Overview of the Affordable Care Act
Since its enactment in 2010, the Affordable Care Act (ACA) has legislated much of how people in the United States acquire health insurance and access medical care. This law, formerly known as the Patient Protection and Affordable Care Act, is intended to provide greater access to health insurance for Americans who might not otherwise qualify. This article can help individuals and employers understand their ACA-related opportunities and requirements.
Impact of the ACA
The inception of the ACA brought many adjustments and enhancements to various aspects of the healthcare system in the United States. According to Healthcare.gov, the legislation is focused on the following three goals:
- To provide more people with access to affordable health insurance
- To cover all adults with income lower than 138% of the federal poverty level under Medicaid
- To lower healthcare costs by innovating the delivery methods of medical services
How Does the Health Insurance Marketplace Work?
In pursuit of the aforementioned aspirations, the ACA led to the creation of the Health Insurance Marketplace, which opened in 2013 and aims to help people who do not obtain health insurance through their employer. The marketplace provides Americans with the opportunity to purchase or change health plans on an annual basis during an open enrollment period starting on Nov. 1. Additional opportunities to elect insurance can also occur after the following events:
- Becoming a parent
- Losing coverage previously acquired through an employer
Employer Requirements Under the ACA
The ACA includes several requirements for employers regarding their workers’ access to health insurance. For larger companies with 50 or more full-time employees, the law generally requires that employers offer health insurance or make an employer-shared responsibility payment to the IRS. Smaller businesses can also benefit from providing health coverage for employees and may be eligible to purchase a plan through the Small Business Health Options Program.
By offering a group health insurance plan to employees, both businesses and their workers may be able to enjoy the following benefits:
- Lower premiums due to risk spread across multiple parties
- The ability for employees to add family members and dependents to the plan
- Employer access to certain tax benefits
If employees’ dependents are offered coverage, they must be allowed to remain on the plan until the age of 26.
Coverage Requirements Under the ACA
Under the ACA, health insurance companies are not allowed to deny coverage based on pre-existing conditions. Furthermore, the legislation requires most insurance plans, including those sold on the Health Insurance Marketplace, to cover various preventive services at no cost to the policyholder, including the following:
- Patient counseling
- Health screenings
Since its inception over a decade ago, the ACA has altered the landscape of the health insurance industry and changed how individuals and families access medical services. Employers have also been greatly affected by the various requirements included in the law.
The experts at Contigo Insurance Agency are well-equipped to help your individuals, families and employers understand the ACA and the various options available to them. Visit our website or call us at 866-210-7007 for more information.
This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.
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