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Affordable Care Act

Updated April 24, 2014

On March 23, 2010, the Affordable Care Act put into action a series of health insurance reforms to be introduced over the next several years. Most changes will take effect by 2014.

Among the changes put in place by the law are several that affect women’s health, consumer protections, and increasing access to insurance coverage for young adults and people who qualify as low-income. The Affordable Care Act also expanded coverage of prescription drugs under Medicare. Depending on your insurance carrier and when you enrolled in your current plan, some of these new requirements may impact your care and your out-of-pocket expenses.

Women’s Health

Women with a new health plan or who enrolled in a health plan after March 23, 2010, have access to free preventive services (without co-pays, co-insurance, or deductibles). Preventive services are services that help you avoid becoming sick, like flu shots. Breast cancer-related services include

  • BRCA counseling about genetic testing for women at high-risk for breast cancer
  • breast cancer chemoprevention counseling for women at high-risk for breast cancer

If you are not the first woman in your family to be diagnosed with breast cancer, BRCA and chemoprevention counseling may be options for other women in your family to explore.

  • breast cancer mammography every 1 to 2 years for women over age 40
  • well-woman visits for preventive care for all women under age 65

Young Adults

In the past, young adults could be removed from their parents’ health insurance plans at a young age or if they were not full-time students. If you are young and do not have access to health insurance through an employer, you can now remain on your parents’ plan until you are 26.

If you are between the ages of 18 and 25, are unemployed and have an income level under $15,856 per year (single person), you may qualify for Medicaid.

Seniors

The Affordable Care Act expands prescription coverage through Medicare Part D, by lowering the amount that you pay for your brand-name and generic medicines while you’re in the Medicare Part D Coverage Gap – known as the “donut hole.” The percentage you save while in the coverage gap will increase each year until 2020.

Pre-Existing Conditions

It is illegal for insurance companies to discriminate against anyone, including children, with pre-existing conditions such as cancer or pregnancy. This includes barring you from coverage or charging higher premiums. One exception is individual grandfathered plans, which may still deny coverage.

State Health Insurance Marketplaces/Exchanges

If you are uninsured or underinsured, you are able to buy private insurance through your state Health Insurance Marketplace/Exchange during an open enrollment period. Trained navigators are available to help you find the best plan for you and your family and to help you determine if you are eligible for any financial assistance in the form of premium tax credits and cost-sharing subsidies, for example.

Financial Assistance to Help Pay for Health Insurance 

If you make less than a certain dollar amount per year, you may qualify for tax credits or cost-sharing subsidies to help pay for insurance. Keep in mind, these tax credits are only available if you buy insurance through your state’s Health Insurance Marketplace.

Coverage for Clinical Trials 

Insurers may no longer drop or limit coverage for people who choose to participate in clinical trials.

General Insurance Restrictions

  • Insurance companies cannot take away coverage when you get sick because of unintentional mistakes on an application.
  • Health plans can no longer have dollar limits on how much coverage you get in a lifetime for most benefits. Annual dollar limits are banned, with the exception of grandfathered plans that existed before March 23, 2010.
  • All non-grandfathered plans are required to limit the amount of out-of-pocket expenses you pay in a year. Non-grandfathered plans are health insurance plans that were new after March 23, 2010, or have lost their grandfathered status by making a substantial change to the plan.

Right to Appeal

The Affordable Care Act gives everyone the right to appeal their insurance company’s coverage decision and provides them information and assistance. This offers you more control over your healthcare decisions.

Learn more about lead reviewer Joanna L. Fawzy Morales, Esq, and the other providers who helped us write this page in our Guide to Understanding Financial Concerns, 1st ed., 2010.

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