP provide free or low-cost coverage to millions of people and families with limited income, disabilities, and some other situations. There’s no limited enrollment period for Medicaid or the Children’s Health Insurance Program (CHIP). You can apply any time. Many states are expanding Medicaid to cover all households below certain incomes. See if your state is expanding and if your income is in range to qualify.
Your children may qualify for CHIP even if you don’t qualify for Medicaid.
SHOP Coverage for Businesses and Non-Profit Organizations
The Small Business Health Options Program (SHOP) Marketplace is for small employers who want to provide health and dental coverage to their employees — affordably, flexibly, and conveniently. To use the SHOP Marketplace, your business or non-profit organization must have 50 or fewer full-time equivalent employees (FTEs). (Some states may use different employee maximums for 2017.)
You can start offering SHOP coverage to your employees any time of year. There’s also no limited enrollment period for small businesses to enroll in SHOP coverage for their employees. You can apply any time.
You Can Apply for Coverage 4 Ways
You can apply for health insurance any way that works for you:
- By phone
- With in-person help
- With a paper application