Job and Financial Concerns

August 31, 2015

On March 23, 2010, the Affordable Care Act (ACA, sometimes also called Obamacare) created a series of health insurance reforms.

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 with low incomes.

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

  • Genetic counselinginfo-icon about BRCA testing for women at high-risk for breast cancer, and, if testing is recommended, the BRCA test.
  • Breast cancer chemopreventioninfo-icon counselinginfo-icon 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 mammograms every 1 to 2 years for women age 50 – 74
  • 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. As part of the ACA, you can now remain on your parents’ plan until age 26 regardless of whether you are a student or are working.

If you are unemployed and have an income level under $16,243 per year (single person, as of 2015), you may also qualify for Medicaidinfo-icon.

Senior Citizens

The Affordable Care Act expands prescriptioninfo-icon coverage through Medicareinfo-icon Part D, by lowering the amount that you pay for your brand-name and genericinfo-icon 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. This includes denying you coverage or charging higher premiums. One exception is individual grandfathered plans, which may still deny coverage.

Grandfathered plans refer to health insurance plans that began before March 23, 2010. If your plan began after that date, it is considered non-grandfathered, and must meet the new requirements set by the ACA. A grandfathered plan may become non-grandfathered if it changes significantly over time. Many insurance companies are opting to update previously-grandfathered plans, which force them to meet ACA requirements.

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.  They can also help you determine if you are eligible for any financial assistance, such as premium tax credits and cost-sharing subsidies.

Financial Assistance to Help Pay for Health Insurance

Depending on your income level, you may qualify for tax credits or cost-sharing subsidies to help pay for health 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 clinicalinfo-icon trials.

General Insurance Restrictions

Insurance companies can’t take away coverage when you get sick because of unintentional mistakes on an application.

Health plans can no longer set 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. 

Right to Appeal

The Affordable Care Act gives everyone the right to appeal their insurance company’s coverage decision. Most states offer a Consumer Assistance Program through the state’s insurance agency, which provides information and assistance with the appeals process.

There are two ways to appeal:

  • an internal appeal asks your insurance company to review their decision and reconsider whether they will cover the claim
  • an external or independent review involves having a third party look at your claim and the insurance company’s decision, and decide whether they support the decision

Under the law, you are allowed to ask for an external review if the insurance company still denies your claim after an internal appeal. To learn more about this process, visit

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Article August 31, 2015