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Health Care Reform:

Health Insurance & Affordable Care Act

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Qualified health plan (QHP)

A qualified health plan is an insurance plan that meets your state's standards for covering basic health needs. Every health plan on your state's Marketplace has to be a qualified health plan. These are some requirements a QHP must meet:

  • Covers essential health benefits such as doctors’ visits and emergency care
  • Limits how much you have to spend in deductibles, copays, and out-of-pocket health care costs
  • Includes a reasonable number, which is decided by your state, of providers in its network
  • Covers individuals and families
  • Must offer the same rate whether you pay for your own insurance or get insurance through your employer
  • Does not discriminate against your age, gender, disability, race, or sexual orientation

If you do not enroll in a qualified health plan, you will have to pay a penalty based on your income level. The exception is if you're in a “grandfathered” plan -- one in existence before the Affordable Care Act was passed in 2010. As long as the grandfathered health plan has not made significant changes to benefits, you do not have to pay the penalty.

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