The Affordable Care Act’s health insurance marketplaces enable Americans to purchase private health care coverage with financial assistance and prohibits insurers from discriminating against people who have preexisting conditions.
Before the Affordable Care Act was in place, millions of low-income Americans could not afford health insurance. Now they are eligible for free preventive services like cancer screenings, cholesterol checks and annual checkups.
1. High deductibles
Under the Affordable Care Act (ACA), health plans must provide certain preventive services without cost sharing requirements – this may include annual physicals, screening tests for various diseases and immunizations.
The Affordable Care Act has prohibited insurance companies from discriminating against people with preexisting conditions or charging more, which has kept premiums more affordable; however, deductibles remain too high for many families; increasing coverage and decreasing deductibles could help increase affordability and improve affordability.
2. Expiring subsidies
Subsidy enhancements under the American Rescue Plan were due to expire in 2022; however, due to Inflation Reduction Act extensions they are extended until 2025.
Without subsidy enhancements, many would find health coverage unaffordable in the marketplaces – particularly those living near poverty lines; for instance, a 60-year-old making over $55,000 would pay roughly 8 1/2 percent of their income towards a Silver plan without subsidies.
3. High deductibles
Before the Affordable Care Act was in place, insurers could deny coverage for preexisting conditions at higher prices and deny coverage altogether if needed. With its introduction of consumer safeguards and protections such as ACOs – that practice no longer existed.
High deductibles still make Marketplace plans unaffordable to millions of people even with increased subsidies, even with increasing health costs over time. They cannot meet their deductibles and may skip needed preventive services due to inability to afford the necessary payments – this ultimately drives up overall health costs further, rendering the ACA less affordable overall.
4. High out-of-pocket costs
Even though the Affordable Care Act has reduced the share of Americans who face very high out-of-pocket costs, cost remains a significant barrier to health insurance coverage.
Affordable Care Act-compliant health plans must set limits on out-of-pocket costs each year; in 2022, that cap stands at $8,700 for an individual and $17,400 for families.
Private health insurance premiums have seen significant increases since the Affordable Care Act’s implementation, leading to higher deductibles and premiums.
5. High deductibles
The Affordable Care Act (ACA) created health insurance marketplaces where financial assistance was available to assist people in affording premiums and cost-sharing costs. The law also mandated new regulations for individual health plans on the individual market as well as annual limits for deductibles in marketplace and cost-sharing reduction (CSR) plans.
United States policymakers have led in advancing key affordability reforms, such as expanding coverage to those with preexisting conditions and eliminating copays and deductibles for preventive services. Unfortunately, however, their gains could be jeopardized as long as the Trump administration’s lawsuit against ACA remains active.
6. High out-of-pocket costs
The Affordable Care Act sets limits on an enrollee’s annual maximum out-of-pocket costs associated with in-network covered services; these amounts tend to increase.
HHS uses a formula to determine how much the limit should increase annually, and in 2020 and 2021 utilized an approach that considered premiums from individual market plans as well as those from employer-sponsored plans when conducting its calculations.
7. High deductibles
Even as coverage expands and patient protections expand, patients continue to bear an ever-increasing share of healthcare costs – due to high premiums, out-of-pocket expenses, restrictive networks and skyrocketing profit margins among top insurers and their CEOs.
The Affordable Care Act has transformed these markets, by limiting cost sharing and providing financial aid for plan premiums and costs based on income. AMA encourages an extension of these provisions moving forward.
8. High deductibles
The Affordable Care Act limits deductibles to the annual health plan premium costs; however, many consumers still find the costs unaffordable even with subsidies available to them.
Studies indicate that high out-of-pocket costs and deductibles deter consumers from seeking care they need. To address this problem, states could expand coverage options by creating plans with lower actuarial values – bronze or silver plans with sizable deductibles could provide effective solutions.
9. High deductibles
High deductibles are one of the key obstacles to accessing health care, shifting risks and costs on to patients while decreasing plan benefits and restricting insurers’ ability to negotiate lower prices for customers. States must make sure they address this critical affordability barrier by tapping into new federal resources available; HSAs may help lower the costs associated with high deductible plans. Learn more.
10. High deductibles
Plans with high deductibles require you to cover more of your health care costs before the insurance company will start paying (known as high deductibles). HSAs may be useful when taking advantage of such plans.
The Affordable Care Act prohibits insurers from discriminating against women by charging more for coverage or excluding essential health benefits like contraception and maternity care, and requires annual limits on cost sharing plans.
