Benefits of the Affordable Care Act

While The Affordable Health Care Act (ACA), also known as Obamacare, continues to spark debate and repeated efforts by GOP lawmakers to repeal the bill, it is instructive to at least examine some of the benefits provided by the law.

Covers People with Preexisting Health Conditions

This is the main benefit of the law. Previously, insurers were free to deny coverage to anyone with a health condition that existed before applying for coverage, thus disqualifying countless individuals with serious health issues and leaving them uninsured.

Accountability For Rate Increases

Under the new law, health insurers must publicly account for new rate increases of 10% or more before premiums can be raised. Also, insurers are required to spend 80% of premium payments on health care and improvement of related activities instead of on administrative and marketing. If the insurer fails to meet the 80/20 goal, you or your employer are supposed to receive a rebate or a direct reduction in a future premium.

No Random Cancellations

The ACA prohibits insurers from canceling your coverage for specious or random reasons. For example, you may have been paying premiums for years but once you made a claim, the insurer could cancel coverage because of an error on your application or for omitting some minor information regarding your health. Under the law, your plan can only be canceled if you purposely included false or incomplete information on your application or you do not pay your premiums on time. You are given 30 days notice of any cancellation and may appeal it.

Covers Children Under Age 26

If you are under the age of 26, you can stay on your parent’s health care plan even if you are married, attending school, not living at home or are financially independent. Until 2014, though, a health care plan does not have to offer you coverage under grandfathered group plans if you are eligible for employer-based coverage.

Eliminates Lifetime Limits on Essential Medical Expenses

The health care law prohibits insurers and self-funded plans from imposing maximum limits on health care expenses paid out over the life of a covered individual.

Provision For Required Benefits Under All Health Plans

Beginning on January 1, 2014, The Affordable Health Care Act requires that all health insurance plans provide the following:

  • Laboratory services
  • Maternity care
  • Mental health and substance abuse
  • Pediatric care
  • Prescription medications
  • Preventive care
  • Vision and dental for children
  • Emergency services
  • Hospitalizations

Free Preventive Care and Annual Checkups

Cost-sharing such as co-payments or deductibles for preventive measures including cancer screenings, immunizations, screening for gestational diabetes, domestic violence screening and contraception supplies are eliminated. Regarding contraception, employers in religious organizations can opt out of paying for supplies though insurers must pay.

Individuals are cautioned, however, that a number of these provisions may not apply to grandfathered group or individual health plans or those created before March 23, 2010. These plans, though, may lose their status if they make significant changes that operate to reduce benefits or increase costs to consumers.

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