In Case You Didn't Know
You may have benefited if:
- You have not been able to afford health insurance.
- Your income has been a little too high to get Medicaid.
- You have young adult children who need insurance coverage.
- You have a chronic or serious health condition.
Fewer Limits on Your Coverage
With health reform, health plans can no longer deny you coverage or say that your coverage has run out.
You can have a long-standing health problem and still get insurance. No matter how good or bad your health might be, health plans must let you buy insurance. Everyone must be offered insurance coverage by insurers even if they already have a health problem, called a pre-existing condition. Plus, having a health problem won’t increase how much you pay for your insurance.
You do not have to worry that your health coverage will run out. Your health plan cannot limit what it spends on your covered benefits each year or in your lifetime.
More Affordable Health Plans
Most people are subject to the Affordable Care Act’s “individual mandate.” That means if you don’t have health insurance, you may be on the hook for a tax penalty. But don't panic. The government has set up ways to help you.
You may be able to buy less expensive insurance through a Marketplace , also called an Exchange. There is a Marketplace available for every state where you can shop for coverage options, select and buy a health plan. This may help if you don’t have insurance now or if you have trouble paying for it. You may have already bought a plan through the Marketplace. If so, you can compare plans and buy a new one, if you like, each year during the annual open enrollment period.
You can review your new insurance options through a Marketplace. You can use a Marketplace online, in person, or by phone. There are customer service representatives who have been trained to answer your questions and who are available by phone. There are also people working in community-based organizations called assisters and navigators who can help you sign up for a health plan in person.
Financial Help to Buy Insurance
You may qualify for financial help to help reduce the cost of your insurance.
You may be able to get a tax credit to lower the cost of your insurance. Whether you qualify for a tax credit, which is also called a subsidy, will depend on your income and how many people are in your family.
In general, you'll be eligible if you're single and make $48,560 or less a year in 2018, or if you have a family of four and make $100,400 or less a year.
You can find out if you qualify for a tax credit when you apply to buy health insurance through your state's Marketplace.
If you still cannot afford insurance, there is a way to avoid paying a fine. The law says if you don’t have health insurance you may be required to pay a tax penalty, which is $695 per adult or 2.5% of your income, whichever is higher. But if you cannot find insurance that costs less than 8.16% of your income (in 2016), or if you face a variety of other situations that make it hard for you to get insurance, you can apply for an exemption. If you qualify, you will not have to pay the tax even if you don’t have coverage. Beginning in 2019, the fine for not having insurance is eliminated.
Expansion of Medicaid
You might be able to use Medicaid for the first time. In some states, Medicaid is changing because of health reform. More people will qualify for it.
Under the new rules, you may be able to get Medicaid in 2018 if your yearly taxable income is no more than $16,753 for one person and $34,638 for a family of four, if your state has expanded Medicaid as allowed under the law. In 2018, 33 states and DC have expanded Medicaid. You can find out if your state is one of them at healthcare.gov.
Extra Benefits Under the Law
The Affordable Care Act provides several protections and benefits, including:
You can keep your children on your health insurance longer. Your children can stay on your policy until they are 26 years old.
You can get some types of care without paying extra costs. Certain tests and checkups, called preventive services, are now completely paid for by your insurance (unless you carry a health insurance plan that was grandfathered in before March 23, 2010 or you have a short-term health plan that provides coverage for less than 12 months). These include a well-child visit each year, blood pressure and cancer screenings, and flu shots. This means:
- You do not have to make a copay. That’s the amount you usually have to pay each time you see a doctor.
- You do not have to pay anything toward your insurance deductible if your health plan has one. The deductible is an amount you must pay before your insurance pays for any of your care.
You’re better protected by insurance. If you or someone in your family gets sick, your insurance company can no longer cancel your coverage. Health insurance plans must cover a list of 10 essential health benefits. Grandfathered health plans and short-term health plans do not have to provide the essential health benefits.
Essential benefits include emergency services, hospitalization, maternity and newborn care, prescriptions, and more. You can choose who will be your primary care provider, often referred to as PCP. Your PCP is your lead health care professional -- the one you see for screenings and when you're sick. A PCP can refer you to specialists if you need them.
It’s your right to appeal insurance decisions. Each plan must have an appeals process, which tells you the steps you must go through to ask a health plan to pay for something they said wasn't covered. When they deny coverage, every health plan must tell their members, in writing, what the appeals process is. You can also appeal to an organization outside your health plan for an independent decision. Your plan must give you information about this external appeals process.