Learn about how the law is affecting Individual & Family policies.
Qualify for Lower Costs
- Get discounted health insurance. You can qualify for a tax subsidy to help pay for your monthly premium and out-of-pocket costs when you use your plan. A tax subsidy is money that the government will pay directly to your brand-name insurance company to make your insurance more affordable.
- Medicaid Expansion. Under ACA, Medicaid has expanded to include more people. The income cut-off used to be 100% FPL, but it was raised 138% FPL. Medicaid can vary state-by-state, and not every state choose to go forward with the expansion.
- Children's Health Insurance Program (CHIP). Since 1997, each state has offered a program to help cover children whose families make too much money for Medicaid but still require some financial assistance toward health insurance.
- Medicare. If someone in your household is 65 years old or older, they qualify for Medicare. You get Part A (hospitalization) at no cost and pay a monthly premium for Part B (medical). Medicare is considered qualified coverage, so you don't need to make any changes to be compliant with the law. ACA made almost no changes to Medicare, except for shrinking the "donut hole" in Part D prescriptions plans over the next several years
Improved Benefits
- You can't be turned down for pre-existing conditions anymore. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or if you use your health plan very often. And no insurance company can drop you just because you get sick.
- You can't be charged extra premium for pre-existing conditions, gender, profession, or how often you use your plan. Also, premiums are changing so that older individuals cannot pay more than three times what a younger person pays for health insurance.
- All plans cover Essential Health Benefits with no yearly or lifetime limits. All plans must include coverage for a set of benefits with no yearly or lifetime limits, so you can never run out of insurance for core care. Essential Health Benefits includes doctor office visits, hospitalization, prescriptions, preventive care, and more.
- Is your family growing? All new plans must include coverage for maternity. If you're pregnant now, you cannot be turned down by any insurance company. And when the baby arrives, you'll get free well checkups and immunizations for your baby.
- Dental and vision care for children under age 19. Is your child overdue for a dental cleaning? Is she squinting to see the board at school? Good news! Dental and vision care for children is included in all new health plans.
- Children up to age 26 can be covered on a parent's health insurance. ACA allows for children up to age 26 to be covered under a parent's health insurance plan. It does not matter if your child is married, a student, or if you claim them as a dependent, or not. They can be covered with under your plan until they turn 26 - no questions asked.
- Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. Preventive care for children is included, too.
You still have the power of choice
- Choose your insurance company. Even if you accept a tax subsidy - where the government helps pay your health insurance costs so your plan stays affordable - you still have the power of choice.
These plans are not issued by the government, but instead, they are issued by private, brand-name insurance companies like BlueCross BlueShield, United Healthcare, Humana, Kaiser Permanente, and more.
Like a particular insurance company? Don't like a different one? No problem! You choose where you want to use your tax subsidy from the participating insurance companies in your area.
- Choose your benefits. Whether you qualify for a tax subsidy or not, you'll be choosing from four categories of plans: Platinum, Gold, Silver, or Bronze.
If you are less than 30 years old (or none of the other plans are affordable), you'll have a fifth plan choice - a "catastrophic plan" - where you'll pay more when you use your plan but pay less each month for the premium.
Keep in mind that subsidies are calculated based on the second lowest cost Silver plan in your area. So if you want to pay less monthly premium, you could enroll in a Bronze plan instead. You'll pay more when you use your plan, but you'll pay much less each month for insurance.
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