The Affordable Care Act (ACA) is an ambitious federal law which is expanding access to health insurance coverage among millions of Americans while simultaneously helping lower healthcare costs and improving access.
The Affordable Care Act (ACA) offers subsidies and tax credits to help lower health insurance premiums for people who cannot afford it, as well as mandating that insurers provide essential health benefits in their policies.
Open Enrollment
The Affordable Care Act offers individuals an annual opportunity to shop and compare plans for health insurance through an open enrollment period, giving them a chance to switch plans, add extra coverage or select lower cost plans.
Employers and Medicare generally hold open enrollment periods each fall, prior to coverage beginning January 1. It’s crucial that individuals take advantage of this opportunity; missing it could cost them coverage until another open enrollment period opens up.
By 2023, thanks to new financial assistance for premiums, 4 out of 5 Americans will be able to find a plan costing $10 or less monthly and enable more individuals to access coverage.
Some types of insurance do not utilize open enrollment periods, including short-term or accident policies and supplemental medical and dental plans that are available throughout the year. Other health plans like employer-sponsored and marketplace health plans do provide an open enrollment period.
Special Enrollment
Open enrollment for individual market marketplace coverage typically runs between November 1 and January 15 in most states; state-run exchanges may have different deadlines.
At other times, enrollment outside open enrollment may become necessary – for instance, when people lose employer-sponsored coverage, age out of a parent’s plan, or relocate. Qualifying events trigger a special enrollment period (SEP), giving up to 60 days post event for people to enroll in health coverage.
Loss of coverage typically initiates a special enrollment period (SEP). Other qualifying life events could include becoming pregnant, gaining legal residency/citizenship status, domestic abuse or being subjected to domestic violence as qualifying events.
Tax Credits
Tax credits are among the many tools of the Affordable Care Act designed to help people save money on health insurance coverage, both monthly and annually. Tax credits may help lower monthly costs as well as your tax bill at year’s end.
Premium tax credits are refundable, meaning they do not count toward federal income taxes when used to purchase insurance policies at affordable costs. They can be an invaluable lifeline for families struggling to cover the expense on their own.
Under the American Recovery and Reinvestment Plan (ARP), individuals who don’t meet Medicaid or Medicare criteria but still want lower insurance costs can access advance premium tax credits (APTC), which help offset some of their insurance expenses. How much you get depends on your family size, income level and other considerations.
Without the Affordable Protection and Treatment Coverage Coalition (APTC), over 3.1 million individuals could lose coverage and become uninsured in 2023, especially low and middle income families.
Eligibility
The Affordable Care Act (ACA) offers several avenues for acquiring health insurance coverage, including federally funded expansion of Medicaid or purchasing subsidized policies from private insurers. Furthermore, this act makes it illegal for insurers to deny coverage or charge higher premiums to people with preexisting conditions.
Affordable Care Act premium tax credits and cost-sharing reduction subsidies are available for households earning incomes that fall within 400% of poverty level, as well as to those purchasing coverage on the Marketplace.
The Affordable Care Act (ACA) mandates that health plans provide essential health benefits (EHBs), such as ambulatory patient services, hospitalization, emergency services, prescription drugs and maternity and newborn care. Furthermore, group health plans cannot impose annual or lifetime dollar limits on EHBs.
